Invited Lecture(JSGCS)
Thu. November 2nd   14:20 - 14:50   Room 7: Portopia Hotel South Wing Ohwada C
Invited Lecture18
 From H. pylori gastritis to gastric cancer: The Vietnam story
Quach Trong Duc
Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City
Gastric cancer (GC) is the fourth most common malignancy in Vietnam. Approximately 90% of GC cases in Vietnam are associated with H. pylori infection. The prevalence of GC in the Northern was double compared to that in the Southern area, partly explained by the difference in salty diet and the distribution of CagA (+) Vac s1m1 H. pylori strains.

More than 90% of GCs have been diagnosed at an advanced stage. An important reason is that Vietnam has yet to have a national screening program for GC. Besides, other challenges include identifying subjects at high risk of GC for appropriate follow-up and incremasing the ability of endoscopists to recognize early gastric lesions. GC in Vietnam is mainly located in the distal part of the stomach. One important feature is that early-onset GC (i.e., < 40 years old) accounts for about 9.1%, which is relatively high compared to many other countries worldwide. Another important feature compared with that in Japanese patients is that the background mucosal tissue in patients with GC was mild atrophy in the antrum in most cases, which is challenging for developing cost-effective screening and surveillance programs.

To identify subjects at high risk of GC, in addition to clinical factors, endoscopic and histopathological evaluation is critical. A recent study showed that the ability of Vietnamese endoscopists to diagnose H. pylori infection endoscopically was equal to Japanese endoscopists if they were adequately trained. The assessment of precancerous gastric lesions in Vietnam is mainly based on the Kimura-Takemoto classification, which has been widely applied for about ten years. Pathological assessment according to the OLGA and OLGIM classifications is not applied in daily practice as this approach is invasive, overloads the health system, and remarkably increases the total cost of the examination.

Future research in Vietnam should focus on the interaction between host, environmental and toxic factors of H. pylori on the development of gastric precancerous lesions and GCs, and the development of a cost-effective and feasible national screening and surveillance program.
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