COVID-19 pandemisinin mide kanseri evresi ve beslenme durumu üzerindeki etkisi

Year 2025, Volume: 8 Issue: 6, 995 - 999, 25.10.2025

Melih Can Gül , Emre Hafızoğlu

https://doi.org/10.32322/jhsm.1749790

Abstract

Giriş: COVID-19 pandemisi, dünya genelinde özellikle gastrointestinal (GI) endoskopi hizmetlerini ciddi şekilde kesintiye uğratmış ve gastrik kanserde gecikmiş tanılar ile evre kayması (stage migration) konusunda endişelere yol açmıştır. Gastrik karsinogenezde önemli rol oynayan Helicobacter pylori (H. pylori) aynı zamanda SARS-CoV-2’ye karşı mukozal duyarlılığı da etkileyebilir. Ancak bu aksaklıkların gastrik kanser profili üzerindeki etkilerine dair gerçek yaşam verileri sınırlıdır. Amaç: Pandemi ve post-pandemi dönemlerinde üst GI endoskopi yapılan hastaların klinik, endoskopik ve patolojik özelliklerini karşılaştırmak ve gastrik kanserli hastalarda beslenme durumu ile tümör yükü arasındaki ilişkiyi değerlendirmek. Yöntemler: Bu retrospektif kohort çalışmaya, dispeptik ya da alarm semptomları nedeniyle üçüncü basamak bir merkezde tanısal üst GI endoskopi yapılan 478 hasta dahil edildi. Hastalar pandemi (Haziran 2021–Haziran 2022; n = 216) ve post-pandemi (Mayıs–Ekim 2023; n = 262) olmak üzere iki gruba ayrıldı. Demografik veriler, semptomlar, endoskopik ve histopatolojik bulgular ile beden kitle indeksi (BKİ) analiz edildi. İstatistiksel analizlerde t-testi, Ki-kare testi, lojistik regresyon ve Spearman korelasyon yöntemleri kullanıldı. Bulgular: Pandemi döneminde değerlendirilen hastalar daha sık alarm semptomları bildirdi ve anlamlı derecede daha düşük kilo ve BKİ’ye sahipti. H. pylori pozitifliği (%41,7 vs. %28,2; p = 0,03), peptik ülser (%16,7 vs. %8,4; p = 0,04) ve gastrik kanser (%7,4 vs. %2,3; p = 0,02) pandemi grubunda daha yüksekti. Gastrik kanser tanısı alan 22 hastanın pandemi döneminde tanı alanlarında daha ileri evre hastalık (T3–T4: %75,0 vs. %33,3; p = 0,02), daha sık nodal tutulum (%62,5 vs. %16,7; p = 0,01) ve daha düşük BKİ saptandı. Çok değişkenli analizde pandemi döneminde endoskopi yapılması, ileri evre gastrik kanser için bağımsız bir risk faktörü olarak bulundu (OR = 3,41; %95 GA: 1,31–8,88; p = 0,008). BKİ ile tümör derinliği (ρ = –0,73) ve nodal tutulum (ρ = –0,87) arasında güçlü ters korelasyonlar gösterildi. Sonuç: COVID-19 pandemisi, tanı gecikmeleri ve ileri evre gastrik kanser olgularının artışı ile ilişkili bulunmuştur. BKİ, tümör agresifliğiyle güçlü ters ilişki göstermiş olup, hastalık yükünü öngörmede pratik bir gösterge olma potansiyeline sahiptir. Ancak çalışmamızdaki hasta sayısının sınırlı olması, bulguların genellenebilirliğini azaltmaktadır. Bu nedenle çok merkezli, daha geniş hasta gruplarını içeren ileri çalışmalara ihtiyaç vardır. Bulgular, salgın dönemlerinde endoskopik tanı hizmetlerinin sürekliliğinin önemini ve beslenme göstergelerinin prognostik değerini vurgulamaktadır

Keywords

Beden Kitle İndeksi; , COVID-19; , Endoskopi; , Gastrik Kanser; , Helicobacter pylori;

The Impact of the COVID-19 pandemic on gastric cancer stage and nutritional status

Abstract

Aims: The COVID-19 pandemic disrupted diagnostic services worldwide, particularly gastrointestinal (GI) endoscopy, raising concerns about delayed diagnoses and stage migration in gastric cancer. Helicobacter pylori (H. pylori), a key factor in gastric carcinogenesis, may also influence mucosal susceptibility to SARS-CoV-2. However, data on how these disruptions affected gastric cancer profiles remain limited. To compare clinical, endoscopic, and pathological features of patients undergoing upper GI endoscopy during and after the COVID-19 pandemic, and to evaluate the association between nutritional status and tumor burden in gastric cancer patients.
Methods: This retrospective cohort study included 478 patients who underwent diagnostic upper GI endoscopy due to dyspeptic or alarm symptoms at a tertiary care center in Turkiye. Patients were divided into two groups: pandemic (June 2021 to June 2022; n=216) and post-pandemic (May to October 2023; n=262). Demographics, symptoms, endoscopic and histopathological findings, and body-mass index (BMI) were analyzed. Statistical methods included t-tests, Chi-square tests, logistic regression, and Spearman correlation.
Results: Patients evaluated during the pandemic more frequently reported alarm symptoms and had significantly lower weight and BMI. H. pylori positivity (41.7% vs. 28.2%; p=0.03), peptic ulcer (16.7% vs. 8.4%; p=0.04), and gastric cancer (7.4% vs. 2.3%; p=0.02) were all more prevalent in the pandemic group. Among 22 patients with gastric cancer, those diagnosed during the pandemic exhibited more advanced disease (T3-T4: 75.0% vs. 33.3%; p=0.02), more frequent nodal involvement (62.5% vs. 16.7%; p=0.01), and BMI. Pandemic-period endoscopy remained an independent predictor of advanced-stage gastric cancer in multivariable analysis (OR=3.41; 95% CI: 1.31-8.88; p=0.008). Strong inverse correlations were found between BMI and tumor depth (p=-0.73), and between BMI and nodal involvement (p=-0.87).
Conclusion: The COVID-19 pandemic was associated with diagnostic delays and increased frequency of advanced-stage gastric cancer. BMI showed a strong inverse relationship with tumor aggressiveness and has potential to serve as a practical indicator of disease burden. These findings underscore the importance of preserving access to endoscopic diagnostics and highlight the prognostic value of nutritional parameters during public health emergencies.

Keywords

BMI , COVID-19 , endoscopy , gastric cancer , Helicobacter pylori , nutritional status

References

• Sahu T, Mehta A, Ratre YK, et al. Current understanding of the impact of COVID-19 on gastrointestinal disease: challenges and openings. World J Gastroenterol. 2021;27(6):449-469. doi:10.3748/wjg.v27.i6.449
• Gralnek IM, Dumonceau JM, Kuipers EJ, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015;47(10):a1-a46. doi:10.1055/s-0034-1393172
• Han X, Yang NN, Nogueira L, et al. Changes in cancer diagnoses and stage distribution during the first year of the COVID-19 pandemic in the USA: a cross-sectional nationwide assessment. Lancet Oncol. 2023;24(8):855-867. doi:10.1016/S1470-2045(23)00293-0
• Sipponen P, Hyvärinen H. Role of Helicobacter pylori in the pathogenesis of gastritis, peptic ulcer and gastric cancer. Scand J Gastroenterol Suppl. 1993;196:3-6. doi:10.3109/00365529309098333
• Ansari S, Yamaoka Y. Helicobacter pylori virulence factor cytotoxin-associated gene a (CagA)-mediated gastric pathogenicity. Int J Mol Sci. 2020;21(19):7430. doi:10.3390/ijms21197430
• Bhattacharjee A, Sahoo OS, Sarkar A, et al. Infiltration to infection: key virulence players of Helicobacter pylori pathogenicity. Infection. 2024;52(2):345-384. doi:10.1007/s15010-023-02159-9
• Tandon A, Baral B, Saini V, et al. The role of Helicobacter pylori in augmenting the severity of SARS-CoV-2 related gastrointestinal symptoms: an insight from molecular mechanism of co-infection. Heliyon. 2024;10(18):e37585. doi:10.1016/j.heliyon.2024.e37585
• Durazzo M, Adriani A, Fagoonee S, Saracco GM, Pellicano R. Helicobacter pylori and respiratory diseases: 2021 update. Microorganisms. 2021;9(10):2033. doi:10.3390/microorganisms9102033
• Shirani M, Pakzad R, Haddadi MH, et al. The global prevalence of gastric cancer in Helicobacter pylori-infected individuals: a systematic review and meta-analysis. BMC Infect Dis. 2023;23(1):543. doi:10.1186/s12879-023-08504-5
• Qu HT, Li Q, Hao L, et al. Esophageal cancer screening, early detection and treatment: current insights and future directions. World J Gastrointest Oncol. 2024;16(4):1180-1191. doi:10.4251/wjgo.v16.i4.1180
• Shah R, Hanna NM, Loo CE, et al. The global impact of the COVID-19 pandemic on delays and disruptions in cancer care services: a systematic review and meta-analysis. Nat Cancer. 2025;6(1):194-204. doi:10.1038/s43018-024-00880-4
• Toyoshima O, Nishizawa T, Yoshida S, et al. Consistency between the endoscopic Kyoto classification and pathological updated Sydney system for gastritis: a cross-sectional study. J Gastroenterol Hepatol. 2022;37(2):291-300. doi:10.1111/jgh.15693
• Sethi A, Swaminath A, Latorre M, et al. Donning a new approach to the practice of gastroenterology: perspectives from the COVID-19 pandemic epicenter. Clin Gastroenterol Hepatol. 2020;18(8):1673-1681. doi:10.1016/j.cgh.2020.04.032
• Gralnek IM, Hassan C, Beilenhoff U, et al. ESGE and ESGENA position statement on gastrointestinal endoscopy and the COVID-19 pandemic. Endoscopy. 2020;52(6):483-490. doi:10.1055/a-1155-6229
• Zhu L, Cai MY, Shi Q, et al. Analysis of selective endoscopy results during the epidemic of Coronavirus disease 2019 (COVID-19). Zhonghua Wei Chang Wai Ke Za Zhi. 2020;23(4):327-331. doi:10.3760/cma.j.issn.1671-0274.2020-0316-00147
• Ma K, Chen X, Xiang X, et al. Willingness to undergo gastroscopy for early gastric cancer screening and its associated factors during the COVID-19 pandemic-a nationwide cross-sectional study in China. Patient Prefer Adherence. 2023;17:505-516. doi:10.2147/PPA.S400908
• Abu-Freha N, Hizkiya R, Abu-Abed M, et al. The impact of the COVID-19 pandemic on colorectal and gastric cancer diagnosis, disease stage and mortality. Front Med (Lausanne). 2022;9:954878. doi:10.3389/fmed.2022.954878
• Fujita S, Sakuramoto S, Miyawaki Y, et al. Impact of the first era of the coronavirus disease 2019 pandemic on gastric cancer patients: a single-institutional analysis in Japan. Int J Clin Oncol. 2022;27(5):930-939. doi:10.1007/s10147-022-02142-8
• Arneiro AJ, Pereira MA, Dias AR, et al. Impact of COVID-19 pandemic on the surgical treatment of gastric cancer: a 3-year analysis. Arq Bras Cir Dig. 2025;37:e1868. doi:10.1590/0102-6720202400074e1868
• Huang K, Zhao X, Chen X, Gao Y, Yu J, Wu L. Analysis of digestive endoscopic results during COVID-19. J Transl Intern Med. 2021;9(1):38-42. doi:10.2478/jtim-2021-0006
• Zhang M, Feng C, Zhang X, et al. Susceptibility factors of stomach for SARS-CoV-2 and treatment implication of mucosal protective agent in COVID-19. Front Med (Lausanne). 2020;7:597967. doi:10.3389/fmed. 2020.597967
• Gonzalez I, Lindner C, Schneider I, et al. Inflammation at the crossroads of Helicobacter pylori and COVID-19. Future Microbiol. 2022;17(2):77-80. doi:10.2217/fmb-2021-0250
• Jasim Abdullah Y, Hasan NF, Zghair Jaber Alsaedi R. Correlation between Helicobacter pylori infection and COVID-19. Iran J War Public Health. 2021;13:255-259.
• Bozdağ E, Gülmez S, Yücesoy FS, et al. Analysis of upper gastrointestinal endoscopy results during the COVID-19 pandemic. Ann Ital Chir. 2022;93:391-397.
• Atak T, Erdoğan KO, Atak İ. An evaluation of gastroscopy findings during the COVID-19 pandemic: a public hospital-based study from Turkey. Cureus. 2023;15(10):e46451. doi:10.7759/cureus.46451
• Al-Momani H, Al Balawi D, Almasri M, et al. Gastroesophageal reflux in lockdown. Future Sci OA. 2023;9(6):FSO863. doi:10.2144/fsoa-2023-0042
• Ma Y, Zhang L, Wei R, et al. Risks of digestive diseases in long COVID: evidence from a population-based cohort study. BMC Med. 2024;22(1):14. doi:10.1186/s12916-023-03236-4
• Xu E, Xie Y, Al-Aly Z. Long-term gastrointestinal outcomes of COVID-19. Nat Commun. 2023;14(1):983. doi:10.1038/s41467-023-36223-7
• Hou S, Song D, Hao R, Li L, Zhang Y, Zhu J. Prognostic relevance of prognostic nutritional indices in gastric or gastro-esophageal junction cancer patients receiving immune checkpoint inhibitors: a systematic review and meta-analysis. Front Immunol. 2024;15:1382417. doi:10.3389/fimmu.2024.1382417
• Gül MC, Çolakoğlu MK, Öter V, et al. Low preoperative cachexia index is associated with severe postoperative morbidity in patients undergoing gastrectomy for gastric cancer. Diagnostics. 2025;15(18):2284. doi:10. 3390/diagnostics15182284
• Xu X, Tian M, Ding CC, Xu H, Wang H, Jin X. Skeletal Muscle Index-Based Cachexia Index as a predictor of prognosis in patients with cancer: a meta-analysis and systematic review. Nutr Rev. 2025;83(3):e852-e865. doi:10.1093/nutrit/nuae094