Burden of disease from Helicobacter pylori infection in western Canadian Arctic communities

Abstract

Background Indigenous communities across the circumpolar north have elevated H. pylori ( Hp ) prevalence and stomach cancer incidence. We aimed to describe the Hp -associated disease burden among western Canadian Arctic participants in community-driven projects that address concerns about health risks from Hp infection. Methods During 2008–2013, participants underwent Hp screening by urea breath test and gastroscopy with gastric biopsies. We estimated Hp prevalence and prevalence by Hp status of endoscopic and histopathologic diagnoses. Results Among 878 participants with Hp status data, Hp prevalence was: 62% overall; 66% in 740 Indigenous participants; 22% in 77 non-Indigenous participants (61 participants did not disclose ethnicity); 45% at 0–14 years old, 69% at 15–34 years old, and 61% at 35–96 years old. Among 309 participants examined endoscopically, visible mucosal lesions were more frequent in the stomach than the duodenum: the gastric to duodenal ratio was 2 for inflammation, 8 for erosions, and 3 for ulcers. Pathological examination in 308 participants with gastric biopsies revealed normal gastric mucosa in 1 of 224 Hp -positive participants and 77% (65/84) of Hp -negative participants with sharp contrasts in the prevalence of abnormalities between Hp -positive and Hp -negative participants, respectively: moderate-severe active gastritis in 50 and 0%; moderate-severe chronic gastritis in 91 and 1%; atrophic gastritis in 43 and 0%; intestinal metaplasia in 17 and 5%. Conclusions The observed pattern of disease is consistent with increased risk of stomach cancer and reflects substantial inequity in the Hp -associated disease burden in western Arctic Canadian hamlets relative to most North American settings. This research adds to evidence that demonstrates the need for interventions aimed at reducing health risks from Hp infection in Indigenous Arctic communities.

Review: Epidemiology of Helicobacter pylori

“…The prevalence of H pylori infection in Western Canadian Arctic communities was investigated by Fagan‐Garcia et al 16 A total of 878 participants were recruited between 2008 and 2013, of whom 62% were H pylori ‐positive (by UBT, histology and/or culture). The largest variation in prevalence concerned ethnicity, with non‐indigenous participants having a much lower prevalence (22%) than indigenous participants (66%).…”

“…The largest variation in prevalence concerned ethnicity, with non‐indigenous participants having a much lower prevalence (22%) than indigenous participants (66%). Furthermore, the prevalence of atrophic gastritis was 43% among H pylori ‐positive individuals, and the prevalence of intestinal metaplasia was 17% 16 …”

Community-driven research in the canadian arctic: dietary exposure to methylmercury and gastric health outcomes

“…Study Design. This research constituted an environmental health component of community-driven projects led by the CANHelp Working Group at the request of community leaders in western Canadian Arctic communities [36,37]. We used a cross-sectional observational study to test the hypothesis that MeHg increases the severity of pre-cancerous gastric lesions and thereby causes them to progress towards gastric cancer, according to a widely accepted model of gastric carcinogenesis [8].…”

Combating Gastric Cancer in Alaska Native People: An Expert and Community Symposium

“…2,3,7 The pattern of gastric cancer in Indigenous Canadians and the Maori of New Zealand is similar to that in the AN population, with cancer occurring at higher rates in younger people and in women compared with their majority populations and with a higher proportion that are diffuse and noncardia in location. 8,9 Esophagogastroduodenoscopy (EGD) performed in Canadian Arctic communities found a high prevalence of severe gastritis and atrophy, 10 although treatment of H pylori was generally successful, and antimicrobial resistance was lower than that seen in Alaska.…”

“…We would like to thank Judith Muller, Jennifer Williamson, Rachel Schaefer, Karli Tyance-Hassel, Jennie Lee, Theresa Wells, Rosalyn Marcellais, and Garret Spargo for their assistance in organizing and facilitating this symposium and Sophie Nothstine for providing the traditional prayer to start our meeting. We would like to thank all participants for their input during this symposium: Joe 3 Frank Sacco, 3 Sarah Nash, 3 Matthew J. Olnes, 3 Karen Miernyk, 1 Dana Bruden, 1 Maya Ramaswamy, 1 Brian McMahon, 1,3 Karen J. Goodman, 4 Adam J. Bass, 5 Chin Hur, 6 Manami Inoue, 7 M. Constanza Camargo, 8 Soo-Jeong Cho, 9 Kalani Parnell, 3 Elizabeth Allen, 10 Tina Woods, 3 and Stephanie Melkonian. 11 1 Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; 2 University of Alaska Anchorage, Anchorage, Alaska; 3 Alaska Native Tribal Health Consortium, Anchorage, Alaska; 4 University of Alberta, Edmonton, Alberta, Canada; 5 Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; 6 Columbia University, New York, New York; 7 Center for Public Health Sciences, National Cancer Center, Tokyo, Japan; 8 Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland; 9 Seoul National University Hospital, Seoul, Korea; 10 This Symposium leader discloses the following: Adam J. Bass receives funding from Bayer, Merck, and Novartis and is a cofounder of Signet Therapeutics.…”