Changing epidemiology of Helicobacter pylori in Asia

Abstract

As in developed societies, the prevalence of Helicobacter pylori has declined rapidly in Asia. This has been shown in both seroprevalence‐based and endoscopy‐based studies. While the decline in the incidence of gastric cancer has now been observed, a decrease in peptic ulcer disease has not been so clearly evident. This apparent paradox can be explained by an increase in non‐H. pylori associated ulcers – such as those related to non‐steroidal anti‐inflammatory drugs or idiopathic ulcers. The increase of gastroesophageal reflux disease in Asia has been widely observed and commented on and its relationship to the decline in H. pylori speculated upon. However there have been few conclusive studies from Asia on this subject. While the improved diagnosis and elimination of H. pylori has contributed to its decline, a more basic change involving large segments of the Asian population must be responsible. An improvement in hygiene and living conditions that results from more affluent Asian societies is thought to be a possible cause.

Prevalence of Helicobacter pylori in Southern Part of Iran

“…In an old study in Shiraz, Iran, the infection rate of more than 85% of adults based on the measuring of IgG against H. pylori using ELISA was reported (25). However, it has been reported that H. pylori prevalence has now started to decline in Asia and the Middle East (26)(27)(28). In a recent study using culturing, Gram staining, and rapid urease test, we reported the H. pylori positivity of 31% in 548 dyspeptic patients of Fars province with both rural and urban nature of lifestyle, Iran, which was surprisingly lower than other local reports (29).…”

The effect of statins on the occurrence of peptic ulcer

“…This is due to the high population of elderly patients because of their high usage of NSAIDS and lowdose aspirin for relief of intense musculoskeletal disorders and prevention of arteriosclerotic disease. This explains (1) the increased frequency of PUD after age 60, and (2) the unchanged hazards ratio in gastric ulcer after treatment with statin, since patients were older and more likely to have past usage of NSAIDs and aspirin [12,13,15,34,35]. It is thought that sufficient gastrointestinal mucosal blood flow is important for inhibiting the back-diffusion of gastric acid and maintaining gastrointestinal mucosal integrity [25].…”

“…While the cases of H. pylori have been decreasing over the last decade due to improved cleanliness and eradication therapy, the rate of PUD has not decreased dramatically in some countries. This leads us to conclude that the usage of NSAIDs and aspirin in the elderly, then, is the reason why PUD is still common [12][13][14].…”

Functional and Molecular Surveillance of Helicobacter pylori Antibiotic Resistance in Kuala Lumpur

“…H. pylori is known to colonize almost half of the population worldwide with varying prevalence rates among different geographical regions with higher rates in developing countries [4]. In many developed societies the prevalence of infection rate has been noted to decrease from the late 90's onwards [5].…”