\udAtrophic gastritis is a risk factor for non-cardia gastric cancer, and gastro-oesophageal reflux\uddisease (GORD) for oesophageal adenocarcinoma. The role of atrophic gastritis and GORD in the\udaetiology of adenocarcinoma of the cardia remains unclear. We have investigated the association\udbetween adenocarcinoma of the different regions of the upper gastrointestinal tract and atrophic\udgastritis and GORD symptoms.\ud\ud138 patients with upper GI adenocarcinoma and age and sex matched controls were studied.\udSerum pepsinogen I/II was used as a marker of atrophic gastritis and categorised to five quintiles.\udHistory of GORD symptoms, smoking and H.pylori infection was incorporated in logistic regression\udanalysis. Lauren classification of gastric cancer was used to subtype gastric and oesophageal\udadenocarcinoma.\ud\udNon-cardia cancer was associated with atrophic gastritis but not with GORD symptoms; 55% of\udthese cancers were intestinal subtype. Oesophageal adenocarcinoma was associated with GORD\udsymptoms, but not with atrophic gastritis; 84% were intestinal subtype. Cardia cancer was positively\udassociated with both severe gastric atrophy [OR, 95% CI: 3.92 (1.77 – 8.67)] and with frequent\udGORD symptoms [OR, 95% CI: 10.08 (2.29 – 44.36)] though the latter was only apparent in the nonatrophic\udsubgroup and in the intestinal subtype. The association of cardia cancer with atrophy was\udstronger for the diffuse versus intestinal subtype and this was the converse of the association\udobserved with non-cardia cancer.\ud\udThese findings indicate two distinct aetiologies of cardia cancer, one arising from severe atrophic\udgastritis and being of intestinal or diffuse subtype similar to non-cardia cancer, and one related to\udGORD and intestinal in subtype, similar to oesophageal adenocarcinoma. Gastric atrophy, GORD\udsymptoms and histological subtype may distinguish between gastric versus oesophageal origin of\udcardia cancer.
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