Cheung Justin, Goodman Karen J, Girgis Safwat, Bailey Robert, Morse John, Fedorak Richard N, Geary Janis, Fagan-Garcia Katharine, van Zanten Sander Veldhuyzen
Division of Gastroenterology, Royal Columbian Hospital, New Westminster, British Columbia, Canada.
BMJ Open. 2014 Jan 8;4(1):e003689. doi: 10.1136/bmjopen-2013-003689.
Helicobacter pylori infection, linked to gastric cancer, is responsible for a large worldwide disease burden. H pylori prevalence and gastric cancer rates are elevated among indigenous Arctic communities, but implementation of prevention strategies is hampered by insufficient information. Some communities in northern Canada have advocated for H pylori prevention research. As a first step, community-driven research was undertaken to describe the H pylori-associated disease burden in concerned communities.
Participants in this cross-sectional study completed a clinical interview and gastroscopy with gastric biopsies taken for histopathological examination in February 2008.
Study procedures were carried out at the health centre in Aklavik, Northwest Territories, Canada (population ∼600).
All residents of Aklavik were invited to complete a clinical interview and gastroscopy; 194 (58% female participants; 91% Aboriginal; age range 10-80 years) completed gastroscopy and had gastric biopsies taken.
This analysis estimates the prevalence of gastric abnormalities detected by endoscopy and histopathology, and associations of demographic and clinical variables with H pylori prevalence.
Among 194 participants with evaluable gastric biopsies, 66% were H pylori-positive on histology. Among H pylori-positive participants, prevalence was 94% for acute gastritis, 100% for chronic gastritis, 21% for gastric atrophy and 11% for intestinal metaplasia of the gastric mucosa, while chronic inflammation severity was mild in 9%, moderate in 47% and severe in 43%. In a multivariable model, H pylori prevalence was inversely associated with previous gastroscopy, previous H pylori therapy and aspirin use, and was positively associated with alcohol consumption.
In this population, H pylori-associated gastric histopathology shows a pattern compatible with elevated risk of gastric cancer. These findings demonstrate that local concern about health risks from H pylori is warranted and provide an example of how epidemiological research can address health priorities identified by communities.
幽门螺杆菌感染与胃癌相关，在全球造成了巨大的疾病负担。在北极原住民社区中，幽门螺杆菌感染率和胃癌发病率均有所升高，但由于信息不足，预防策略的实施受到阻碍。加拿大北部的一些社区倡导开展幽门螺杆菌预防研究。作为第一步，开展了社区主导的研究，以描述相关社区中与幽门螺杆菌相关的疾病负担。
这项横断面研究的参与者于2008年2月完成了临床访谈和胃镜检查，并取胃活检组织进行组织病理学检查。
研究程序在加拿大西北地区阿克拉维克的健康中心进行（人口约600人）。
邀请阿克拉维克的所有居民完成临床访谈和胃镜检查；194人（58%为女性参与者；91%为原住民；年龄范围10 - 80岁）完成了胃镜检查并进行了胃活检。
本分析估计了通过内镜检查和组织病理学检测到的胃部异常的患病率，以及人口统计学和临床变量与幽门螺杆菌感染率的关联。
在194名有可评估胃活检结果的参与者中，66%的组织学检查显示幽门螺杆菌呈阳性。在幽门螺杆菌阳性的参与者中，急性胃炎患病率为94%，慢性胃炎患病率为100%，胃萎缩患病率为21%，胃黏膜肠化生患病率为11%，而慢性炎症严重程度为轻度的占9%，中度的占47%，重度的占43%。在多变量模型中，幽门螺杆菌感染率与既往胃镜检查、既往幽门螺杆菌治疗及阿司匹林使用呈负相关，与饮酒呈正相关。
在该人群中，与幽门螺杆菌相关的胃组织病理学表现与胃癌风险升高相符。这些发现表明，当地对幽门螺杆菌健康风险的担忧是有道理的，并提供了一个流行病学研究如何解决社区确定的健康优先事项的范例。
