Ji Hyun Song, Young Sun Kim, Nam Ju Heo, Joo Hyun Lim, Sun Young Yang, Goh Eun Chung, Joo Sung Kim

Although several studies have investigated excessive salt intake as a risk factor for gastric precancerous lesions such as atrophic gastritis (AG) and intestinal metaplasia (IM), the evidence is insufficient to make conclusion. We evaluated the association between gastric precancerous lesions and salt intake. From 2008 to 2015, the medical records of 728 subjects who underwent upper gastrointestinal endoscopy and sodium excretion in 24-hr urine tests were retrospectively reviewed. Sixty-six subjects were excluded due to diuretics use (n = 55), diagnosis with a gastric neoplasm (n = 4), or the cases of IM in the absence of atrophy (n=7), so 662 subjects were included. AG and IM were diagnosed by endoscopic findings. The subjects were grouped into three levels by tertiles of 24-hr urine sodium excretion. A total of 192 (29.0%) had AG without IM and 112 (16.9%) had AG with IM. The number of 276 subjects (61.5%) were infected with Helicobacter pylori (Hp). In multivariate analyses, Hp infection (OR = 14.17, 95% CI 7.12-28.22) was associated with AG without IM. Highest level of sodium excretion (OR = 2.870, 95% CI 1.34-6.14), heavy smoking (≥ 20 pack-year) (OR = 2.75, 95% CI 1.02-7.39), and Hp infection (OR = 3.96, 95% CI 2.02-7.76) were associated with AG with IM. Our endoscopy based study suggested that high salt intake could be associated with an increased risk of AG with IM. Low salt diet might be helpful to prevent gastric carcinogenesis.