exudates and Stomach-Neoplasms

Incidence rates of gastric cancer in Malaysia has declined by 48% among males and 31% among females in the latest\ reporting period of 13 years. Malays used to have age-standardized-rates only a fifth of those in Chinese and Indians,\ but the incidence among them is slightly rising even as the rates drop in the other races. Besides ethnicity, a low level\ of education, high intake of salted fish and vegetables, H pylori infection and smoking are risk factors. Consumption\ of fresh fruit and vegetable is protective. Variation in the strains of H pylori infection affect gastric cancer risk, with\ hspEAsia isolates among Chinese appearing linked to a high incidence than with hpAsia2 or hpEurope strains among\ Indians and Malays. It was reported in the 1980s that only about 3% of patients presented with early gastric cancer, but\ more encouraging rates reaching 27% with Stage 1 and 2 disease have been reported in the twenty-first century from\ leading centres. More tumours occur in the distal stomach except in Kelantan, where the incidence is low and main site\ is the cardia. Prompt endoscopy is advocated and open access, with direct referrals, to such services using a weighted\ scoring system should be more utilized. In view of the high rate of late disease laparoscopic staging unnecessary\ laparotomy needs to be avoided. Late presentation of gastric cancer however, is still predominant and the mortality to\ incidence ratio is relatively high. Besides seeking to reduce risk factors and achieve early detection, implementation\ of improved care for patients with late disease must be promoted in Malaysia.

Topics: Biomedical Research; Helicobacter Infections; Helicobacter pylori; Humans; Incidence; Malaysia; Stomach Neoplasms

The study of Helicobacter pylori in Malaysia has given several important insights into the epidemiology of the infection and pathogenesis of disease. Malaysia has a multiracial Asian population with three major Asian races living together-Malay, Chinese, and Indian. Races remain fairly distinct because of a paucity of interracial marriages. The "Racial Cohort Hypothesis" proposes that the infection occurs within racial groups rather than between. As such, the high prevalence among Indians (> 50%) and Chinese (40-50%) reflects the high prevalence in their countries of origin even though migration had taken place more than two generations before. The Malays have a comparatively low prevalence of about 10-20%. Despite the high prevalence of H. pylori, the Indians have a low gastric cancer incidence of less than 10 per 100 000 per year. This is in contrast to the Chinese who has an incidence in excess of 20 per 100 000 per year. We have called this the "Indian Enigma." The reason for this enigma is unclear and is the result of interaction between bacterial virulence factors, host susceptibility, and environmental factors. Phylogenetically, Chinese bacterial strains are distinct from Indians and Malays and are predominantly hpEastAsia/hsp EAsia. CagA EPIYA motifs among Chinese belong predominantly to the more virulent ABD motif. There is no clear distinguishing profile among host genetic factors. Environmental factors particularly diet may play an important role. Indians consume chilies and curries, which may be gastro protective, whereas Chinese consume more preserved and salted foods, which are thought to be carcinogenic.

Topics: China; Cohort Studies; Disease Susceptibility; Environment; Feeding Behavior; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; India; Malaysia; Phylogeny; Prevalence; Racial Groups; Stomach Neoplasms

Reported associations of capsaicin with gastric cancer development have been conflicting. Here, we examine 10 published articles that explore these associations using 2,452 cases and 3,996 controls.. We used multiple search strategies in MEDLINE through PubMed to seek for suitable articles that had case-control design with gastric cancer as outcome.. The outcomes of our study shows protection (odds ratio [OR] 0.55, P = 0.003) and susceptibility (OR 1.94, P = 0.0004), both significant with low and medium-high intake of capsaicin, respectively, although under relatively heterogeneous conditions (P(heterogeneity) = <0.0001). Outlier analysis resulted in loss of overall heterogeneity (P = 0.14) without affecting the pooled ORs. Among the subgroups, low intake elicited protection in both Korean (OR 0.37) and Mexican (OR 0.63) populations while high intake rendered these subgroups susceptible (OR 2.96 and OR 1.57, respectively). These subgroup values were highly significant (P = 0.0001-0.01) obtained in heterogeneous conditions (P(heterogeneity) < 0.0001-0.04). The homogeneous (P(heterogeneity) = 0.27-0.37) H. pylori (OR 0.60 and 1.69) effects were highly significant (P < 0.001) in the low and medium-high intake analyses, respectively. Given outcomes from the tests of interaction, high capsaicin intake is significantly different from the protection that low consumption offers.. This meta-analysis implies moderation in capsaicin consumption in order to derive its protective benefits.

Topics: Animals; Anticarcinogenic Agents; Apoptosis; Asia; Capsaicin; Capsicum; Cell Line, Tumor; Cell Transformation, Neoplastic; Diet; Disease Susceptibility; Dose-Response Relationship, Drug; Gastric Mucosa; Gastritis; Gene Expression Regulation; Helicobacter Infections; Helicobacter pylori; Humans; Life Style; Malaysia; Research Design; Risk; Stomach Neoplasms

Helicobacter pylori (H. pylori) infection is etiologically associated with gastric cancer and peptic ulcer diseases which are both important public health burdens which could be largely eliminated by H. pylori eradication. However, some investigators urge caution based on the hypothesis that eradication of H. pylori may result in an increase in the incidence of gastroesophageal reflux disease, esophageal adenocarcinoma, and childhood asthma. The ethnic Malays of northeastern Peninsular Malaysia have long had a low prevalence of H. pylori infection and, as expected, the incidence of gastric cancer and its precursor lesions is exceptionally low. The availability of a population with a low H. pylori prevalence and generally poor sanitation allows separation of H. pylori from the hygiene hypothesis and direct testing of whether absence of H. pylori is associated with untoward consequence. Contrary to predictions, in Malays, erosive esophagitis, Barrett's esophagus, distal esophageal cancers, and childhood asthma are all of low incidence. This suggests that H. pylori is not protective rather the presence of H. pylori infection is likely a surrogate for poor hygiene and not an important source of antigens involved in the hygiene hypothesis. Helicobacter pylori in Malays is related to transmission from H. pylori-infected non-Malay immigrants. The factors responsible for low H. pylori acquisition, transmission, and burden of H. pylori infection in Malays remain unclear and likely involves a combination of environmental, host (gene polymorphisms), and strain virulence factors. Based on evidence from this population, absence of H. pylori infection is more likely to be boon than a bane.

Topics: Helicobacter Infections; Helicobacter pylori; Humans; Malaysia; Peptic Ulcer; Prevalence; Stomach Neoplasms

Observations of racial differences in the prevalence of Helicobacter pylori in Malaysia have been intriguing. The Indians and Chinese consistently have a higher prevalence compared to the Malays. The racial cohort theory has been proposed to explain these differences where transmission and perpetuation of infection takes place within a racial group rather than between races, races being separate owing to the low rate of interracial marriages. Studies have demonstrated distinctive bacterial strains between races. Phylogenetic studies have shown that H. pylori isolates amongst Chinese and Indians are distinctive while Malays have Indian and other strains suggesting a more recent acquisition of the bacterium from Indians. H. pylori is recognized as the major causative factor in peptic ulcer disease and gastric cancer. Despite the high prevalence of H. pylori, Indians have a relatively low prevalence of peptic ulcer disease and a low incidence of gastric cancer. This paradox with regards to gastric cancer has been termed the "Indian enigma". Bacterial strain differences between races may be putative but this observation may also indicate gastroprotective environmental factors or a lower genetic susceptibility to develop cancer in the Indians.

Topics: Helicobacter Infections; Helicobacter pylori; Humans; Malaysia; Peptic Ulcer; Phylogeny; Prevalence; Stomach Neoplasms

The incidence of surgery for gastric cancer in Singapore increased during the period 1951 to 1980 (males from 3.5 to 8.7 per 100,000 per year: females from 0.5 to 4.2 per 100,000 per year). This increase occurred mainly during the first decade of the study and was confined to persons aged 55 and above. Chinese had the highest incidence, followed by Indians and then Malays. These racial differences remained unchanged over the period of study.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; China; Female; Humans; India; Malaysia; Male; Middle Aged; Sex Factors; Singapore; Stomach Neoplasms

In the global phase 3 RAINBOW study, ramucirumab plus paclitaxel significantly improved overall survival compared with placebo plus paclitaxel in patients with advanced gastric or gastro-oesophageal junction (GEJ) adenocarcinoma. RAINBOW-Asia, a bridging study with similar design to RAINBOW, aimed to evaluate the efficacy and safety of ramucirumab plus paclitaxel for advanced gastric or GEJ adenocarcinoma in Asian, predominantly Chinese, patients.. RAINBOW-Asia was a randomised, double-blind, placebo-controlled, phase 3 trial done at 32 centres in China, Malaysia, the Philippines, and Thailand. Adult patients (≥18 years) with metastatic or locally advanced, unresectable gastric or GEJ adenocarcinoma who previously received fluoropyrimidine-platinum-based chemotherapy were randomly assigned with a centralised interactive web response system in a 2:1 ratio to receive ramucirumab 8 mg/kg or placebo intravenously on days 1 and 15 plus paclitaxel 80 mg/m. Between March 2, 2017, and June 30, 2020, 440 patients were randomly assigned to receive ramucirumab plus paclitaxel (n=294) or placebo plus paclitaxel (n=146). Median progression-free survival was 4·14 months (95% CI 3·71-4·30) in the ramucirumab plus paclitaxel group compared with 3·15 months (2·83-4·14) in the placebo plus paclitaxel group (hazard ratio [HR] 0·765, 95% CI 0·613-0·955, p=0·0184). Median overall survival was 8·71 months (95% CI 7·98-9·49) in the ramucirumab plus paclitaxel group and 7·92 months (6·31-9·10) in the placebo plus paclitaxel group (HR 0·963, 95% CI 0·771-1·203, p=0·7426). The most common grade 3 or worse treatment-emergent adverse events were decreased neutrophil count (159 [54%] of 293 patients in the ramucirumab plus paclitaxel group vs 56 [39%] of 145 in the placebo plus paclitaxel group), decreased white blood cell count (127 [43%] vs 42 [29%]), anaemia (46 [16%] vs 24 [17%]), hypertension (21 [7%] vs nine [6%]), and febrile neutropenia (18 [6%] vs one [<1%]).. These findings, along with the results from RAINBOW, support the use of ramucirumab plus paclitaxel as second-line therapy in a predominantly Chinese population with advanced gastric or GEJ adenocarcinoma.. Eli Lilly and Company, USA.. For the Chinese translation of the abstract see Supplementary Materials section.

Topics: Adenocarcinoma; Administration, Intravenous; Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal, Humanized; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Case-Control Studies; China; Double-Blind Method; Esophageal Neoplasms; Esophagogastric Junction; Female; Humans; Malaysia; Male; Middle Aged; Paclitaxel; Philippines; Placebos; Progression-Free Survival; Ramucirumab; Safety; Stomach Neoplasms; Thailand; Treatment Outcome; Vascular Endothelial Growth Factor Receptor-2

Gastric cancer (GC) is one of the leading causes of all new cancer cases globally. Although it is no longer reported in the top 10th most common cancer in Malaysia, geographical distribution and ethnic influences still obviously exist.. This is a retrospective analysis of histopathological records in a public tertiary health care centre in Malaysia. The computerised laboratory information system from the histopathology department of the hospital was retrieved for the period of 2005-2018. Descriptive analysis was done using Microsoft Excel.. There was a total of 233 histologically confirmed GC cases. The burden of GC was observed to be an increasing trend from 2016 onwards. Among them, 64% were male and 36% were female. The youngest age of diagnosis was 19, while the oldest one was 93. Malaysian Chinese were found to have the highest incidences (41.63%), followed by Malays (32.19%) and Malaysian Indians (23.61%). All cases were of adenocarcinoma cell types and were found to have poorly differentiated in majority at the time of diagnosis.. Although this report only represents one tertiary health care centre in Malaysia, the Indian Enigma was still observed, as stated in other literatures. Over time, the incidence of GC in Malays has increased. Consideration of lifestyle modifications, health education and Helicobacter pylori eradication in various nations' National Health Insurance plans, are encouraged as prevention is always better than treatment or cure, including the cost load.

Topics: Adult; Aged; Aged, 80 and over; Asian People; Female; Humans; Malaysia; Male; Middle Aged; Public Health; Retrospective Studies; Stomach Neoplasms; Young Adult

Topics: Adenocarcinoma; Feasibility Studies; Female; Gastrectomy; Humans; Incidence; Laparoscopy; Malaysia; Male; Retrospective Studies; Safety; Stomach Neoplasms; Survival Rate

Gastric leiomyoma of the antrum intussuscepted into first part of the duodenum is a rare complication. We report here an 80-year-old woman who presented at the Sarawak General Hospital, Kuching, Sarawak, Malaysia with early satiety and epigastric fullness for 3 months. She had no prior medical or surgical history other than an uneventful open cholecystectomy. Upper endoscopy showed a large submucosal mass in the first part of duodenum with pyloric converging gastric folds. Computed tomography scan of the abdomen showed a gastroduodenal intussusception with a 4x6cm mass at the junction between the first and second part of duodenum. Laparoscopic transgastric resection was performed. Histopathological examination of the resected specimen confirmed leiomyoma. She remained well at 43 months follow-up.

Topics: Aged, 80 and over; Female; Humans; Intussusception; Laparoscopy; Leiomyoma; Malaysia; Stomach Neoplasms; Treatment Outcome

Human epidermal growth factor receptor 2 (Erbb2/HER2) overexpression, which was previously detected in invasive breast cancer, has now been implicated in advanced gastric cancer (GC) and gastroesophageal junction cancer (GEC). A study was conducted to determine the rate of HER2 positivity in patients with locally advanced or metastatic GC and GEC in Malaysia and to assess the impact of various demographic and clinical parameters on HER2 positivity.. A total of 228 adult patients with GC or GEC were enrolled from Subang Jaya Medical Centre, Malaysia, for retrospective (210) and prospective study. All patients were subjected to the HER2 immunohistochemistry test using an FDA-approved, standardized test kit. Carcinomas scoring 2+ on immunohistochemistry were further tested with HER2 in situ hybridization (ISH) using an FDA-approved test kit.. The overall rate of HER2 positivity in the population studied was 24.6% (n = 56). The rate was significantly higher in men than in women (29.6 vs. 16.3%; p = 0.024). HER2 overexpression was significantly more common in diffuse type than in intestinal type of tumors (39.8 vs. 14.9%; p < 0.001). In our study, out of 56 samples, 44 (78.6%) were considered for gene amplification testing, out of which 40 (90.1%) samples showed gene amplification. There was no statistically significant correlation between HER2 positivity and patient age, race, tumor location, tumor differentiation, and TNM staging.. HER2 overexpression was evident in nearly 25% of the Malaysian patients with locally advanced or metastatic gastric cancer. The overexpression correlated significantly with male gender and diffuse-type tumors. The majority of the IHC-positive tumors demonstrated c-erb2 gene amplification and this finding reached statistical significance.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Immunohistochemistry; Malaysia; Male; Middle Aged; Neoplasm Metastasis; Prevalence; Receptor, ErbB-2; Stomach Neoplasms

The multiracial population in Malaysia has lived together for almost a century, however, the risk of gastric cancer among them varies. This study aimed to determine the distribution of different gastric adenocarcinoma subtypes and Helicobacter pylori infection status among gastric adenocarcinoma patients. Patients with gastric adenocarcinoma were enrolled from November 2013 to June 2015. Blood samples were collected for detection of H. pylori using ELISA method. Gastric adenocarcinoma cases were more prevalent in the Chinese (52.8%), followed by the Malays (41.7%) and least prevalent in the Indians (5.6%). Gastric adenocarcinoma located in the cardia was significantly more prevalent in the Malays (66.7%) compared to the Chinese (26.3%), whereas non-cardia cancer was diagnosed more in the Chinese (73.7%) compared to the Malays (33.3%) [P = 0.019; OR = 5.6, 95 CI: 1.27 to 24.64]. The Malays also had significantly higher prevalence of gastric tumour located at the cardia or fundus than other gastric sites compared to the Chinese (P = 0.002; OR: 11.2, 95% CI: 2.2 to 56.9). Among the cardia gastric cancer patients, 55.6% of the Malays showed intestinal histological subtype, whereas all the Chinese had the diffuse subtype. More than half of the patients (55.3%) with gastric adenocarcinoma were positive for H. pylori infection and among them, 66.7% were Chinese patients. The risk of gastric adenocarcinoma in our population is different among ethnicities. Further studies on host factors are needed as it might play an important role in gastric cancer susceptibility in our population.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Female; Helicobacter Infections; Helicobacter pylori; Humans; Malaysia; Male; Middle Aged; Stomach Neoplasms

Vena cava compression is a relatively rare initial manifestation of underlying malignancy. The superior vena cava syndrome, which is characterized by facial plethora, jugular venous distension, and arm swelling, is a well-known entity associated with bronchogenic carcinoma. Less common is the compression of the inferior vena cava. To the best of my knowledge, this is the first reported case of newly diagnosed gastric adenocarcinoma presenting initially as the inferior vena cava syndrome. The unique aspect about this case is that it highlights a rare presentation before diagnosis of gastric adenocarcinoma.. A 56-year-old Malaysian woman with a past medical history of iron deficiency anemia presented with lower extremity edema and progressive fatigue of 1 month's duration. She had significant worsening of leg swelling after standing for short periods of time. She also reported epigastric discomfort, which led to an additional workup, including computed tomography of the abdomen and pelvis. This revealed a 3cm×2.9cm mass in the stomach, extensive hepatic metastasis, and severe inferior vena cava compression. The patient was examined further with esophagogastroduodenoscopy, and a biopsy showed gastric adenocarcinoma.. This report describes a case of a patient with inferior vena cava syndrome as a unique presentation of previously undiagnosed stage IV gastric adenocarcinoma. Patients presenting with inferior vena cava syndrome should undergo prompt evaluation for underlying malignancies that have a predilection for hepatic metastasis. This case is important because earlier recognition of this syndrome can lead to earlier workup and thus detection of malignancy. Prompt initiation of treatment, including chemotherapy or vena cava stent placement, can result in improved patient outcome.

Topics: Adenocarcinoma; Anemia, Iron-Deficiency; Antineoplastic Combined Chemotherapy Protocols; Budd-Chiari Syndrome; Disease Progression; Edema; Endoscopy, Gastrointestinal; Fatigue; Female; Humans; Lower Extremity; Malaysia; Middle Aged; Neoplasm Staging; Paclitaxel; Stomach Neoplasms; Syndrome; Tomography, X-Ray Computed; Trastuzumab; Treatment Outcome; Vena Cava, Inferior

Helicobacter pylori infection results in diverse clinical conditions ranging from chronic gastritis and ulceration to gastric adenocarcinoma. Among the multiethnic population of Malaysia, Indians consistently have a higher H. pylori prevalence as compared with Chinese and Malays. Despite the high prevalence of H. pylori, Indians have a relatively low incidence of peptic ulcer disease and gastric cancer. In contrast, gastric cancer and peptic ulcer disease incidence is high in Chinese. H. pylori strains from Chinese strains predominantly belong to the hspEAsia subpopulation while Indian/Malay strains mainly belong to the hspIndia subpopulation. By comparing the genome of 27 Asian strains from different subpopulations, we identified six genes associated with risk of H. pylori-induced peptic ulcer disease and gastric cancer. This study serves as an important foundation for future studies aiming to understand the role of bacterial factors in H. pylori-induced gastro-duodenal diseases.

Topics: Amino Acid Sequence; Bacterial Outer Membrane Proteins; Fructose-Bisphosphate Aldolase; Gastritis; Genes, Bacterial; Genetic Association Studies; Genetic Variation; Helicobacter Infections; Helicobacter pylori; Humans; Malaysia; Molecular Sequence Data; Multilocus Sequence Typing; Peptic Ulcer; Phylogeny; Stomach Neoplasms

To identify genes associated with gastric precancerous lesions in Helicobacter pylori (H. pylori)-susceptible ethnic Malays.. Twenty-three Malay subjects with H. pylori infection and gastric precancerous lesions identified during endoscopy were included as "cases". Thirty-seven Malay subjects who were H. pylori negative and had no precancerous lesions were included as "controls". Venous blood was collected for genotyping with Affymetrix 50K Xba1 kit. Genotypes with call rates < 90% for autosomal single nucleotide polymorphisms (SNPs) were excluded. For each precancerous lesion, associated SNPs were identified from Manhattan plots, and only SNPs with a χ² P value < 0.05 and Hardy Weinberg Equilibrium P value > 0.5 was considered as significant markers.. Of the 23 H. pylori-positive subjects recruited, one sample was excluded from further analysis due to a low genotyping call rate. Of the 22 H. pylori-positive samples, atrophic gastritis only was present in 50.0%, complete intestinal metaplasia was present in 18.25%, both incomplete intestinal metaplasia and dysplasia was present in 22.7%, and dysplasia only was present in 9.1%. SNPs rs9315542 (UFM1 gene), rs6878265 (THBS4 gene), rs1042194 (CYP2C19 gene) and rs10505799 (MGST1 gene) were significantly associated with atrophic gastritis, complete intestinal metaplasia, incomplete metaplasia with foci of dysplasia and dysplasia, respectively. Allele frequencies in "cases" vs "controls" for rs9315542, rs6878265, rs1042194 and rs10505799 were 0.4 vs 0.06, 0.6 vs 0.01, 0.6 vs 0.01 and 0.5 vs 0.02, respectively.. Genetic variants possibly related to gastric precancerous lesions in ethnic Malays susceptible to H. pylori infection were identified for testing in subsequent trials.

Topics: Adult; Aged; Asian People; Case-Control Studies; Chi-Square Distribution; Female; Gastritis, Atrophic; Gastroscopy; Gene Frequency; Genetic Predisposition to Disease; Helicobacter Infections; Helicobacter pylori; Humans; Malaysia; Male; Metaplasia; Middle Aged; Phenotype; Polymorphism, Single Nucleotide; Precancerous Conditions; Predictive Value of Tests; Risk Factors; Stomach Neoplasms

Helicobacter pylori is the main bacterial causative agent of gastroduodenal disorders and a risk factor for gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. The draft genomes of 10 closely related H. pylori isolates from the multiracial Malaysian population will provide an insight into the genetic diversity of isolates in Southeast Asia. These isolates were cultured from gastric biopsy samples from patients with functional dyspepsia and gastric cancer. The availability of this genomic information will provide an opportunity for examining the evolution and population structure of H. pylori isolates from Southeast Asia, where the East meets the West.

Topics: Biopsy; DNA, Bacterial; Dyspepsia; Genome, Bacterial; Helicobacter Infections; Helicobacter pylori; Humans; Malaysia; Molecular Sequence Data; Sequence Analysis, DNA; Stomach Neoplasms

The contribution of human genetic polymorphisms to Helicobacter pylori infection and gastric cancer (GC) development remains unclear due to geographic variation in the association between specific host genetic polymorphisms and GC. In the current study we investigated the association between polymorphisms related to immune and cancer-related pathways and H. pylori infection among the major ethnicities, Chinese, Malay and Indian, resident in Singapore and Malaysia as well as the association between these polymorphisms and GC development in ethnic Chinese patients.. Thirty-four polymorphisms in 26 genes were typed by mass spectrometry in 422 patients undergoing endoscopy (162 Chinese, 113 Indian and 87 Malay controls and 60 Chinese GC cases). Patients were assessed for evidence of H. pylori infection. Odds ratios (OR) and confidence intervals (CI) were obtained using logistic regression models.. The prevalence of 16 polymorphisms varied significantly among the ethnicities. In the Chinese subgroup, nominally significant associations were shown between (i) EBBR2+1963G (rs1801200) and H. pylori infection (per-allele OR: 0.48, 95% CI 0.23, 0.98, P = 0.04), (ii) PTGS2-1195G (rs689466) and an increased risk of GC on adjusting for H. pylori status (OR: 1.53, 95% CI 0.99, 2.37, P = 0.05), and (iii) IL1B-1473C (rs1143623) and a decreased risk of GC (OR: 0.64, 95% CI 0.41, 0.99, P = 0.05). Borderline significant associations were seen between IL2-330G (rs2069762) (OR 1.45, 95% CI 0.95, 2.15, P = 0.06) and IL13-1111T (rs1800925) (OR 0.65, 95% CI 0.42, 1.01, P = 0.06) and H. pylori infection.. These findings contribute to the understanding of the genetic variation between ethnicities, which may influence H. pylori susceptibility and the outcome of infection.

Topics: Adult; China; Female; Genetic Predisposition to Disease; Genetic Variation; Helicobacter Infections; Helicobacter pylori; Humans; India; Logistic Models; Malaysia; Male; Middle Aged; Polymorphism, Genetic; Singapore; Stomach Neoplasms

Dramatic changes in the prevalence and pattern of gastrointestinal disease has taken place in Asia in recent years.. To compare the prevalence of duodenal (DU) and gastric ulcers (GU), erosive oesophagitis (EO), gastric cancer (GCA) and oesophageal cancer (OCA) and Helicobacter pylori infection over a 10-year interval of time in a multiracial South-East Asian population.. Endoscopy records of first time gastroscopy in the University of Malaya Medical Centre, Kuala Lumpur, Malaysia were reviewed for 1989/1990 and 1999/2000.. In the period of 1989-1990, 3252 records and in 1999-2000, 4615 records were analysed. Both DU (21.1-9.5%) and GU (11.9-9.4%) had decreased significantly (P < 0.001). EO had increased significantly from 2.0% to 8.4% (P < 0.001). Both GCA and OCA had declined in the 10-year interval. Helicobacter pylori prevalence had decreased from 51.7% to 30.3% (P < 0.001).The decrease in DU and GU was seen in all racial groups. The increase in EO was most marked in Indians and the decrease in GCA in Chinese. The proportion of H. pylori-associated DU and GU had also decreased with time.. Peptic ulcers and H. pylori infection had declined over a 10-year period of time and showed an opposing time trend with EO, which had increased dramatically. Both GCA and OCA had declined in prevalence.

Topics: Asian People; Esophageal Neoplasms; Esophagitis, Peptic; Female; Helicobacter Infections; Helicobacter pylori; Humans; Malaysia; Male; Peptic Ulcer; Prevalence; Stomach Neoplasms

The Malaysian National Cancer Registry (NCR) report for the period 2003-2005 shows an incidence of stomach cancer of 2.2 for Malay, 11.3 for Chinese and 11.9 for Indian males per 100,000 population. Malay (1.3), Chinese (7.2) and Indian (7.2) women have rates lower than men. Malays in Peninsular Malaysia have five times less stomach cancer than Chinese and Indians. This racial difference is more marked than that noted in the Singapore cancer registry. Regional data from Kelantan has an even lower rate for Malays there (1.5 for males and 0.9 for females per 100,000 population). The incidence of Helicobacter pylori infection, a known risk factor for stomach cancer, is low among Malays.

Topics: China; Female; Humans; Incidence; India; Malaysia; Male; Registries; Stomach Neoplasms

Topics: Helicobacter Infections; Helicobacter pylori; Humans; India; Malaysia; Prevalence; Reproducibility of Results; Stomach Neoplasms

To determine the risk factors for gastric cancer (GCA), with particular emphasis on ethnicity in our multiracial population.. A prospective case control study with ratio of cancer:controls of 1:2. Diagnosis of H. pylori was made by serology using the ELISA technique. Dietary intake was assessed by dietary recall over the preceding 6 months.. Eighty-seven cases of GCA were enrolled. The cancers were predominantly distal in location and of the intestinal type. Risk factors identified following multiple logistic regression analysis were: Chinese race (OR 10.23 [2.87-36.47]), H. pylori (OR 2.54 [1.16-5.58]), low level of education (OR 9.81 [2.03-47.46]), smoking (OR 2.52 [1.23-5.15]), and high intake of salted fish and vegetables (OR 5.18 [1.35-20.00]) were identified as significant independent risk factors for GCA, while high intake of fresh fruits and vegetables was protective for GCA (OR 0.15 [0.04-0.64]). Chili intake was not a significant protective factor following multivariate analysis.. Chinese race was a strong independent predictor of GCA. H. pylori was an important predictor of GCA with a 2.5-fold greater risk in our patients. Despite a high prevalence of H. pylori, the prevalence of GCA among Indians was low and this paradox can be appropriately called the "Indian enigma."

Topics: Case-Control Studies; Chi-Square Distribution; China; Enzyme-Linked Immunosorbent Assay; Female; Helicobacter Infections; Helicobacter pylori; Humans; Incidence; India; Logistic Models; Malaysia; Male; Middle Aged; Prevalence; Prospective Studies; Risk Factors; Stomach Neoplasms

Topics: Helicobacter Infections; Helicobacter pylori; Humans; Malaysia; Stomach Neoplasms

In Singapore, the highest incidence of gastric cancer occurs in the Chinese (C), with lower rates among Malay (M) and Indian (I) subjects. The purpose of the present paper was to examine whether racial differences in the prevalence of Helicobacter pylori and serum pepsinogen (PG) could account for this difference.. A randomized community health survey involving 7000 asymptomatic healthy individuals was conducted. Among the Chinese, Malay and Indian respondents, subjects were matched for age, gender and race and a total of 595 sera were obtained. The H. pylori seropositivity and serum PG levels were determined by ELISA. The dependency of the cumulative gastric incidence rate on H. pylori seroprevalence was evaluated by linear regression. The racial difference in the seroprevalence of H. pylori and low serum PG was determined.. The H. pylori seroprevalence was similar between Chinese and Indian subjects, but significantly lower among Malay subjects (C, 46.3%; M, 27.9%; I, 48.1%). The gastric cancer incidence rates correlated with H. pylori seropositivity for the Chinese and Malay subjects, but not for the Indian subjects. The prevalence of low PG was highest in Indian subjects (PG I low: C, 2.1%; M, 5.4%; I, 14.2%; P < 0.0001; PG I:II ratio low: C, 5.3%; M, 5.9%; I, 12.6%; P = 0.012), even when adjusted for gender and the presence of H. pylori.. The difference in gastric cancer incidence correlated with H. pylori seroprevalence for Chinese and Malay subjects. The lower incidence of gastric cancer among Indian subjects cannot be explained by differences in H. pylori or serum PG. Other modifying factors such as host and environmental factors may be important.

Topics: Adult; Aged; Asian People; China; Female; Helicobacter pylori; Humans; Incidence; India; Malaysia; Male; Middle Aged; Pepsinogen A; Seroepidemiologic Studies; Singapore; Stomach Neoplasms; Surveys and Questionnaires; Urban Population

A retrospective study on demographics of gastric carcinoma was conducted in Hospital Pulau Pinang (HPP) with the aim of comparing it to a previous study done in Hospital Universiti Sains Malaysia (HUSM), Kelantan. The incidence of gastric carcinoma was much higher in Penang compared to Kelantan. It was commonest in males and Chinese. The incidence and site of gastric carcinoma closely parallels Helicobacter pylori infection rates. This was evidenced by the higher incidence and non-cardia location of gastric carcinomas in an area with higher H. pylori infection rates (HPP) compared to a much lower incidence and preponderance of cardia tumours in HUSM where the H. pylori infection rate is exceptionally low.

Topics: Adult; Aged; Aged, 80 and over; Female; Helicobacter Infections; Helicobacter pylori; Humans; Malaysia; Male; Middle Aged; Prevalence; Stomach Neoplasms

Gastric cancer is an important cause of death among patients with malignancies in Malaysia. Survival of patients with gastric cancer is dependent on the stage at which diagnosis is made. We report our experience in dealing with gastric cancer in a major Ministry of Health Hospitals in Malaysia. A retrospective review of two hundred and fifty consecutive histologically proven gastric adenocarcinoma at Hospital Ipoh for the period January 1988 to 1998 was performed. The study confirms that gastric cancer is a disease of the elderly and has a male preponderance. It is also identifies the Chinese and Indians to be at increased risk of gastric cancer when compared to the Malays. The most striking finding in this study was the very late stage of disease at time of presentation. Eighty-two percent of the patients presented with stage IV disease and curative surgery was offered only to a 16% of them. In a substantial number of patients not even a palliative procedure was offered. Early detection is the key to improving survival in gastric cancer patients. There is an urgent need for clinicians to change their approach to the management of the disease. Patients with dyspeptic symptoms should be investigated early rather then wait for classical symptoms of gastric cancer.

Topics: Aged; Female; Humans; Malaysia; Male; Middle Aged; Retrospective Studies; Stomach Neoplasms

Epstein-Barr virus (EBV) has consistently been detected in the tumour cells of nasopharyngeal carcinoma and lymphoepithelial-like carcinoma of the salivary glands, and have occasionally been found in similar tumours at other sites. Moreover, recent studies from various parts of the world including the Orient have shown about 10% of gastric carcinomas to be EBV-associated. We studied 50 gastric carcinomas from Malaysia to investigate its association with EBV in the Malaysian population. They comprised 37 intestinal and 13 diffuse type carcinomas from 32 male and 18 female patients, age range from 29 to 86 years with an ethnic distribution of Malay: Chinese: Indian with the ratio of 4: 27: 19. EBV gene and gene-expression were examined in sections of formalin-fixed, paraffin-embedded tissue using commercially available probes for detecting EBV encoded RNAs (EBERs) by in situ hybridization and monoclonal antibodies to EBV latent membrane protein-1 (LMP-1) by standard immunohistochemistry. Five of 50 gastric carcinomas showed EBER intranuclear positivity in all tumour cells but no cases expressed LMP-1. The EBV-associated cases were classified as intestinal type in 4 and diffuse type in one case and all were histologically unremarkable. EBV-positive tumours were found in 3 Chinese and 2 Indian patients with none in the small Malay group. Four EBV-positive tumours were in male patients, with age-range of 65 to 86 years. We conclude that our findings of about 10% of Malaysian gastric carcinomas being EBV-associated is in line with the results from other parts of the world and from other ethnic groups.

Topics: Adult; Aged; Aged, 80 and over; Epstein-Barr Virus Infections; Female; Herpesvirus 4, Human; Humans; Immunohistochemistry; In Situ Hybridization; Malaysia; Male; Middle Aged; RNA, Messenger; RNA, Viral; Stomach Neoplasms; Tumor Virus Infections; Viral Matrix Proteins

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.

Topics: Age Factors; China; Cross-Sectional Studies; Dyspepsia; Endoscopy, Gastrointestinal; Esophagitis; Female; Helicobacter Infections; Helicobacter pylori; Humans; India; Malaysia; Male; Peptic Ulcer; Prevalence; Risk Factors; Sex Factors; Stomach Neoplasms

Topics: Administration, Topical; Animals; Anticarcinogenic Agents; Antineoplastic Agents; Carcinoma; Cell Division; Cells, Cultured; Disease Models, Animal; Dose-Response Relationship, Drug; Female; HeLa Cells; Humans; Juniperus; Malaysia; Mice; Plant Extracts; Plant Leaves; Skin Neoplasms; Specific Pathogen-Free Organisms; Stomach Neoplasms; Tetradecanoylphorbol Acetate; Tumor Cells, Cultured

Topics: Adult; Aged; Diagnosis, Differential; Duodenitis; Dyspepsia; Endoscopy; Esophageal Neoplasms; Female; Gastritis; Humans; Malaysia; Male; Middle Aged; Peptic Ulcer; Stomach Neoplasms

Topics: Adolescent; Adult; Aged; Breast Neoplasms; Child; Child, Preschool; Female; Hospitals, University; Humans; Infant; Leukemia; Liver Neoplasms; Lung Neoplasms; Malaysia; Male; Middle Aged; Neoplasms; Stomach Neoplasms; Uterine Cervical Neoplasms

Topics: Adolescent; Adult; Duodenal Ulcer; Ethnicity; Female; Follow-Up Studies; Humans; Malaysia; Male; Middle Aged; Peptic Ulcer Perforation; Pneumoperitoneum; Postoperative Complications; Stomach Neoplasms; Stomach Rupture; Stomach Ulcer

Topics: Adult; Age Factors; Aged; Biopsy; China; Colonic Neoplasms; Ethnicity; Female; Humans; India; Malaysia; Male; Middle Aged; Rectal Neoplasms; Sex Factors; Stomach Neoplasms