Abstract
Background: The rate of gastric cancer in the Northwest Territories Aboriginal population is higher than the rest of the Canada. The aims of this study were to determine theHelicobacter pylori (Hp) prevalence and antibiotic resistance pattern in this community. Methods: As part of a community health project focused on Hp risks, including urea breath test (UBT) screening, residents (age ≥ 9 yrs) of Aklavik, a remote town of 620 inhabitants in the Northwest Territories of Canada, were invited to undergo endoscopy in February 2008. An on-site unit was assembled in the local health centre to perform upper gastrointestinal endoscopy with gastric biopsies for Hp culture and antibiotic susceptibility. Positive Hp cultures were tested using the E-test method for susceptibility to metronidazole, clarithromycin, amoxicillin, ciprofloxacin, tetracycline, nitrofurantoin, and rifampin. Results: Hp prevalence was 55% among the 240 residents who had a UBT. Of all eligible participants, 35% (n = 194) underwent endoscopy and biopsies for culture, with UBT-positive residents more likely to consent to endoscopy. The mean (±SD) age of the participants was 40 (±17) years and 59% were female. Hp culture results were available from 170; 117 (69%) were Hp positive. Antibiotic resistance was found in 33% (n = 33) of 99 Hp-positive cultures tested. Resistance to only metronidazole, clarithromycin, or amoxicillin was present in 23% (n = 23), 4% (n = 4), 0% (n = 0), respectively. There were no cases of resistance to rifampin and tetracycline. Multi-drug (≥ 2) resistance was present in 6 cases (6%). Conclusion: There is a high prevalence of Hp infection with relatively low levels of antibiotic resistance and occasional multi-drug resistance to antibiotics among residents in this Canadian arctic hamlet. A randomized control trial is being conducted to determine the optimal treatment to cure Hp infection in this community.
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