The risk is multifactorial that may include interaction with potentially contaminated environmental sources such as local drinking water, swimming in rivers, and the ingestion of fecally contaminated vegetables have all been reported as risk factors for the acquisition of H. pylori infection [10, 12]. In 1994, the International Agency for Research on Cancer categorized H. pylori infection

as a definite group I carcinogen [13]. Gastric cancer is the second leading cause of cancer-related buy GW-572016 death in the world, and its risk varies among the countries and populations in the world [14]. Bhutan is a small country located in south Asia, at the eastern end of the Himalayas, and it shares borders with south, east, and west by India and to the north China. Although the prevalence of H. pylori in Bhutan has not been elucidated, the World Health Organization (WHO) reported the incidence of gastric cancer to be very high in Bhutan [15]. Moreover, it has been reported that mortality from gastric cancer https://www.selleckchem.com/products/Methazolastone.html in Bhutan is very high (24.2 deaths/100,000 population) compared with that of India, Bangladesh, and Thailand [16]. The reason for this high incidence of gastric cancer has not been explained. Further data regarding H. pylori infection

in Bhutan are critical to understanding the epidemiology of the infection and H. pylori-related diseases including gastric cancer. Therefore, we conducted the current study to determine the prevalence Evodiamine of H. pylori infection by age, gender, occupation, sanitation, crowding, and geographic area within Bhutan. A cross-sectional seroepidemiologic study was carried out among unrelated Bhutanese individuals between June and September 2012. The study population consisted of those who attended the digestive disease outpatient clinic at the National Referral

Hospital, Thimphu, for upper gastrointestinal complaints and dyspepsia were included after obtaining informed consent. All patients were qualified and underwent upper endoscopic examination during the study period participated in the study. Demographic information, occupation, family size living in the same household, consumption of betel nut, and aspects of household environment including type of latrines and source of drinking water were collected. The study started in June and ended November 2012. Informed consent was obtained from all participants. Bhutan is a remote Himalayan country between India and Tibet (China) with a population consists of only 800,000 citizens residing in 18,147 mi2 (47,000 km2) (Fig. 1). Seventy percent of country is rural and agriculture based, and the literacy rate is 47% (2011 Census). More than 30% of Bhutan populations live below poverty level. The climate in Bhutan varies with elevation, from subtropical in the south to temperate in the highlands and polar-type climate, with year-round snow in the north. Bhutan is demographically divided into four main regions: southern, western, eastern, and central.