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Background and Aim: The prevalence of Helicobacter pylori infection is exceptionally low among the Malays in the north-eastern region of Peninsular Malaysia. The reasons are unknown. Our aim was to compare environmental factors that differed in relation to H. pylori prevalence among Malays born and residing in Kelantan. Methods: A case-control study was conducted among Malays in Kelantan who underwent upper endoscopy between 2000 and 2008. Helicobacter pylori status was determined by gastric histology. Sociocultural and dietary factors were assessed using a validated investigator-directed questionnaire administered after 2008, and the data were analyzed using logistic regression analysis. Results: The study group consisted of 161 subjects (79 H. pylori positive and 82 controls). Univariable analysis identified five poor sanitary practices associated with an increased prevalence of H. pylori infection: use of well water, use of pit latrine, less frequent boiling of drinking water, and infrequent hand wash practice after toilet use and before meals. Multivariable logistic regression analysis identified three variables inversely associated with H. pylori infection: frequent consumption of tea (OR: 0.023, 95% CI: 0.01-0.07), frequent use of 'budu' or local anchovy sauce (OR: 0.09, 95% CI: 0.1-0.7), and frequent use of 'pegaga' or centenella asiatica (OR: 0.25, 95% CI: 0.1-0.65). Conclusions: Under the assumption that sanitary, sociocultural, and dietary habits have not changed over the years, we can conclude that an increased risk of H. pylori was associated with unsanitary practices whereas protection was associated with consumption of tea and locally produced foods, 'pegaga' and 'budu.' These dietary factors are candidates for future study on the effects on H. pylori transmission. [ABSTRACT FROM AUTHOR]

Background: Obesity, gastroesophageal reflux, and Barrett's esophagus have all been linked to esophageal adenocarcinoma. In addition, the decline in Helicobacter pylori (H. pylori) infection in affluent societies has also been suggested to be a major factor in the recent rise in the incidence of esophageal adenocarcinoma. If H. pylori infection has a protective role, populations with a naturally low prevalence of H. pylori infection such as the ethnic Malays of Northeastern Peninsular Malaysia should have high rates of esophageal adenocarcinoma.Aim: To test this hypothesis, we investigated the incidence of esophageal carcinoma among the ethnic Malays of the state of Kelantan in Northeastern Peninsular Malaysia.Methods: The pathology services in the state of Kelantan are provided by two main hospitals. The histopathological records of both hospitals were systematically examined to retrieve all cases of esophageal carcinoma diagnosed between 2004 and 2008. Incidence rates were determined based on the most recent population census.Results: The age-standardized incidence rates (per 100,000 population) of esophageal adenocarcinoma among Malay men and women were 0.75 and 0.69, respectively. The corresponding rates for squamous cell carcinoma of the esophagus were 0.66 and 1.34, respectively.Conclusions: The low rates of adenocarcinoma and squamous cell carcinoma of the esophagus in the study area, despite the fact that H. pylori infection is virtually absent, does not support the hypothesis that the absence of H. pylori infection is a pivotal factor in the pathogenesis of these cancers. [ABSTRACT FROM AUTHOR]