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Extremely high prevalence of Helicobacter pylori infection in Bhutan
Ratha-korn Vilaichone, Varocha Mahachai, Seiji Shiota, Tomohisa Uchida, Thawee Ratanachu-ek, Lotay Tshering, Nguyen Lam Tung, Toshio Fujioka, Masatsugu Moriyama, Yoshio Yamaoka
Ratha-korn Vilaichone, Gastroenterology Unit, Department of Medicine, Thammasat University Hospital, Pathumthani 12120, Thailand
Varocha Mahachai, GI and Liver Center, Bangkok Medical Center, Bangkok 10310, Thailand
Seiji Shiota, Yoshio Yamaoka, Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu 879-5593, Japan
Tomohisa Uchida, Nguyen Lam Tung, Masatsugu Moriyama, Department of Molecular Pathology, Oita University Faculty of Medicine, Yufu 879-5593, Japan
Thawee Ratanachu-ek, Department of Surgery, Rajavithi Hospital, Bangkok 10400, Thailand
Lotay Tshering, Department of Surgery, Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
Nguyen Lam Tung, Department of Gastroenterology, 108 Hospital, Hanoi 12771, Vietnam
Toshio Fujioka, Department of Gastroenterology, Oita University Faculty of Medicine, Yufu 879-5593, Japan
Yoshio Yamaoka, Department of Gastroenterology and Hepatology, Baylor College of Medicine and Michael DeBakey Veterans Affairs Medical Center, Houston, TX 77030, United States
Author contributions: Vilaichone R and Yamaoka Y made contribution to study design, acquisition of data, analysis and interpretation of data; Mahachai V made contribution to study design, acquisition of data, analysis and interpretation of data, final approval of the manuscript to be published; Shiota S and Tung NL made contribution to analysis and interpretation of data; Uchida T, Ratanachu-ek T and Tshering L made contribution to acquisition of data; Fujioka T and Moriyama M made contribution to revising the manuscript for important intellectual content.
Supported by A Grant from the grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan, No. 23790798; A Grant from the National Research University Project of the Thailand Office of Higher Education Commission; The National Institutes of Health (DK62813) and the grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan, No. 22390085 and No. 22659087
Correspondence to: Varocha Mahachai, MD, FRCP(C), FACG, AGAF, Professor and Director, GI and Liver Center, Bangkok Medical Center, New Petchburi Road, Bangkapi, Huay Khwang, Bangkok 10310, Thailand. vilaichone@yahoo.com
Telephone: +66-2-3103401 Fax: +66-2-7551953
Received: November 16, 2012
Revised: February 13, 2013
Accepted: February 28, 2013
Published online: May 14, 2013
AIM: To revealed the prevalence of Helicobacter pylori (H. pylori) infection in the Bhutanese population.
METHODS: We recruited a total of 372 volunteers (214 females and 158 males; mean age of 39.6 ± 14.9 years) from three Bhutanese cities (Thimphu, Punaka, and Wangdue). The status of H. pylori infection was determined based on five different tests: the rapid urease test (CLO test), culture, histology, immunohistochemistry (IHC), and serum anti H. pylori-antibody.
RESULTS: The serological test showed a significantly higher positive rate compared with the CLO test, culture, histology and IHC (P < 0.001, P < 0.001, P = 0.01, and P = 0.01, respectively). When the subjects were considered to be H. pylori positive in the case of at least one test showing a positive result, the overall prevalence of H. pylori infection in Bhutan was 73.4%. The prevalence of H. pylori infection significantly decreased with age (P < 0.01). The prevalence of H. pylori infection was lower in Thimphu than in Punakha and Wangdue (P = 0.001 and 0.06, respectively). The prevalence of H. pylori infection was significantly higher in patients with peptic ulcers than in those with gastritis (91.4% vs 71.3%, P = 0.003).
CONCLUSION: The high incidence of gastric cancer in Bhutan may be attributed to the high prevalence of H. pylori infection.
Core tip: The high prevalence of Helicobacter pylori (H. pylori) infection in Bhutan may contribute to the high incidence of peptic ulcers and gastric cancer. The prevalence of H. pylori infection in the capital city, Thimphu, was significantly lower than that of other rural areas. Therefore, performing eradication therapy of H. pylori and improving the sanitary conditions to decrease the rate of H. pylori infection in Bhutan can contribute to decreasing H. pylori-related diseases such as peptic ulcers and gastric cancer.
