Prevalence of and risk factors for Helicobacter pylori infection in a multi‐racial dyspeptic Malaysian population undergoing endoscopy

Abstract

The aim of the present study was to determine the risk factors for Helicobacter pylori in a dyspeptic Malaysian population. A cross-sectional survey of 1060 consecutive patients presenting with dyspepsia at the Endoscopic Unit, University Hospital, Kuala Lumpur, Malaysia from January 1994 to July 1995 was undertaken. All patients answered a detailed questionnaire and underwent endoscopy, with two antral biopsies taken for diagnosis of H. pylori using a rapid urease test. An overall H. pylori prevalence of 49.0% was recorded. Helicobacter pylori prevalence in relation to the major endoscopic diagnoses were as follows: non-ulcer dyspepsia (NUD) 31.2%; duodenal ulcer (DU) 91.4%; and gastric ulcer (GU) 74.1%. The prevalence among the races were as follows: Malay 16.4%; Chinese 48.5%; and Indians 61.8%. Multiple logistic regression analysis identified the following as independent risk factors: > 45 years old 1.5 (1.1,2.0); male gender 1.6 (1.2,2.1); ethnic group: Chinese 2.5 (1.7,3.7); Indians 4.9 (3.2,7.5); level of education: low 2.3 (1.5,3.5); middle 1.7 (1.1,2.6); and smoking 1.6 (1.2,2.3). Analysis was also performed on DU, GU and non-UD patients separately; in both DU and GU patients, H. pylori prevalence was high regardless of age, sex, race or level of education. However, in DU patients, Indian race had an independent risk factor (Odds ratio = 7.8 (1.2,48.4)). The findings in the NUD group reflected the findings in the ¿all patients' group; > 45 years old, male gender, Indian and Chinese race, and low level of education were also significant, independent risk factors. The overall differences in H. pylori prevalence between the different subgroups were mainly due to differences in the NUD group. The increased risk of H. pylori infection in Chinese and Indians points to either an inherent ethnic genetic predisposition or to socio-cultural practices peculiar to the particular race which may be responsible for transmission of the infection.

Prevalence of Helicobacter pylori infection in dyspeptic patients in Iran

“…H. pylori infection can be related to low levels of sanitation, hygiene, education. [8][9][10] In this study, no relationship was observed between education status and H. pylori infection. However, further studies are needed, especially in poor socioeconomic and rural areas.…”

“…It has been reported that the prevalence of H. pylori infection was related to several of these factors, including socioeconomic status, crowded living conditions, low levels of hygiene, age, geographical region, ethnic group, cigarette and alcohol consumption. [8][9][10] Also, prevalence of H. pylori infection differs both between and within countries. 11,12 Although in the Iranian population the prevalence has been reported to range from 57 to 91%, [13][14][15][16][17] …”

Ethnicity and H. Pylori as Risk Factors for Gastric Cancer in Malaysia: A Prospective Case Control Study

“…In a seroprevalence study from Singapore, a significant linear correlation was found for Chinese and Malay subjects but not for Indians (18). We have previously noted this paradox with peptic ulcer disease where a larger proportion of H. pylori-positive Indian patients had nonulcer dyspepsia compared to Chinese and Malays (19). The lower frequency of GCA among Indians despite the high H. pylori prevalence can indeed be termed the "Indian enigma" and suggests the influence and interaction with other, probably protective factors.…”

Follow-Up Care After a Diagnosis of Helicobacter pylori Infection in an Asian Immigrant Cohort

“…H. pylori infection is common in China (61%), Taiwan (54%), Korea (69%), and Malaysia (49%), the countries of origin for the participants in this study. [5][6][7][8] The evidence that H. pylori infection increases a person's risk for gastric cancer is convincing. A large prospective study followed over 1,000 Japanese patients who underwent esophagogastroduodenoscopy (EGD) for various reasons, and found that only patients infected with H. pylori went on to develop gastric cancer.…”