• Gastritis
• Helicobacter pylori
• Intestinal metaplasia
• Rapid urease test
• Updated sydney system

• Humans
• Chronic Disease
• Gastritis/diagnosis
• Gastritis/microbiology
• Gastritis/pathology
• Helicobacter pylori/isolation & purification
• Helicobacter Infections/complications
• Helicobacter Infections/pathology
• Metaplasia/pathology
• Intestines/pathology
• Prospective Studies
• Gastric Mucosa/microbiology
• Gastric Mucosa/pathology
• Male
• Female
• Adolescent
• Adult
• Middle Aged
• Aged
• Pyloric Antrum/microbiology
• Pyloric Antrum/pathology
• Risk Factors

• Gastric precancerous conditions
• Gastric precancerous lesions; integrated medicine; diagnosis
• Surveillance
• Treatment

• CI2021A01004 innovative project in science and technology of China academy of Chinese medical sciences (CACMS)

• Gastric cancer
• OLGA
• OLGIM intestinal metaplasia
• Risk stratification
• Subtypes

Indonesia is a big country with multiethnic populations whose gastric cancer risks have not been elucidated. We performed a nationwide survey and obtained histological specimens from 1053 individuals in 19 cities across the country. We examined the gastric mucosa, the topography, the atrophic gastritis risk factors, and the gastric cancer risk scores. Almost half (46.1%) of the patients with dyspeptic symptoms had histological abnormalities; chronic (36.3%) and atrophic gastritis (28.9%) being the most frequent. Individuals of the Timor ethnicity had the highest prevalence of acute (52.6%) and chronic gastritis (68.4%), even those negative for H. pylori. Our topographic analysis showed the majority of patients had predominantly antral acute and chronic gastritis. A multivariate logistic regression model showed age (Odds ratio [OR], 1.107), Timor ethnicity (OR, 8.531), and H. pylori infection (OR, 22.643) as independent risk factors for presence of atrophic gastritis. In addition, the gastric cancer risk score was highest in those from Timor, Papuan, and Bugis ethnic populations. Overall, Indonesia is a low-risk gastric cancer country. However, several ethnic groups displayed severe gastric mucosa symptoms suggesting policy makers should focus on those ethnic groups to perform gastric cancer screenings and to eradicate H. pylori.

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Cross-Sectional Studies
• Ethnicity
• Female
• Gastric Mucosa/pathology
• Gastritis/complications
• Gastritis/pathology
• Gastritis, Atrophic/complications
• Gastritis, Atrophic/pathology
• Helicobacter Infections/complications
• Helicobacter Infections/pathology
• Helicobacter pylori
• Humans
• Indonesia/epidemiology
• Male
• Metaplasia
• Middle Aged
• Prevalence
• Risk Factors
• Stomach Neoplasms/epidemiology
• Stomach Neoplasms/etiology
• Stomach Neoplasms/pathology
• Young Adult

• R01 DK062813 NIDDK NIH HHS
• Ministry of Education, Culture, Sports, Science and Technology (JP)
• Ministry of Education, Culture, Sports, Science and Technology
• Kementerian Riset Teknologi Dan Pendidikan Tinggi Republik Indonesia

• Gastric cancer
• Malaysia

• Biomedical Research
• Helicobacter Infections/complications
• Helicobacter Infections/virology
• Helicobacter pylori/isolation & purification
• Humans
• Incidence
• Malaysia/epidemiology
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/epidemiology
• Stomach Neoplasms/therapy

To evaluate the association between VEGF-634G>C gene polymorphism with premalignant gastric lesions as well as the level of VEGF.

This cross-sectional study included patients with H. pylori gastritis at Haji Adam Malik General Hospital, Permata Bunda General Hospital, and Universitas Sumatera Utara Hospital, Medan, Indonesia. Detection of H. pylori infection was made using positive results of ¹⁴C-UBT, rapid urease test, and/or immunohistochemistry. Gastric premalignant lesion diagnosis was made when one or more of the following were present: chronic atrophic gastritis, intestinal metaplasia, or dysplasia. Real-time polymerase chain reaction (RT-PCR) was used to examine VEGF-634G>C gene polymorphism. Additionally, serum samples of patients with H. pylori gastritis were obtained to determine the level of circulating VEGF. Data were analysed using SPSS version 22.

A total number of 87 patients with H. pylori gastritis were included in this study. Of all participants, 26 patients (29.9%) showed gastric premalignancy. There was a significant association between GG+GC genotype of VEGF-634G>C and gastric premalignant lesions (P = 0.003; OR (CI 95%) = 6.07 (1.88-41.71)). VEGF-634 G>C polymorphism also showed an association with VEGF serum levels (P = 0.005). Patients with the GG+GC genotype would be at risk of 3.16 times to have high VEGF levels compared to CC genotypes.

VEGF-634G>C polymorphism, in particular, GG+GC genotype was associated with an increased risk of gastric premalignant transformation as well as having high VEGF levels in patients with H.pylori gastritis.

• Gastric premalignant lesion
• Helicobacter pylori
• VEGF
• polymorphism

Gastric intestinal metaplasia is the most common precancerous lesion of gastric cancer. Due to the unsatisfying treatment efficacy for gastric cancer especially advanced gastric cancer, the key steps of prevention and treatment of gastric cancer are lowering the incidence and improving the early diagnosis. Therefore, it is very important to clarify the risk factors associated with gastric cancer and its precancerous lesion for first-line prevention of gastric cancer. Accumulated evidence indicates that the development of gastric intestinal metaplasia is closely related to Helicobacter pylori infection, age, sex, family history of gastric cancer, smoking, high salt diet, bile acid reflux and so on. This review mainly focuses these factors associated with gastric intestinal metaplasia.

• Gastric intestinal metaplasia
• Risk factors
• Gastric cancer

• virulence factors

Gastric intestinal metaplasia is an important stage in the development of gastric cancer. Limited data is available regarding the prevalence of gastric intestinal metaplasia in the United States. We conducted a retrospective review of esophagogastroduodenoscopies performed in our endoscopy unit between the months of April and October 2010 to evaluate the prevalence and the epidemiologic and endoscopic features of gastric intestinal metaplasia in an underserved population in the United States.

• Causes
• Helicobacter pylori
• Malays
• Malaysia
• consequences
• low prevalence

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.

• Dyspepsia
• Functional dyspepsia
• Irritable bowel syndrome
• Malaysia

AIM: To identify genes associated with gastric precancerous lesions in Helicobacter pylori (H. pylori)-susceptible ethnic Malays.

METHODS: 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 χ²P value < 0.05 and Hardy Weinberg Equilibrium P value > 0.5 was considered as significant markers.

RESULTS: 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.

CONCLUSION: Genetic variants possibly related to gastric precancerous lesions in ethnic Malays susceptible to H. pylori infection were identified for testing in subsequent trials.

• Gastric precancerous lesions
• Gene polymorphisms
• Genome-wide association
• Helicobacter pylori
• Malays

• Adult
• Aged
• Asian People/genetics
• Case-Control Studies
• Chi-Square Distribution
• Female
• Gastritis, Atrophic/diagnosis
• Gastritis, Atrophic/ethnology
• Gastritis, Atrophic/genetics
• Gastritis, Atrophic/microbiology
• Gastroscopy
• Gene Frequency
• Genetic Predisposition to Disease
• Helicobacter Infections/complications
• Helicobacter Infections/diagnosis
• Helicobacter Infections/ethnology
• Helicobacter Infections/microbiology
• Helicobacter pylori/pathogenicity
• Humans
• Malaysia/epidemiology
• Male
• Metaplasia
• Middle Aged
• Phenotype
• Polymorphism, Single Nucleotide
• Precancerous Conditions/diagnosis
• Precancerous Conditions/ethnology
• Precancerous Conditions/genetics
• Precancerous Conditions/microbiology
• Predictive Value of Tests
• Risk Factors
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/ethnology
• Stomach Neoplasms/genetics
• Stomach Neoplasms/microbiology

The 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.

The 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.

The 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.

FD was more common than one had expected among Malays attending primary care clinic in an area with low prevalence of H. pylori.

Gastric cancer remains the second most frequent cause of cancer-related mortality in the world. Screening programs in some Asian countries are impractical in the majority of other countries worldwide. Therefore, follow-up of precancerous lesions is advisable for secondary gastric cancer prevention. Intestinal metaplasia (IM) is recognized as a precancerous lesion for gastric cancer, increasing the risk by 6-fold. IM is highly prevalent in the general population, being detected in nearly 1 of every 4 patients undergoing upper endoscopy. The IM prevalence rate is significantly higher in patients with Helicobacter pylori (H. pylori) infection, in first-degree relatives of gastric cancer patients, in smokers and it increases with patient age. IM is the “breaking point” in the gastric carcinogenesis cascade and does not appear to regress following H. pylori eradication, although the cure of infection may slow its progression. Gastric cancer risk is higher in patients with incomplete-type IM, in those with both antral and gastric body involvement, and the risk significantly increases with IM extension over 20% of the gastric mucosa. Scheduled endoscopic control could be cost-effective in IM patients, depending on the yearly incidence of gastric cancer in IM patients, the stage of gastric cancer at diagnosis discovered at surveillance, and the cost of endoscopy. As a pragmatic behavior, yearly endoscopic control would appear justified in all IM patients with at least one of these conditions: (1) IM extension > 20%; (2) the presence of incomplete type IM; (3) first-degree relative of gastric cancer patients; and (4) smokers. In the remaining IM patients, a less intensive (2-3 years) could be proposed.

• Intestinal metaplasia
• Gastric cancer
• Follow-up
• Prevention
• Risk factors

• Aged
• Case-Control Studies
• Drinking Water
• Feeding Behavior
• Female
• Helicobacter Infections/epidemiology
• Helicobacter pylori
• Humans
• Malaysia/epidemiology
• Male
• Middle Aged
• Prevalence
• Socioeconomic Factors

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.