Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2018; 24(35): 4061-4068
Published online Sep 21, 2018. doi: 10.3748/wjg.v24.i35.4061
Serum anti-Helicobacter pylori antibody titer and its association with gastric nodularity, atrophy, and age: A cross-sectional study
Osamu Toyoshima, Toshihiro Nishizawa, Kosuke Sakitani, Tadahiro Yamakawa, Yoshiyuki Takahashi, Nobutake Yamamichi, Keisuke Hata, Yasuyuki Seto, Kazuhiko Koike, Hidenobu Watanabe, Hidekazu Suzuki
Osamu Toyoshima, Toshihiro Nishizawa, Kosuke Sakitani, Tadahiro Yamakawa, Yoshiyuki Takahashi, Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
Nobutake Yamamichi, Kazuhiko Koike, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Keisuke Hata, Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Yasuyuki Seto, Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Hidenobu Watanabe, Pathology and Cytology Laboratory Japan, Tokyo 166-0003, Japan
Hidekazu Suzuki, Medical Education Center, Keio University School of Medicine, Tokyo 160-8582, Japan
Author contributions: All authors were involved in designing the study; Toyoshima O, Nishizawa T, Sakitani K, and Suzuki H prepared the manuscript; Toyoshima O was involved with statistical analysis.
Institutional review board statement: This retrospective study was approved by the Ethical Review Committee of Hattori Clinic on September 7, 2017.
Informed consent statement: Written informed consent was obtained from all participants.
Conflict-of-interest statement: During the last five years, Yamamichi N received funds for the research from Denka Seiken Co., Ltd.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Osamu Toyoshima, MD, Director, Gastroenterology, Toyoshima Endoscopy Clinic, 6-17-5 Seijo, Setagaya-ku, Tokyo 157-0066, Japan.
Telephone: +81-3-54299555 Fax: +81-3-54299511
Received: July 17, 2018
Peer-review started: July 17, 2018
First decision: July 31, 2018
Revised: August 2, 2018
Accepted: August 24, 2018
Article in press: August 24, 2018
Published online: September 21, 2018

To clarify the role of serum anti-Helicobacter pylori (H. pylori) antibody titers in gastric cancer.


In this cross-sectional study, the effect of patients’ baseline characteristics and endoscopic findings on their serum antibody titers were assessed. We evaluated consecutive patients who underwent esophagogastroduodenoscopy and their first evaluation for H. pylori infection using a serum antibody test. We excluded patients with a history of eradication therapy. The participants were divided into four groups according to their E-plate serum antibody titer. Patients with serum antibody titers < 3, 3-9.9, 10-49.9, and ≥ 50 U/mL were classified into groups A, B, C, and D, respectively.


In total, 874 participants were analyzed with 70%, 16%, 8.7%, and 5.1% of them in the groups A, B, C, and D, respectively. Patients in group C were older than patients in groups A and B. Gastric open-type atrophy, intestinal metaplasia, enlarged folds, diffuse redness, and duodenal ulcers were associated with a high titer. Regular arrangements of collecting venules, fundic gland polyps, superficial gastritis, and gastroesophageal reflux disease were related to a low titer. Multivariate analysis revealed that nodularity (P = 0.0094), atrophy (P = 0.0076), and age 40-59 years (vs age ≥ 60 years, P = 0.0090) were correlated with a high serum antibody titer in H. pylori-infected patients. Intestinal metaplasia and atrophy were related to age ≥ 60 years in group C and D.


Serum antibody titer changes with age, reflects gastric mucosal inflammation, and is useful in predicting the risk of gastric cancer.

Keywords: Antibody, Helicobacter pylori, Gastritis, Gastric cancer, Endoscopy

Core tip: A positive-low serum anti-Helicobacter pylori (H. pylori) antibody titer (E-plate Eiken) (10-49.9 U/mL) and a negative-high titer (3-9.9 U/mL) are associated with intestinal-type gastric cancer. A positive-high titer (≥ 50 U/mL) correlates with diffuse-type gastric cancer. Few studies have reported on the relationship between the serum antibody titer and endoscopic findings. In H. pylori-infected patients, a high titer of serum antibody was associated with gastric nodularity and atrophy. In H. pylori-infected patients, the antibody titer decreased in patients aged 60 years. Intestinal metaplasia and gastric atrophy were related to age ≥ 60 years in patients with positive titers.