title: Distribution of gastric carcinoma in an area with a high prevalence of Helicobacter pylori.
abstract: OBJECTIVE
  South Asia is an enigma for gastric cancer (GC) because it is a low risk region with a high prevalence of Helicobacter pylori (H. pylori) infections. We evaluated the trend of GC clinical presentation and risk factors in patients with dyspeptic symptoms.
  
  
  METHODS
  The medical records of patients, coded by the international classification of diseases (ICD-10-CM, 2015, Diagnosis Code C16.9) for malignancies of stomach diagnosed by esophagogastroduodenoscopy (EGD) and histopathology, were studied.
  
  
  RESULTS
  394 GC cases with a mean age of 54±15 years, range of 18 to 88, were analyzed. 256 (65%) were male. Distal non-cardiac and cardiac tumors were 302 (77%) and 92 (23%) cases, respectively. The WHO classification of GC defined 222 (56%) cases as intestinal type adenocarcinoma, 68 (17%) cases as signet ring cell carcinoma (SRC), 62 (16%) cases as diffuse type and 42 (11%) cases as B cell non-Hodgkin lymphoma. The co-morbid conditions associated with GC were H. pylori infection (positive in 246 (62%) cases), diabetes mellitus type 2 (in 90 (23%) cases), and cigarette smoking (in 94 (24%) cases). Of the male patients, 88 (34%) (p<0.001) were smokers. Body mass index was abnormal in all age groups and in both sexes. Cardiac regions for GC were more common in the 46- to 60-year old age range and in males. Diffuse GC was seen in all age groups but there were significantly more common in the 18- to 45-year old age range. Gastric non-Hodgkin's lymphoma was seen at an early age of 18-45 years in 14(12%) and a later of 61-88 years in 20 (15%).
  
  
  CONCLUSIONS
  Intestinal type GC is common at all ages but SRC and diffuse GC are more common in patients less than 50 years old. SRC and diffuse GC were not specific to the elderly in our study population.
authors.affiliation: Departments of Medicine, Aga Khan University, Karachi, Pakistan. javed.yakoob@aku.edu.
authors.forename: Javed
authors.initials: J
authors.lastname: Yakoob
authors.forename: Syeda Sadia
authors.initials: SS
authors.lastname: Fatima
authors.forename: Zaigham
authors.initials: Z
authors.lastname: Abbas
authors.forename: Syed Farrukh
authors.initials: SF
authors.lastname: Mustafa
authors.forename: Hamza Abdur Rahim
authors.initials: HA
authors.lastname: Khan
authors.forename: Muhammad Faraz
authors.initials: MF
authors.lastname: Raghib
authors.forename: Safia
authors.initials: S
authors.lastname: Awan
authors.forename: Zubair
authors.initials: Z
authors.lastname: Ahmad
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001210:Asia, Southeastern / Q000453:epidemiology; D002277:Carcinoma / Q000453:epidemiology* / Q000382:microbiology; D018279:Carcinoma, Signet Ring Cell / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult