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Relation of H. pylori to gastric and esophageal adenocarcinomas. H. pylori colonization increases risk for atrophic gastritis and intestinal metaplasia, leading to gastric adenocarcinoma, a process requiring 40–70 years on average. Evidence now indicates that lack of H. pylori, especially cagA+ strains, a process that I have termed “acagia,” increases risk for GERD, then Barrett's esophagus, leading to dysplasia and esophageal adenocarcinoma, a process requiring at least 20 years.
