METHODS: A large-scale prospective seroepidemiological study in West and East Malaysia using the HEL-p II commercial enzyme-linked immunosorbent assay kit (AMRAD, Melbourne, Australia) to detect H. pylori antibodies. Populations surveyed in West Malaysia were a rural community from Kuala Pilah, and blood donors from Kuala Lumpur and Kota Baru. Subjects studied in East Malaysia were volunteer blood donors from Kota Kinabalu, and blood donors and healthy volunteers from Sibu. Statistical analyses using multiple logistic regression analysis were carried out to identify independent risk factors for H. pylori infection
RESULTS: A total of 2,381 subjects were evaluated. H. pylori prevalence varied from different areas of study and ranged from a low of 26.4% in blood donors from Kota Baru to a high of 55.0% in Kota Kinabalu. The most striking differences, however, were noted in the prevalence rates among different racial groups. Prevalence rates among the Malays ranged from 11.9 to 29.2%, while the Chinese ranged from 26.7 to 57.5%, and those of Indians in two studies were 49.4 and 52.3%. In every location, Malays had a significantly lower prevalence compared with the other races. The highest prevalence rates were recorded among the indigenous races in Kota Kinabalu, East Malaysia. There was no difference between males and females in the studies. An increasing trend with age was noted in the majority of studies; however, no increase in prevalence rates was noted among the Malays.
CONCLUSIONS: The pattern of infection in a multiracial population in Malaysia points to a 'racial cohort' phenomenon. The infection appears to be confined to a racial group, with the Malays having consistently low prevalence rates. This observation may provide clues to the mode of transmission of infection.
METHODS: Serum samples from asymptomatic children tested for H. pylori seropositivity using an ELISA test.
RESULTS: Five hundred and fourteen healthy urban Malaysian children aged 0.5 to 17 (mean 5.9) years from three different racial groups had their blood tested for H. pylori antibodies. The overall prevalence was 10.3%. There was no significant difference in the prevalence of infection between boys and girls, but a significant rise was noted with increasing age (P = 0.009). Seropositivity was most common in the Indians and lowest in the Malays (P = 0.001). Father's level of education did not affect the child's rate of H. pylori seropositivity.
CONCLUSION: The prevalence of H. pylori seropositivity among asymptomatic urban Malaysian children is lowest in Malays. Intermediate in Chinese and highest in Indians. The racial differences found in children are consistent with those found in Malaysian adults.
AIM: To assess the efficacy, safety and compliance of an H. pylori eradication regimen and examine clinical factors that potentially determine eradication.
METHODS: Consecutive outpatients from a multicultural, south east Asian, population with H. pylori infection, with or without peptic ulcer, were treated with lansoprazole 30 mg, amoxycillin 1 gm, clarithromycin 500 mg, twice a day for seven days. Eradication was assessed by either rapid urease, histology or urea breath test. Compliance and side effects were recorded. The eradication rate and effect of ethnicity, age, sex, usage of alcohol, smoking and non-steroidal anti-inflammatory drugs, history of ulcer and endoscopic diagnosis on eradication were examined by univariate and multivariate analysis.
RESULTS: Of 113 patients, the eradication rate by intention to treat was 98/113 (87%) (95% confidence interval [CI] 80-93%) and per protocol was 98/106 (92%) (95% CI 87-97%). Using Fisher's exact test, eradication was more successful in Chinese (intention to treat and per protocol respectively p=0.02 and p<0.001) compared to non-Chinese. By logistic regression analysis ethnicity was an independent factor associated with eradication success (p=0.0025). Side effects occurred in five (4.4%), resulting in cessation of treatment.
CONCLUSIONS: This one week eradication regimen is safe and effective in south east Asians. Chinese ethnicity may be associated with a higher likelihood of eradication success.