Community-driven research onHelicobacter pylori infection in theCanadian Arctic: the Old CrowH. pylori Project Laura Aplin1*, Janis Geary2, Sander Veldhuyzen van Zanten1,Brendan Hanley3, Diane Kirchgatter3, Karen J. Goodman1,2,The Old Crow H. pylori Project Planning Committee andThe CANHelp Working Group 1Department of Medicine, University of Alberta, Edmonton, Canada; 2Department of Public Health Sciences,University of Alberta, Edmonton, Canada; 3Health and Social Services, Government of Yukon, Whitehorse,Canada Helicobacter pylori infection has been agrowing planning committee and includes 6 main components: health concern in northern Canada due to the surveys of health and socio-environmental factors, urea awareness of its link to stomach cancer. Both breath test (UBT) screening for H. pylori infection, upper H. pylori prevalence and stomach cancer rates are elevated gastrointestinal endoscopy, treatment, knowledge ex- in Arctic Aboriginal populations (1). This project arose as an extension of the Canadian North Helicobacter pylori(CANHelp) Working Group’s pilot project, the Aklavik H. pylori Project. The CANHelp Working Group links re- During 2010 and 2011, all residents of Old Crow were searchers from the University of Alberta with northern com- invited to be screened for H. pylori infection by UBT munity leaders and health officials. The initial H. pylori and interviewed using structured questionnaires to ascer- project was established in Aklavik, Northwest Territories tain health factors, individual-level socio-environmental in 2007 in response to concerns about health risks from factors and household-level environmental factors. All H. pylori raised by community leaders and their health residents of Old Crow who gave informed consent were care providers. The following year, a Member of the eligible. Parental consent and child’s assent were obtained Yukon Legislative Assembly (MLA) for the Vuntut Gwitchin First Nation contacted the CANHelp Working In 2012, we invited all residents of Old Crow to Group to inquire about developing a local H. pylori undergo endoscopy with gastric biopsy, in temporary research project in response to similar health concerns endoscopy units in the Old Crow Health Centre. A team raised by residents of Old Crow, Yukon (population: 250, of gastroenterologists, endoscopy nurses, service aids Â90% Aboriginal). Later that year, the Vuntut Gwitchin and an endoscopy technical support specialist travelled General Assembly passed by consensus a resolution that to Old Crow for 1 week to perform the procedures.
the University of Alberta team carry out H. pylori This component aimed to characterise prevalent gastric research in Old Crow for citizens who wished to par- disease and bacterial strains among H. pylori-positive ticipate. As a result, the CANHelp Working Group project participants. Participants ]15 years of age could established the Old Crow H. pylori Project in November also enrol in a treatment trial comparing 2 of the best available H. pylori therapies. Both therapies were 10 dayslong: sequential therapy consisted of a proton pump inhibitor and amoxicillin for days 1Á5, followed by a The Old Crow H. pylori Project aims to investigate the proton pump inhibitor, clarithromycin and metronida- disease burden related to H. pylori infection and identify zole for days 6Á10; quadruple therapy consisted of a strategies for reducing health-related risks. This project proton pump inhibitor with bismuth, metronidazole and was designed and conducted in collaboration with a local Table I. Pathology findings (Sydney classification) from 63 Old difference is large enough to demonstrate a clear super- These results contribute to evidence demonstrating thatcommunities in northern Canada are disproportionately affected by H. pylori infection, considering the high prevalence observed in Old Crow relative to the pre- valence across southern Canada, typically around 30% (2). The frequency of severe inflammation among project participants in Old Crow is also uncommonly high.
H. pylori infection, in nearly any population, is almostalways accompanied by chronic gastritis, which is usually mild and asymptomatic (3). In contrast, high prevalence From November 2010 to August 2012, 199 residents con- of severe inflammation is more characteristic of popula- sented to participate in the Old Crow H. pylori Project; tions at high risk of stomach cancer. The success of the 50% were male aged 1Á88 years. Of the 199 participants, Old Crow H. pylori Project, as demonstrated by the high 145 completed questionnaire-based interviews, 192 un- level of participation, is the result of close partnership derwent a UBT (UBT positivity 068%), 65 consented with the local planning committee and ongoing commu- to upper gastrointestinal endoscopy, 63 had biopsies collected for culture and histopathology, 86 consentedto treatment and 70 enrolled in the treatment trial.
Gastric biopsies were examined at the University of Findings from the Old Crow H. pylori Project show that Alberta and analysed to estimate the frequency of endo- community concerns over risks from H. pylori infection scopically visible gastric abnormalities, pathological dis- are well placed. The effective collaboration with com- ease outcomes and H. pylori strains resistant to antibiotics.
munity members and health officials strengthens the Pathologic findings from 63 endoscopy participants with CANHelp Working Group’s ability to effectively address community concerns about this infection.
Antibiotic resistance frequencies from 53 participants with successful culture were as follows: 42% for metro- nidazole, 25% for clarithromycin, 8% for ciprofloxacin, 1. Cheung J, Goodman K, Munday R, Heavner K, Huntington J, 2% (borderline) for tetracycline and 0 for amoxicillin, Morse J, et al. Helicobacter pylori infection in Canada’s arctic: searching for the solutions. Can J Gastroenterol. 2008;22:912Á6.
Treatment trial participants also underwent a follow- 2. Goodman KJ, Jacobson K, van Zanten SV. Helicobacter pylori up UBT to determine the success of each therapy, for infection in Canadian and related Arctic Aboriginal popula- which preliminary results are available. For those pre- tions. Can J Gastroenterol. 2008;22:289Á95.
scribed sequential therapy (n 020), treatment success 3. Brown LM. Helicobacter pylori: epidemiology and routes of was 60% (12/20; 95% confidence interval 36Á81%), while for those given quadruple therapy (n 020), treatmentsuccess was 92% (17/20; 95% confidence interval 62Á 97%). Despite the small numbers with a post-test, this



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