Published online Feb 14, 2014. doi: 10.3748/wjg.v20.i6.1503
Revised: November 12, 2013
Accepted: November 28, 2013
Published online: February 14, 2014
Processing time: 133 Days and 22.2 Hours
Helicobacter pylori (H. pylori) is a gram negative microaerophilic bacterium which resides in the mucous linings of the stomach. It has been implicated in the causation of various gastric disorders including gastric cancer. The geographical distribution and etiology of gastric cancer differ widely in different geographical regions and H. pylori, despite being labeled as a grade I carcinogen, has not been found to be associated with gastric cancer in many areas. Studies in Asian countries such as Thailand, India, Bangladesh, Pakistan, Iran, Saudi Arabian countries, Israel and Malaysia, have reported a high frequency of H. pylori infection co-existing with a low incidence of gastric cancer. In India, a difference in the prevalence of H. pylori infection and gastric cancer has been noted even in different regions of the country leading to a puzzle when attempting to find the causes of these variations. This puzzle of H. pylori distribution and gastric cancer epidemiology is known as the Indian enigma. In this review we have attempted to explain the Indian enigma using evidence from various Indian studies and from around the globe. This review covers aspects of epidemiology, the various biological strains present in different parts of the country and within individuals, the status of different H. pylori-related diseases and the molecular pathogenesis of the bacterium.
Core tip: This review highlights the unusual finding of low prevalence of gastric cancer despite high prevalence of Helicobacter pylori in India and its probable causes including diet and genetic variations as seen in Indian patients. This finding is attributed to increased genetic resistance in addition to a vegetarian diet rich in antioxidants.