title: Disease manifestations of Helicobacter pylori infection in Arctic Canada: using epidemiology to address community concerns.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Participants in this cross-sectional study completed a clinical interview and gastroscopy with gastric biopsies taken for histopathological examination in February 2008.
  
  
  METHODS
  Study procedures were carried out at the health centre in Aklavik, Northwest Territories, Canada (population ∼600).
  
  
  METHODS
  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.
  
  
  METHODS
  This analysis estimates the prevalence of gastric abnormalities detected by endoscopy and histopathology, and associations of demographic and clinical variables with H pylori prevalence.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Gastroenterology, Royal Columbian Hospital, New Westminster, British Columbia, Canada.
authors.forename: Justin
authors.initials: J
authors.lastname: Cheung
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Goodman
authors.forename: Safwat
authors.initials: S
authors.lastname: Girgis
authors.forename: Robert
authors.initials: R
authors.lastname: Bailey
authors.forename: John
authors.initials: J
authors.lastname: Morse
authors.forename: Richard N
authors.initials: RN
authors.lastname: Fedorak
authors.forename: Janis
authors.initials: J
authors.lastname: Geary
authors.forename: Katharine
authors.initials: K
authors.lastname: Fagan-Garcia
authors.forename: Sander Veldhuyzen
authors.initials: SV
authors.lastname: van Zanten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000453:epidemiology*; D016480:Helicobacter pylori; D006801:Humans; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D055815:Young Adult