Further evidence for an exceptionally low prevalence of Helicobacter pylori infection among peptic ulcer patients in north-eastern peninsular Malaysia

The Helicobacter pylori infection rate was determined in 124 consecutive pa tients with duodenal ulcers (DU), gastric ulcers (GU), duodenal erosions or gastric erosions diagnosed by endoscopy at a single institution in north-e astern peninsular Malaysia in 1996-97. Biopsies of the gastric antrum and b ody were subjected to the urease test, Gram staining of impression smears, culture and histopathological examination. Serology was undertaken on all p atients using a locally validated commercial kit. Infection was defined as a positive result in at least one test. The infection rates were 20% (10/50 ), 21.2% (7/33), 16.7% (1/6) and 17.1% (6/35) in DU, GU, duodenal erosion a nd gastric erosion patients, respectively. The infection rate among Malays [7.0%, (6/86)] was fewer than in non-Malays [47.4% (18/38)] (P < 0001). The re was a higher infection rate among males, who constituted 62.1% (77/124) of me sample. Seventy-eight patients (62.9%) were receiving non-steroidal a nti-inflammatory drugs (NSAIDs) and 33 patients (26.6%) were neither receiv ing NSAIDs nor were infected with H. pylori. The H. pylori infection rate a mong peptic ulcer patients in this predominantly Malay rural population app ears to be the lowest reported in the world thus far. Empirical H. pylori e radication therapy in peptic ulcer patients is clearly not indicated in thi s community. The possible reasons for the low prevalence of H. pylori infec tion are discussed.