***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Helicobacter pylori ( H. pylori ) , atrophic gastritis , dietary and life‐style factors have been associated with gastric cancer ( GC ) . These factors have been evaluated in a large case – control study nested in the European Prospect i ve Investigation into Cancer and Nutrition carried out in 9 countries , including the Mediterranean area . Participants , enrolled in 1992–1998 , provided life‐style and dietary information and a blood sample ( 360,000 ; mean follow‐up : 6.1 years ) . For 233 GC cases diagnosed after enrolment and their 910 controls individually‐matched by center , gender , age and blood donation date H. pylori antibodies ( antilysate and antiCagA ) and plasma Pepsinogen A ( PGA ) were measured by ELISA methods . Severe chronic atrophic gastritis ( SCAG ) was defined as PGA circulating levels < 22 μg/l . Overall , in a conditional logistic regression analysis adjusted for education , smoke , weight and consumption of total vegetables , fruit , red and preserved meat , H. pylori seropositivity was associated with GC risk . Subjects showing only antibodies anti‐H. pylori lysate , however , were not at increased risk , while those with antiCagA antibodies had a 3.4‐fold increased risk . Overall , the odds ratio associated with SCAG was 3.3 ( 95 % CI 2.2–5.2 ) . According to site , the risk of noncardia GC associated with CagA seropositivity showed a further increase ( OR 6.5 ; 95 % CI 3.3–12.6 ) ; on the other h and , a ten‐fold increased risk of cardia GC was associated with SCAG ( OR 11.0 ; 95 % CI 3.0–40.9 ) . These results support the causal relationship between H. pylori CagA+ strains infection , and GC in these European population s even after taking into account dietary habits . This association was limited to distal GC , while serologically defined SCAG was strongly associated with cardia GC , thus suggesting a divergent risk pattern for these 2 sites . © 2006 Wiley‐Liss , Recently , gastric fundic atrophy is reported to be an independent risk factor for esophageal squamous-cell carcinoma ( ESCC ) . The aim of this study is to investigate the acid secretory level in ESCC in a case-control study . From April 2004 to March 2008 , 100 consecutive subjects with early ESCC and 100 age- and sex-matched asymptomatic controls were prospect ively enrolled .  Gastrin-stimulated acid output was assessed by endoscopic gastrin test . Conditional regression analyses were used to adjust for other potential confounders . Multivariate analyses revealed a strong association between profound hypochlorhydria and ESCC with odds ratio ( 95 % confidence interval ) : 6.0 ( 1.9–18.4 ) . The association remained significant after adjusting for the effect of gastric atrophy as a covariate . The association became stronger as the ESCC developed more distal site of the esophagus . This study indicates that profound hypochlorhydria is a strong independent risk factor for ESCC even after adjusting for the influence of gastric atrophy Background and aim : Helicobacter pylori infection and gastric atrophy are both risk factors for gastric cancer . We aim ed to eluci date the natural history of gastric cancer development according to H pylori infection and gastric atrophy status . Subjects and methods : A total of 9293 participants in a mass health appraisal programme  were c and i date s for inclusion in the present prospect i ve cohort study : 6983 subjects revisited the follow up programme .  Subjects were classified into four groups according to serological status at initial endoscopy . Group A ( n = 3324 ) had “ normal ” pepsinogen and were negative for H pylori antibody ; group B ( n = 2134 ) had “ normal ” pepsinogen and were positive for H pylori antibody ; group C ( n = 1082 ) had “ atrophic ” pepsinogen and were positive for H pylori antibody ; and group D ( n = 443 ) had “ atrophic ” pepsinogen and were negative for H pylori antibody . Incidence of gastric cancer was determined by annual endoscopic examination . Results : Mean duration of follow up was 4.7 years and the average number of endoscopic examinations was 5.1 . The annual incidence of gastric cancer was 0.04 % ( 95 % confidence interval ( CI ) 0.02–0.09 ) , 0.06 % ( 0.03–0.13 ) , 0.35 % ( 0.23–0.57 ) , and 0.60 % ( 0.34–1.05 ) in groups A , B , C , and D , respectively . Hazard ratios compared with group A were 1.1 ( 95 % CI 0.4–3.4 ) , 6.0 ( 2.4–14.5 ) , and 8.2 ( 3.2–21.5 ) in groups B , C , and D , respectively . Age , sex , and “ group ” significantly served as independent valuables by multivariate analysis . Conclusions : The combination of serum pepsinogen and anti-H pylori antibody provides a good predictive marker for the development of gastric cancer The results of prospect i ve studies of the association between dietary salt intake and  gastric cancer  occurrence remain controversial . To examine this issue in a cohort study of a general population , 2,476 subjects aged 40 years or older were stratified into 4 groups according to the amount of daily salt intake : namely , < 10.0 , 10.0 - 12.9 , 13.0 - 15.9 , and > or = 16.0 per day and were followed up prospect ively for 14 years . During the follow-up period , 93 subjects developed gastric cancer . The age- and sex-adjusted incidence was significantly higher in the second to fourth groups than in the first group ( age- and sex-adjusted hazard ratio [ 95 % confidence interval ] , 2.42 [ 1.24 - 4.71 ] for the second group ; 2.10 [ 1.03 - 4.30 ] for the third group ; 2.98 [ 1.53 - 5.82 ] for the fourth group ) . This association remained substantially unchanged even after adjusting for other confounding factors such as age , sex , Helicobacter pylori infection , atrophic gastritis , medical history of peptic ulcer , family history of cancer , body mass index , diabetes , total cholesterol , physical activity , alcohol intake , smoking habit and other dietary factors . In the stratified analysis , a significant salt-cancer association was observed only in subjects who had both Helicobacter pylori infection and atrophic gastritis ( age- and sex-adjusted hazard ratio , 2.87 [ 1.14 - 7.24 ] ) . Our findings suggest that high dietary salt intake is a significant risk factor for gastric cancer ; moreover , this association was found to be strong in the presence of Helicobacter pylori infection with atrophic gastritis Objective . Cardia , non-cardia and intestinal and diffuse subtypes of gastric cancer may have different trends and etiological factors . However , the available information is not always collected in population cancer registries , and heterogeneous criteria have been applied for the histopathological classification of tumors . We describe the pathological features of incident gastric and esophageal cancers identified within the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) . Material and methods . In an investigation on gastric and esophageal cancer ( EUR-GAST ) in the EPIC project , a validation study of diagnoses reported by EPIC centers was conducted by a European panel of pathologists . Original pathology reports , stained slides of tumors and the respective paraffin blocks were requested from the centers . Results . The whole series encompassed 467 cancer cases ( gastric and esophageal cancers ) . Material was available for histopathological validation in 263 cases ( 56 % ) ; in the remaining cases , information was retrieved from the original reports ( n=110 ; 24 % ) or codes provided by the EPIC centers ( n=94 ; 20 % ) . Among cases su bmi tted to histopathological validation reported originally as unknown histotype or unknown site , a specific diagnosis was made in 95 % and 74 % of the cases , respectively . In cases for which only the original reports were available , the respective percentages were 46 % and 67 % . Gastric adenocarcinomas were classified according to site ( cardia ( 29.4 % ) , non-cardia ( 48.2 % ) and unknown ( 22.4 % ) ) and histological type ( intestinal ( 33.4 % ) , diffuse ( 33.7 % ) and mixed , unclassified or unknown ( 32.9 % ) ) . Frequency of cardia was higher in Northern countries ( 35 % ) than in Mediterranean countries ( 18 % ) . Conclusions . In addition to providing epidemiological data within the EPIC cohort on gastric and esophageal adenocarcinomas , the results reported here confirm the relevance of a validation study , notably for multicenter studies Objective : Low serum pepsinogen I ( PGI ) and low pepsinogen I/pepsinogen II ratio ( PGI/II ratio ) are markers of gastric fundic atrophy . We aim ed to prospect ively test the association between serum PGI/II ratio and risks of gastric non-cardia adenocarcinoma , gastric cardia adenocarcinoma , and oesophageal squamous cell carcinoma ( OSCC ) . Design : Case – cohort study nested in a prospect i ve cohort with over 15 years of follow-up . Setting : Rural region of the People ’s Republic of China . Subjects : Men and women aged 40–69 years at study baseline . Main outcome measures : Adjusted hazard ratios and 95 % confidence intervals for the association between serum PGI/II ratio and cancer risk . Results : Compared to subjects with PGI/II ratio of > 4 , those with ⩽4 had hazard ratios ( HRs ) ( 95 % CIs ) of 2.72 ( 1.77 to 4.20 ) and 2.12 ( 1.42 to 3.16 ) for non-cardia and cardia gastric adenocarcinomas , respectively . Risk of both cancers was also increased when we used other cut points ranging from 3 to 6 , or quartile models , or nonlinear continuous models . Risk of OSCC was marginally increased in those with PGI/II ratio ⩽4 , with HR ( 95 % CI ) of 1.56 ( 0.99 to 2.47 ) , but quartile models and continuous models showed no increased risk . The nonlinear continuous models suggested that any single cut point collapsed subjects with dissimilar gastric adenocarcinoma risks , and that using cut points was not an efficient use of data in evaluating these associations . Conclusion : In this prospect i ve study , we found similar and significantly increased risks of non-cardia and cardia gastric adenocarcinomas in subjects with low PGI/II ratio but little evidence for an association with the risk of OSCC OBJECTIVES : A recent study in Sweden has reported that gastric atrophy is associated with an increased risk for esophageal squamous cell carcinoma . However , this finding needs to be confirmed in other ethnic groups due to the wide geographic variation of this cancer . OBJECTIVES : To investigate whether gastric atrophy is associated with a risk for esophageal squamous cell carcinoma using a case-control study in Japanese subjects , a population known to have a high prevalence of H. pylori infection and accompanying gastric atrophy . METHODS : Seventy-three patients who had undergone endoscopic mucosal resection for superficial esophageal squamous cell carcinoma , and 73 sex- and age-matched controls , were enrolled prospect ively . Gastric fundic atrophy was evaluated by histology of biopsy specimens and serum  pepsinogen I level ( cutoff level 25 ng/mL ) . Conditional logistic regression model with adjustment for potential confounding factors was used to assess the associations . RESULTS : Gastric atrophy , defined histologically or serologically , was independently associated with an increased risk for esophageal squamous cell carcinoma and the risk seemed to increase with the progression of the atrophy . Multivariate odds ratio ( 95 % confidence interval ) for histological fundic atropy , fundic intestinal metaplasia , and serological atrophy are 4.2 ( 1.5–11.7 ) , 10.7 ( 2.3–50.4 ) , and 8.2 ( 2.2–30.4 ) , respectively . CONCLUSIONS : Gastric atrophy , a newly recognized risk factor for esophageal squamous cell carcinoma in Sweden , is likely to be a risk factor in other areas . Further studies are warranted to explore the causal relationship The authors examined whether a serum pepsinogen test ( SPT ) based on the combination of the serum pepsinogen I level and pepsinogen I/II ratio is a good predictor of gastric cancer occurrence in a general Japanese population . A total of 2,446 subjects aged > or = 40 years were classified into negative , positive , and strong-positive  SPT  groups and were followed prospect ively for 14 years ( 198 
    Output:
    
This study found two- to threefold increased risk of OSCC and GCA but a possible reduced risk of OAC in people with gastric atrophy .