Incidence of Esophageal Carcinoma Among Malays in North-Eastern Peninsular Malaysia: An Area with an Exceptionally Low Prevalence of Helicobacter pylori Infection

Lee, Yeong Yeh; Raj, S Mahendra; Sharif, Sharifah Emilia Tuan; Salleh, Rosemi; Ayub, Mukarramah Che; Graham, David Y.

doi:10.1007/s10620-010-1473-1

Cited by 18 publications

(15 citation statements)

References 29 publications

(33 reference statements)

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“…In contrary to beliefs of some investigator, based on the hypothesis that eradication of H. pylori may result in an increase in the incidence of gastroesophageal reflux disease and therefore esophageal cancer, the age-standardized incidence for esophageal cancer among ethnic Malays from Kelantan was only 1.6/100,000 in males and 2.2/100,000 in females 26. Likewise, in a retrospective study involving 1,895 consecutive patients undergoing upper endoscopy between 2005 and 2007 in a tertiary hospital in Kelantan, only 0.8% of patients had Barrett's esophagus 27.…”

Section: Organic Causes Of Dyspepsia Are Uncommon Among Malayscontrasting

confidence: 69%

What Indigestion Means to the Malays?

Lee

Chua

2013

J Neurogastroenterol Motil

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Despite being a large ethnic group within the South-East Asia, there is a paucity of reported literatures on dyspepsia in the Malay population. Recent population-based studies indicate that uninvestigated dyspepsia, based on the Rome II criteria, is reported in 12.8% and 11.6% of Malays in the urban and rural communities respectively. Organic causes of dyspepsia including upper gastrointestinal tract cancers, its precancerous lesions, and erosive diseases are uncommon which is largely due to an exceptionally low prevalence of Helicobacter pylori infection in this population. On the other hand, functional dyspepsia and irritable bowel syndrome are relatively common in the Malays than expected. Within a primary care setting, functional dyspepsia, based on the Rome III criteria, is reported in 11.9% of Malays, of which epigastric pain syndrome is found to be more common. Married Malay females are more likely to have functional dyspepsia and psychosocial alarm symptoms. Also based on the Rome III criteria, irritable bowel syndrome, commonly overlapped with functional dyspepsia, is reported in 10.9% of Malays within a community-based setting. Rather than psychosocial symptoms, red flags are most likely to be reported among the Malays with irritable bowel syndrome despite having a low yield for organic diseases. Based upon the above observations, "proton pump inhibitor test" is probably preferable than the "test and treat H. pylori" strategy in the initial management of dyspepsia among the Malays.

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Section: Organic Causes Of Dyspepsia Are Uncommon Among Malayscontrasting

confidence: 69%

What Indigestion Means to the Malays?

Lee

Chua

2013

J Neurogastroenterol Motil

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“…The north-eastern region of Peninsular Malaysia consists of ethnic Malays in 90% of its population and is very much rural and poor when compared to the West coast of the Peninsular. The prevalence of H. pylori infection is also exceptionally low in this region in the order of 4 - 5% and likewise organic dyspepsia [6-8,19-21]. The reported FD rate of 10% in the current study was therefore not as uncommon as one would have expected.…”

Section: Discussionsupporting

confidence: 41%

A Rome III survey of functional dyspepsia among the ethnic Malays in a primary care setting

et al. 2013

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BackgroundsThe study aimed to survey for FD in a primary care setting in a population known to have an extremely low prevalence of Helicobacter pylori (H. pylori) infection, with the hypothesis that in such a population, dyspepsia should have been relatively less common.MethodsThe Rome III FD Diagnostic Questionnaire was translated into the Malay language and later tested for reliability. A prospective cross-sectional survey was then performed involving 160 Malay patients attending primary care clinic after informed consent. Patients positive for symptoms of FD were subjected to upper endoscopy and exclusion of H. pylori infection. Univariable and multivariable analyses were used to test for associated risk factors.ResultsThe back-translated questionnaire was similar to the original English version and was reliable (Cronbach Alpha-coefficient 0.85). Of the 160 surveyed subjects, 19 of them (11.9%) had symptoms of FD. With exclusion of erosive diseases (3/160 or 1.9%) from endoscopy, 16 subjects or 10% had FD. None of the 19 subjects were positive for H. pylori infection. Epigastric pain syndrome was present in 11/16 (68.8%) and the rest, overlap with postprandial distress syndrome. With multivariable analysis, a married status (OR = 8.1; 95% CI 1.0-36.5) and positive psychosocial alarm symptoms (OR = 3.8; 95% CI 1.0-14.0) were associated with FD. Of those married subjects, females were more likely to have FD and psychosocial symptoms than men (6.3% vs. 1.9%), P = 0.04.ConclusionsFD was more common than one had expected among Malays attending primary care clinic in an area with low prevalence of H. pylori.

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“…Thirteen studies were excluded, as they did not provide sufficient data (reasons for exclusion detailed in Appendix ). Data were extracted from 83 studies; however, 11 of these studies had to be excluded from the statistical analysis as they contained data from same populations already described in other articles . Our final statistical analysis included 72 studies.…”

Section: Resultsmentioning

confidence: 99%

Helicobacter pylori infection reduces the risk of Barrett's esophagus: A meta‐analysis and systematic review

et al. 2018

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IntroductionThe prevalence of Helicobacter pylori infection (HPI) has been decreasing in developed countries, with an increasing prevalence of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) at the same time. The aim of our meta‐analysis was to quantify the risk of BE in the context of HPI.MethodsA systematic search was conducted in 3 databases for studies on BE with data on prevalence of HPI from inception until December 2016. Odds ratios for BE in HPI were calculated by the random effects model with subgroup analyses for geographical location, presence of dysplasia in BE, and length of the BE segment.ResultsSeventy‐two studies were included in the meta‐analysis, including 84 717 BE cases and 390 749 controls. The overall analysis showed that HPI reduces the risk of BE; OR = 0.68 (95% CI: 0.58‐0.79, P < .001). Subgroup analyses revealed risk reduction in Asia OR = 0.53 (95% CI: 0.33‐0.84, P = .007), Australia OR = 0.56 (95% CI: 0.39‐0.80, P = .002), Europe OR = 0.77 (95% CI: 0.60‐0.98, P = .035), and North‐America OR = 0.59 (95% CI: 0.47‐0.74, P < .001). The risk was significantly reduced for dysplastic BE, OR = 0.37 (95% CI: 0.26‐0.51, P < .001) for non‐dysplastic BE, OR = 0.51 (95% CI: 0.35‐0.75, P = .001), and for long segment BE, OR = 0.25 (95% CI: 0.11‐0.59, P = .001) in case of HPI.ConclusionsThis extensive meta‐analysis provides additional evidence that HPI is associated with reduced risk of BE. Subgroup analyses confirmed that this risk reduction is independent of geographical location. HPI is associated with significantly lower risk of dysplastic, non‐dysplastic, and long segment BE.

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Incidence of Esophageal Carcinoma Among Malays in North-Eastern Peninsular Malaysia: An Area with an Exceptionally Low Prevalence of Helicobacter pylori Infection

Abstract: The low rates of adenocarcinoma and squamous cell carcinoma of the esophagus in the study area, despite the fact that H. pylori infection is virtually absent, does not support the hypothesis that the absence of H. pylori infection is a pivotal factor in the pathogenesis of these cancers.

Cited by 18 publications

References 29 publications

What Indigestion Means to the Malays?

What Indigestion Means to the Malays?

A Rome III survey of functional dyspepsia among the ethnic Malays in a primary care setting

Helicobacter pylori infection reduces the risk of Barrett's esophagus: A meta‐analysis and systematic review

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