Gastric cancer in Ardabil, Iran--a review and update on cancer registry data.

The incidence rate of gastric cancer in western countries has shown a remarkable decline in recent years while it is still the most common cancer among men in Iran. Ardabil, a North Western province, was found to have the highest rate of GC in Iran and one of the highest gastric cardia cancer rates in the world. We used the most recent data from Ardabil cancer registry to update on the incidence and mortality of GC and performed an extensive search of the English and Persian literature in Pub Med, Embase and all 5 Persian web-based databases, respectively, to summarize all possible risk factors for GC in Ardabil. The age-standardized incidence rate of gastric cancer was 51.8 (95% CI: 47.8-55.8) in men and 24.9 (95% CI: 21.5-27.2) in women per 100,000. Age-standardized mortality rates for gastric cancer in this population were 32.2 (95% CI: 29.1-35.3) and 16.3 (95% CI: 13.9-18.6). The gastric cardia sub-site was the most common location (32.7%) in Ardabil. According to our review H.pylori infection, gastroesphageal reflux symptoms, tobacco smoking, and high intakes of salt, red meat and dairy products increase the risk of GC while diets with a high content of allium vegetables and fruits, especially citrus fruits, and consumption of fresh fish, were significantly protective against GC. We conclude that Ardabil has the highest rate of GC in Iran and one the highest rates of gastric cardia cancer in the world, with no evidence of decline in incidence since 2000. In addition to H.pylori infection, the epidemic of gastroesphageal reflux disease and several dietary factors may be responsible for the very high incidence of gastric cardia cancer in Ardabil.

Low Helicobacter pylori eradication rates with 4- and 7-day regimens in an Iranian population.

BACKGROUND: In Iran, there is insufficient information on the efficacy of Helicobacter pylori eradication regimens shorter than 10 days. This study aims at assessing the efficacy of 4- and 7-day H. pylori eradication regimens in a high-incidence area of gastric cancer in Iran. METHODS: Subjects with an endoscopic diagnosis of gastritis, positive urease test, and a histological diagnosis of chronic gastritis were enrolled. Patients were randomly assigned to one of three groups: AOC7 (1000 mg amoxicillin, 20 mg omeprazole, and 500 mg clarithromycin twice daily for 7 days), FOT4 (200 mg furazolidone, 20 mg omeprazole, and 500 mg tetracycline twice daily for 4 days) and FOT7 (the same treatment as the FOT4 group but for 7 days). Sensitivity to these antibiotics was determined in all isolates recovered from culture. The efficacy of eradication was assessed 8 weeks after the end-of-treatment by the 14C-urea breath test. RESULTS: One hundred and twenty-eight patients were enrolled in the study. Culture was positive for 84 patients and none of these were resistant to amoxicillin, tetracycline or furazolidone, 1.2% were resistant to clarithromycin and 32.1% to metronidazole. Forty-five, 41 and 42 patients were randomly allocated to the AOC7, FOT4, and FOT7 groups, respectively. The intention-to-treat eradication rates were 35.5, 17.1, and 23.8% for the AOC7, FOT4, and FOT7 groups, respectively. CONCLUSION: Treatment regimens of 4 or 7 days are unacceptable for H. pylori infection in Iran, even in the presence of a favorable sensitivity profile.