It Should Be Possible to Eliminate Peptic Ulcer Disease and Gastric Carcinoma from Saudi Arabia

Abstract

Until recently, it would have been unthinkable to suggest that it might be possible to eliminate peptic ulcers and gastric carcinoma from the Kingdom of Saudi Arabia. This possibility now deserves serious consideration. This change in thinking is a direct result of recent studies linking the seemingly different diseases to an infection with a bacterium, Helicobacter pylori. H. pylori infection has been linked to gastric carcinoma, peptic ulcer disease, and gastric B-cell lymphoma.1-5 The tremendous morbidity and mortality from H. pylori infection are only now becoming appreciated. The cumulative risk of developing a peptic ulcer is 15% to 20% and 0.5% to 1% risk of developing gastric carcinoma. The risk of gastric lymphoma is unknown. Overall, the recognized rate of mortality or morbidity related to H. pylori infection is 20% to 30% of those infected.It has long been appreciated that chronic atrophic gastritis was a precursor lesion to gastric carcinoma and that, in areas of the world where atrophic gastritis was common in young adults, gastric cancer was frequent. Gastritis was also known to be almost universally present in patients with gastric or duodenal ulcer disease. 2,6,7 Studies of the epidemiology of these gastritis-associated diseases demonstrated that unidentified environmental factor(s) were involved in development of gastritis and in progression from atrophic gastritis to gastric cancer. Despite a large number of studies and clues such as differences in prevalence of gastritis depending on socioeconomic class, ethnic group, age, implicating environmental factors, no common theme or factor emerged until approximately 10 years ago when H. pylori was cultured from the gastric mucosa of patients with gastritis and ulcer disease. It was subsequently shown that ingestion of H. pylori resulted in gastritis and that gastritis improved and even actually reversed following eradication of the infection. [8][9][10] Over the last decade, H. pylori has become established as the major cause of gastritis in humans. Recently, a number of investigators have conclusively demonstrated that eradication of the H. pylori infection effectively cures peptic ulcer disease. [11][12][13][14][15][16][17][18][19][20] In this instance, "cure" means that the natural history of ulcer disease changes, as ulcers do not recur. Thus, no H. pylori, no ulcer. 7H. pylori, gastritis, and gastric carcinoma: The latent period between development of atrophic gastritis and gastric carcinoma is measured in decades, whereas the latent period for peptic ulcer is shorter. 21 It follows that the spectrum of H. pylori-related disease present in a population reflects the average age of acquisition of the infection. 1,22 In developing countries, the majority of individuals acquire H. pylori infection in early childhood and, as a result, atrophic gastritis is common in mid-life. In developed countries, gastric carcinoma is typically a disease of the elderly and reflects the fact that this group represents those who developed H. pylori infection in chil...

Upper Gastrointestinal Diseases in Symptomatic Jordanians: A Prospective Endoscopic Study

“…This study is the first from Jordan to report on this association, and the findings are similar to others from the region. [27][28][29][30][31] The absolute prevalence of duodenal ulcer is not known. It is estimated to occur in about 6% to 15% of the population.…”