Abstract
BACKGROUND AND AIM: Helicobacter pylori infection rates and severity and susceptibility to gastric diseases vary widely in different populations because of different H. pylori strains, lifestyles, and genetic factors. South and Southeast Asia is a region where many ethnic groups are intermingled, and H. pylori strains have been shifting from Western-type to East Asian-type strains. We aimed to investigate the different endoscopic and histopathologic features in five South and Southeast Asian countries. METHODS: We examined differences in endoscopic and histopathological gastritis and H. pylori infection status in 2426 patients from South and Southeast Asian populations in Vietnam, Thailand, Myanmar, Bangladesh, and Nepal. RESULTS: Among Asian patients with abdominal symptoms, such as epigastric pain, nausea, abdominal discomfort, constipation, and heartburn, the prevalence of gastric disease, H. pylori infection status (current, past, and non-infection), and severity of histopathological gastritis significantly differed between countries. Less than 10% of patients had atrophy and intestinal metaplasia, irrespective of country and H. pylori infection status; their severity when present was also mild. Although patients with gastric cancer had higher rates of atrophy and intestinal metaplasia compared with those with other diseases, half of them had no pathological atrophy or intestinal metaplasia. CONCLUSIONS: Gastric condition and susceptibility to gastric disease differed among South and Southeast Asian populations. H. pylori infection rates remain high in Asian countries, but the frequency and severity of atrophy and gastric mucosal atrophy were low.