The Seroprevalence and Eradication Success of Helicobacter pylori in Indigenous People of Seletar in Southern Malaysia

Background: Helicobacter pylori prevalence rate varies widely from one geographical area to another
and marked differences have been noted among different ethnic groups. While several studies have
been carried out to review the prevalence of H. pylori among the major races in Malaysia, only one is
available to study the indigenous Penan community in East Malaysia.
Aims: The aims of this study are to determine the seroprevalence of H. pylori in the indigenous
Seletar community in Southern Malaysia and the effectiveness of the eradication program.
Methods: A seroepidemiological study was done to determine H. pylori infection by serological assay
of H. pylori antibodies and the demographic pattern. Serological assay was carried out using the
Visual H. pylori Quickpac Test. All serological positive patients were then subjected to an endoscopic
study and the Campylobacter-Like Organism-test (CLO-test). Positive patients were then offered for
eradication using triple therapy of Omeprazole 20mg, Amoxycillin 1gm and Metronidazole 400mg
twice daily for one week. Subjects will be required to perform a Urea Breath Test (UBT) four weeks
after therapy to determine the success of eradication. When attending for UBT, the medication diary
will be assessed. UBT was conducted using a 13C IRIS (Infra Red Isotope Analyzer) breath test kit.
Results: We studied a total of 298 subjects with a mean age of 34.9 years. The seroprevalence was
37.9% and CLO-test positivity on Oesophagogastroduodenoscopy (OGDS) was 98.9%.
Histopathological examination showed evidence of gastritis in 97% of the positive patients. Majority of
subjects (96%) showed evidence of acute on chronic inflammation. The follow-up of patients that
came back for the UBT after completing the eradication process was 73.5%. Out of these, 63.9%
showed negative UBT. However, only 48.6% complied with medication based on medication diary.
Since only two subjects out of 35 who complied remains positive, the eradication success rate was
94.3%.
Conclusion: Previous studies have shown that the prevalence of H. pylori in a Malaysian cohort
ranges from 26.4% to 55% with the highest in Indians of about 35.6% out of the three major races,
followed by Chinese (28.6%) and Malays (28.5%). The indigenous people of Penan in East Malaysia
showed 37.7% positivity, which is almost similar to our study that showed 37.9%. The prevalence is
supported by the CLO-test that proved that the sensitivity of the serological assay was 98.9%.
However, our study also proved that the eradication process was very efficient if subjects were
compliant on medication. This study shows that despite the very low socio-economic status of the
indigenous community, this is not the sole factor in determining H. pylori infection. This may also be
due to genetic factors and probably a recent arrival of H. pylori in this isolated and remote community.