86% of Bhutanese carry a H Pylori strain comparatively more susceptible to Gastric Cancer

A 2012 study by the Jigme Dorji Wangchuk National Referral Hospital (JDWNRH) in collaboration with foreign experts found that around 86 percent of Bhutanese carry the Heliobacter Pylori.

H Pylori is a bacteria that enters the body and lives in the stomach and digestive system and has a high co-relation to most ulcer cases. In many cases it does not cause any visible symptoms.  In a few cases it can cause Gastric cancer.

This information was derived based on a 2012 study of 244 patients of different age groups and sexes from the western, central, eastern and southern regions of Bhutan. 86 percent of this varied group tested positive for the virus.

However, this is not the real bad new as H Pylori is known to be globally prevalent with more than half of the global population having the bacteria which is also more prevalent in developing countries.

The real issue of concern is that a recent 2015 article in the international Medical Journal known as ‘BioMed Research International’ found Bhutan’s H Pylori strain is found to be comparatively more susceptible to Gastric Cancer then other Asian countries like India, Myanmar and Vietnam among others.

The journal says, “Gastric cancer is a significant health problem in Asia. Although the prevalence of Helicobacter pylori infection is similar in Bhutan, Vietnam, and Myanmar, the incidence of gastric cancer is highest in Bhutan, followed by Vietnam and Myanmar.”

The medical journal pins down this reason to the more virulent strain of H Pylori in Bhutan. It says that the prevalence of combined cagA, vacA s1, vacA m1, and jhp0562-positive/β-(1,3)galT-negative genotype was significantly higher in Bhutan than in Vietnam and Myanmar and this correlated with higher gastric cancer cases.

Data from GLOBOCAN 2008 showed the incidence of Gastric Cancer in Bhutan which was 24.2 cases out of 100,000 persons per year was higher than that in Kazakhstan at 20.6 per 100,000 persons  per year, Vietnam at 18.9 persons per 100,000 or Myanmar at 11.0 persons per 100,000 per year.

However, four years later, data from GLOBOCAN 2012 reported that the Gastric Cancer in Bhutan had fallen to 17.2 cases per 100,000 per year, which was still higher than the Vietnam and Myanmar, but lower than that of Kazakhstan.

However, the report says that estimates in Bhutan are somewhat uncertain, because of the extremely low number of Gastric Cancer cases reported. When the journal itself performed a survey using gastro duodenal endoscopy in Bhutan in 2010, they found five cases of Gastric Cancer among 372 volunteers and in the second survey performed in 2014; there were six cases of Gastric cancer among 470 volunteers.

“Therefore, we believe that the actual number of GC patients in Bhutan is higher than previously estimated,” says the journal.

High prevalence of H Pylori does not always mean high prevalence of Gastric Cancer. Indian also has a very high rate of H Pylori but much lower rates of Gastric Cancer compared to Bhutan and other countries.

The World Health Organization in the past has also reported the incidence of stomach cancer to be very high in Bhutan.

In the 2012 original study prevalence of H. pylori was significantly lower among household with less than 4 persons living in the same household. Source of drinking water, type of occupation, type of latrines, or consumption of betel nut showed no association with H Pylori prevalence. Analysis revealed that residing region was the only significant variable.  H Pylori prevalence was lower in the southern region of Bhutan at 78% compared with the central region with 97%, eastern region at 91% and the western region at 83%.

According to the medical website WebMD, for decades, doctors thought people got ulcers from stress, spicy foods, smoking, or other lifestyle habits. But when scientists discovered H Pylori in 1982, they found that the germs were the cause of most stomach ulcers.

After H Pylori enters the body, it attacks the lining of the stomach, which usually protects a person from the acid the body uses to digest food. Once the bacteria have done enough damage, acid can get through the lining, which leads to ulcers. These may bleed, cause infections, or keep food from moving through your digestive tract.

Though the exact mode of transmission is yet to be known people can get H Pylori from food, water, or utensils. It’s more common in countries or communities that lack clean water or good sewage systems. You can also pick up the bacteria through contact with the saliva or other body fluids of infected people.

Many people get H Pylori during childhood, but adults can get it, too. The germs live in the body for years before symptoms start, but most people who have it will never get ulcers. Doctors aren’t sure why only some people get ulcers after an infection. A smaller number develops Gastric Cancer.

In many cases the cure is a two week antibiotics course prescribed by the doctor but in recent times the abuse of antibiotics have lead to antibiotic resistant strains that need a longer and repeated courses of stronger antibiotics.

It is understood that alkaline rich food like broccoli, cabbage, spinach, kale and other greens including most fruits and vegetables inhibit H Pylori and can reduce its damage but they do not cure it. Acidic diets like processed meat, red meat, junk food, sugar, excess salt, caffeine etc encourages H Pylori and also irritates the stomach.

H Pylori can be diagnosed with a blood test or stool test in Bhutan while other countries also have a breath test.

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