Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Mar 7, 2006; 12(9): 1346-1351
Published online Mar 7, 2006. doi: 10.3748/wjg.v12.i9.1346
Causal role of Helicobacter pylori infection in gastric cancer: An Asian enigma
Kartar Singh, Uday C Ghoshal
Kartar Singh, Uday C Ghoshal, Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
Supported by grants from the Indian Council of Medical Research, No. 5/4/3-5/03/99-NCD-II
Correspondence to: Professor Kartar Singh, Director, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
Telephone: +91-522-2668017 Fax: +91-522-2668017
Received: August 14, 2005
Revised: August 20, 2005
Accepted: August 26, 2005
Published online: March 7, 2006

Helicobacter pylori (H pylori) has been etiologically linked to gastric cancer. H pylori infection is more frequent in less developed Asian countries like India, Bangladesh, Pakistan, and Thailand and is acquired at early age than in more developed Asian countries like Japan and China. Frequency of gastric cancer, however, is very low in India, Bangladesh, Pakistan and Thailand compared to that in Japan and China. Similar enigma has been reported from Africa as compared to the West. Seroprevalence of H pylori infection in adult populations of India, Bangladesh, Pakistan and Thailand varies from 55% to 92%. In contrast, seroprevalence of H pylori in Chinese and Japanese adults is 44% and 55%, respectively. Annual incidence rate of gastric cancer in India, Bangladesh, and Thailand is 10.6, 1.3, 7.1 per 100 000 populations, respectively; in contrast, that in China and Japan is 32-59 and 80-115 per 100 000 populations, respectively. Several studies from India failed to show higher frequency of H pylori infection in patients with gastric cancer than controls. Available evidences did not support difference in H pylori strains as an explanation for this enigma. Despite established etiological role of H pylori, situation is somewhat enigmatic in Asian countries because in countries with higher frequency of infection, there is lower rate of gastric cancer. Host’s genetic make-up and dietary and environmental factors might explain this enigma. Studies are urgently needed to solve this issue.

Keywords: Stomach cancer, Helicobacter pylori, Tropical countries, Carcinogenesis, Infectious diseases