Epidemiology of Helicobacter pylori and Gastric Atrophy in Rural Southwestern Uganda: The ENIGMA Uganda Study.
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BACKGROUND: Characterizing the epidemiology of Helicobacter pylori (H. pylori) infection and gastric atrophy (GA) is essential for informing preventive strategies in anticipation of the rising gastric cancer burden. The International Agency for Research on Cancer has initiated global studies to characterize these epidemiological patterns using a standardized framework, including in Uganda. MATERIALS AND METHODS: This population-based study included 700 individuals aged 1-69 years, randomly selected from the General Population Cohort in rural Uganda, stratified by sex and age. Participants completed a structured questionnaire to assess risk factors related to H. pylori infection and GA, underwent anthropometric measurements, and provided blood samples. Anti-H. pylori IgG antibodies were measured using enzyme-linked immunosorbent assays (ELISA). In individuals aged ≥ 40 years, plasma pepsinogen I (PG I) and pepsinogen II (PG II) concentrations were measured by ELISA to define gastric atrophy. RESULTS: The age-standardized H. pylori seroprevalence was 76%. The crude seroprevalence was 63% in children aged 1-9 years, rose to over 80% in individuals aged 10-39 years, and then declined modestly in older age groups (73% in individuals aged ≥ 40). Men aged ≥ 40 years had a lower H. pylori seroprevalence compared to women aged ≥ 40 years (68% vs. 78%, p < 0.05). Serologically defined GA was uncommon, with an overall prevalence of 6% (17/301; 95% CI: 3%-9%) among individuals aged ≥ 40 years. Obesity (aOR 6.0, 95% CI 1.6-20.9) and less than daily chili consumption (aOR 4.3, 95% CI 1.4-14.9) were associated with higher odds of GA among participants aged ≥ 40 years, after adjustment for age and sex. CONCLUSIONS: In this population-based study in rural southwestern Uganda, H. pylori infection was acquired early in life and was highly prevalent, whereas serologically defined gastric atrophy remained relatively uncommon. This distinct epidemiological pattern warrants further validation and investigation.