The concordance between endoscopic and histological gastritis was determined in 52 patients referred for upper gastrointestinal endoscopy. The study was conducted in Northeastern Peninsular Malaysia, an area with a low background prevalence of H. pylori infection. Endoscopic and histological gastritis were assessed in accordance with the Sydney System. The results showed poor concordance between endoscopic and histological gastritis even after reclassifying mild endoscopic gastritis as normal. The low prevalence of H. pylori was validated in this study.
A survey of 142 cases of acute pancreatitis was undertaken in two major hospitals serving the state of Kelantan in Malaysia. Females outnumbered males by a ratio of more than 3:1. The incidence among females peaked in the third decade of life. Twenty-one percent (23/109) of the females were pregnant. Ultrasonography revealed gallstones in only 9.4% (13/138). However, abnormalities of serum transaminases were found in 35% (35/100), suggesting that occult gallstones or microlithiasis may be the cause in a significant proportion of patients. Alcohol was virtually absent as an aetiological factor. There was a higher frequency of Ascaris infection in this group than a control hospital population (11/35 vs 33/242; p < 0.02) suggesting that ascariasis may be an important cause of acute pancreatitis in Kelantan. Only 8.4% fell into the category of severe pancreatitis. The overall mortality rate was 2.1%.
A study to determine the effect of antihelminthic treatment on growth and nutritional status was undertaken on 103 children in the second grade of primary school, 71 of whom were found to be infected with Ascaris lumbricoides or Trichuris trichiura. The median Ascaris and Trichuris intensities in the infected group were 19,600 (range; 0-488,000) and 2,800 (range; 0-84,600) eggs per gram of feces respectively. Forty-three children harbored both types of worm. Fourteen weeks after two 400 mg doses of albendazole were administered to infected children, the increases in weight, height, weight for age, height for age and weight for height were significantly higher among infected children than controls who were uninfected at baseline. The observed gains were independent of sex and socioeconomic status. Decrease in log transformed Trichuris intensity correlated with increases in weight (r=0.24; p=0.02) and weight for age (r=0.20; p=0.06) but decrease in Ascaris intensity did not correlate with increases in any of the anthropometric parameters. The results suggest that antihelminthic treatment has beneficial short-term effects on growth and nutritional status of a modest magnitude among early primary schoolchildren in the area.
Objective. This study was undertaken to gain an insight into the relationship between Helicobacter pylori (H. pylori) infection, Barrett's esophagus and reflux esophagitis in an area of exceptionally low prevalence of H. pylori infection. Methods. A total of 1895 consecutive upper endoscopies performed between January 2005 and July 2007 were reviewed. 120 cases of columnar-lined esophagus and endoscopic esophagitis were evaluated. H. pylori infection was determined using the urease test and/or histology. Results. The rate of endoscopic esophagitis was 5.49% (80 Malays, 24 non-Malays) while histological reflux esophagitis was found in 3.75% (56 Malays, 15 non-Malays). Barrett's esophagus was present in 0.79% (11 Malays, 4 non-Malays). H. pylori infection was present in 8/120 or 6.67% subjects. Conclusion. The low rate of Barrett's esophagus in this population does not support the hypothesis that the absence of H. pylori infection is more than a minor risk factor for Barrett's esophagus.
Intestinal permeability of 246 early primary schoolchildren at 2 schools (106 of whom were infected with intestinal helminths) was assessed by using the lactulose/mannitol differential absorption test. The ratio of the urinary recoveries of lactulose and mannitol was determined after oral administration of a standard solution of the 2 sugars. Assessment of intestinal permeability was repeated on 100 infected children after treatment and on a cohort of 68 uninfected children. Infected and uninfected groups were compared with respect to baseline lactulose/mannitol ratio (L/M1) and change in lactulose/mannitol ratio between assessments (delta L/M). The correlations between baseline intensity of infection and L/M1, and between fall in intensity and delta L/M, were evaluated. Based on a crude index of socioeconomic status, each child was assigned to one of 3 socioeconomic groups; all but 3 children belonged to either groups 2 or 3. Trichuris trichiura and Ascaris lumbricoides were the 2 predominant infections; the hookworm infection rate was relatively low. The results suggested that helminthiasis exerted only a marginal effect on intestinal permeability, the impact of which in children from lower socioeconomic backgrounds was negligible in comparison with the cumulative effects of other factors.
Stool examination of 249 early primary schoolchildren at 2 schools in north-eastern peninsular Malaysia revealed that 73 were infected with Ascaris lumbricoides, 103 with Trichuris trichiura, and 18 with hookworms. Infected children were treated with a single dose of 400 mg of albendazole. The school attendance records during a 60 d period before treatment and 2 consecutive 60 d periods after treatment were examined. The absenteeism rate did not improve more among infected children after treatment than it did among the uninfected control children. The correlation between worm intensity and the number of lost school-days was poor. There was no evidence that intestinal helminthiasis caused school absenteeism among this group of children.
Stool specimens of 104 primary schoolchildren (mean+/-SD age = 8.2+/-0.3 years) were examined for helminth eggs and for occult blood to investigate the possibility that trichuriasis causes occult intestinal bleeding in the absence of the overt Trichuris dysentery syndrome. A commercially available guaiac test was used to detect fecal occult blood. Sixty-one children had Trichuris infection, 11 of whom had heavy infections (> 10,000 eggs per gram of feces [epg]), and 53 had Ascaris infections. No hookworm infection was detected. Baseline screening yielded only one weakly positive occult blood test result in a child with a light (800 epg) Trichuris infection. Serial stool occult blood testing on the 11 subjects with heavy trichuriasis and 8 uninfected controls yielded a single weakly positive result in the control group. The results provide no evidence that trichuriasis predisposes to significant occult gastrointestinal bleeding in children in the absence of the dysenteric syndrome.
The Helicobacter pylori infection rate was determined in 124 consecutive patients with duodenal ulcers (DU), gastric ulcers (GU), duodenal erosions or gastric erosions diagnosed by endoscopy at a single institution in north-eastern peninsular Malaysia in 1996-97. Biopsies of the gastric antrum and body were subjected to the urease test, Gram staining of impression smears, culture and histopathological examination. Serology was undertaken on all patients using a locally validated commercial kit. Infection was defined as a positive result in at least one test. The infection rates were 20% (10/50), 21.2% (7/33), 16.7% (1/6) and 17.1% (6/35) in DU, GU, duodenal erosion and gastric erosion patients, respectively. The infection rate among Malays [7.0%, (6/86)] was lower than in non-Malays [47.4% (18/38)] (P < 0.001). There was a higher infection rate among males, who constituted 62.1% (77/124) of the sample. Seventy-eight patients (62.9%) were receiving non-steroidal anti-inflammatory drugs (NSAIDs) and 33 patients (26.6%) were neither receiving NSAIDs nor were infected with H. pylori. The H. pylori infection rate among peptic ulcer patients in this predominantly Malay rural population appears to be the lowest reported in the world thus far. Empirical H. pylori eradication therapy in peptic ulcer patients is clearly not indicated in this community. The possible reasons for the low prevalence of H. pylori infection are discussed.
We studied asymptomatic primary schoolchildren in northeastern Malaysia with light to moderate trichuriasis to determine the effect of albendazole treatment on growth rates and TNF-alpha levels. Thirty-seven schoolchildren aged 6-7 years with stool samples positive for Trichuris trichiura and negative for other geohelminths and protozoa were randomized to receive albendazole 400 mg or a placebo daily for 2 days. Anthropometric parameters at baseline, 3, 6 and 12 months were compared between the 2 groups. The placebo group had a significantly greater increase in height (p = 0.04) than the albendazole treatment group. There were no significant differences in urinary TNF-alpha levels (p = 0.8) between the 2 groups and no significant changes between baseline and 1 month post-treatment levels. Further studies are needed to determine the etiology of this apparent association between the albendazole treatment group and the delay in growth rate at 6 months post-treatment.
Whether the exceptionally low prevalence of Helicobacter pylori (HP) infection reported among Malays is also present among aborigines (the Orang Asli) living in northeastern Peninsular Malaysia is unknown. We studied asymptomatic Orang Asli from settlements situated 210 km from the city of Kota Bharu. The HP infection status was confirmed by a validated serology test. Nineteen percent of 480 Orang Asli tested positive for HP infection. The prevalence was 40.6% in the birth cohort of the 1940s and declined steadily in later cohorts to under 10% among 12-30 year olds. This may be related to the phases of relocation from the jungles into resettlement camps and ultimately into designated villages near rivers. The low prevalence pattern after the 1970s was probably partly a result of improvement in sanitation and hygiene practice in these villages but other unidentified factors may also be operating.
The prevalence of Helicobacter pylori infection was determined in peptic ulcer patients, in non-ulcer dyspepsia (NUD) patients, and in the general adult population. The H. pylori infection rate ascertained by microbiologic examination of multiple gastric antral biopsy specimens was 50% (17 of 34) in duodenal ulcer (DU), 5% (1 of 22) in gastric ulcer, and 9% (15 of 159) in NUD patients. A seroepidemiologic survey showed a prevalence of only 4.2% among 496 blood donors and 4.8% among 921 subjects who attended health screening clinics. H. pylori infection is relatively uncommon and does not appear to be the predominant factor in the pathogenesis of peptic ulcer disease in the area. The incidence of peptic ulcer perforations in the area in 1991-92 was 1.5 per 100,000 person-years, reflecting a relatively low frequency of peptic ulcers, which might be due to the low prevalence of H. pylori infection in the population.
Obesity, gastroesophageal reflux, and Barrett's esophagus have all been linked to esophageal adenocarcinoma. In addition, the decline in Helicobacter pylori (H. pylori) infection in affluent societies has also been suggested to be a major factor in the recent rise in the incidence of esophageal adenocarcinoma. If H. pylori infection has a protective role, populations with a naturally low prevalence of H. pylori infection such as the ethnic Malays of Northeastern Peninsular Malaysia should have high rates of esophageal adenocarcinoma.
The aim of the present study was to determine the cost-efficiency of different duodenal ulcer disease treatment practices in Malaysia. Six Malaysian gastroenterologists met to discuss the direct costs related to Helicobacter pylori (HP) eradication treatment. Five treatment strategies were compared: (i) histamine H2 receptor antagonists (H2RA), acid suppression therapy for 6 weeks followed by maintenance therapy as needed; (ii) bismuth triple + proton pump inhibitor (PPI), bismuth (120 mg, q.i.d.), metronidazole (400 mg; t.i.d.), tetracycline (500 mg, q.i.d.) for 7 days and PPI, b.i.d., for 7 days; (iii) OAC, omeprazole (20 mg, b.i.d.), amoxycillin (1000 mg, b.i.d.) and clarithromycin (500 mg, b.i.d.) for 7 days; (iv) OMC, omeprazole (20mg, b.i.d.), metronidazole (400mg, b.i.d.) and clarithromycin (500 mg, b.i.d.) for 7 days; and (v) OAM, omeprazole (20 mg, b.i.d.), amoxycillin (1000 mg, b.i.d.) and metronidazole (400 mg, b.i.d.) for 7 days. A decision tree model was created to determine which therapy would be the most cost-effective. The model considered eradication rates, resistance to anti-microbial agents, compliance and cost implications of treatment regimens, physician visits and ulcer recurrences during a 1 year time period assumption. The H2RA maintenance therapy was the most expensive treatment at Malaysian Ringgit (MR) 2335, followed by bismuth triple therapy (MR 1839), OMC (MR 1786), OAM (MR 1775) and OAC, being the most cost-effective therapy, at MR 1679. In conclusion, HP eradication therapy is superior to H2RA maintenance therapy in the treatment of duodenal ulcer disease. Of the HP eradication regimens, OAC is the most cost-effective.
A review of the records at a teaching hospital in Kelantan revealed that 175 new cases of peptic ulcer disease were diagnosed endoscopically over a period of 5 years. The ratio of duodenal to gastric ulcers was 2:1. Male patients outnumbered females by 2.7:1. There was a disproportionately high number of Chinese patients. A striking observation was that an unusually large proportion (45%) of patients had presented with acute gastrointestinal bleeding. The implication is that peptic ulcer disease in this region may be underdetected; the diagnosis often coming to light only after a serious complication has supervened.
Helicobacter pylori-associated gastric carcinoma is generally more common in the antrum/body and is of the intestinal type. The aim of this study was to determine the pattern of gastric carcinoma in an area known to have a low prevalence of H. pylori. Pathology records of gastric carcinoma diagnosed at Hospital University Sains Malaysia between 1995 and 1999 were retrieved and studied. There were a total of 23 cases. The median age was 60 years. Eighteen patients were Malay and 5 were Chinese. The most common location of the tumour was the cardia/gastrooesophageal junction (61%, 14/23 patients). The majority was of the intestinal type (69.6%, 16/23). The frequency of gastric carcinoma appears to be exceptionally low in the area of study. The Chinese population was over-represented. The higher frequency of tumour in the cardia/gastro-oesophageal junction as compared to the antrum and body is in sharp contrast to most other studies. This reaffirms the notion that Helicobacter pylori infection is a causative agent for non-cardia gastric carcinomas.