Identification of life habits factors as risk for gastritis and colitis occurrence in a mestizo population of Chabeklumil, Chiapas, México ()
1. INTRODUCTION
In México lifestyle, culture and economic resources of its inhabitants have modified morbidity trends in the last decade; such that gastritis became the fourth new disease in the population, and is growing since consumption of irritant food and drinks is raising [1]. Then, chronic gastritis has been associated with peptic ulcer and in advanced stages with the development of gastric adenocarcinoma [2].
On the other hand, severe forms of gastric disease have been associated to Helicobacter pylori infection, and it is known that in developing countries prevalence of the bacterium is 80% - 90% among middle-aged adults, while it is 20% - 50% in developed countries [3-6]. Therefore, H. pylori infection is a necessary but not a sufficient cause for those pathologies. In support of this contention there is a recent report where patients with H. pylori infection showed no significant difference from bacterium-free patients [7]. Furthermore, recent data suggest that H. pylori presence in the gastrointestinal tract might be a normal colonization of the bacterium in the gastric microbiome, rather than an infection per se [8]. So, it is important to study other factors that might be involved in gastritis and colitis occurrence [3,9,10].
In that regard, Mexican territory is formed by 31 States and 1 Federal District, and among them many rural communities of extreme poverty do exist. Chiapas State accounts for many counties (“Municipios”) in extreme poverty conditions; one of these communities is Chabeklumil, located in “Municipio” Sitalá showing a population of 10,246 [1].
Chabeklumil is an agricultural community where coffee and hot peppers are the main crops, which are involved in their daily consumption by the population [11]. Moreover, people work for long periods of time during each day exposed to sunshine, they are subjected to fasting for many hours and eat late once arriving home, mainly irritant foods; in addition, they lack basic services like electricity, tap water and sewage [11]. All together, these conditions seem to favor gastritis and colitis occurrence [12,13]. Therefore we aimed to identify which are those factors that, according to gender, age, and lifestyle favor gastritis and/or colitis occurrence in the inhabitants of Chabeklumil, Sitalá, Chiapas.
2. METHOD
2.1. Design
The study was observational, descriptive, transversal and prospective.
2.2. Sample Selection
The participants were field workers with low income and socio-economic status. A file was created for each individual by the nurses in Chabeklumil, a community located in the south of México. Participants (346) of both genders, from 11 years of age completed the questionnaire. The questionnaire included variables such as fasting period, irritant food and drink consumption, stress, alcohol consumption, smoking habits, demographic information and socio-economic aspects. Subjects also had to reside within 40 km of Chabeklumil and have an identifiable address. In addition, we gave them information for prevention and treatment of their illnesses.
2.3. Data Collection
All the data were collected by experienced nurses at the public plaza in Chabeklumil town. The participants received verbal and written information about the purpose of the study, its procedure, and the nature of their voluntary participation. Written consent/finger printing was obtained from all the participants in this study. Once the participants agreed, they were asked to fill out a questionnaire on their socio-demographic information and health behavior. All the assessments were completed in 1 h.
2.4. Ethical Approval
The Ministry of Social Development (SEDESOL, México), and Facultad de Estudios Superiores Iztacala (U.N. A.M.) Ethical Committees found the study protocol’s formal approval unnecessary, and it is part of a Program for High Poverty Community Assistance (Estrategia 100 × 100). In addition, we gave them information for prevention and treatment of their illnesses.
2.5. Analysis
A descriptive analysis was carried out in order to analyze the distribution of the variables. To establish statistical significance of life habits risk factors among males and females a Z-test for proportions was applied, with a critical value of 5%.
3. RESULTS
3.1. Socio-Demographic Data
The predominant gender in the working population of Chabeklumil was female (56.1%, 194 women), most of them were adult (48% women, 19 - 59 years of age, Table 1); whereas males accounted for 152 (43.9% men), most in the adulthood (38% men, Table 1).
3.2. Gastritis and/or Colitis and Risk Factors Prevalence
The female inhabitants of Chabeklumil exposed to risk factors that filled up the questionnaire for gastric illnesses were 194, from them 58 showed initial symptoms of gastritis and/or colitis, such as: discomfort in the epigastric area, abdominal pain, diarrhea, colics. The observed frequency for gastritis was: 50 adults, 6 adolescents, and 2 elderly (Table 2). In contrast, 136 women showed typical signs and symptoms for gastritis/colitis, i.e., dyspepsia, feeling of fullness or burning in the epigastric area, constant abdominal pain, and the observed frequency was: 68 showed gastritis, 44 colitis, and 24 both illnesses (Table 2).
Regarding male population, 152 of them filled the questionnaire and 60 males showed initial symptoms of the diseases, where 52 were adult, 6 adolescents and 2 elderly (Table 2); while 92 men showed clear signs and
Table 1. Socio-Demographic data of inhabitants of Chabeklumil, Sitalá, Chiapas (346 clinical files, 2007), grouped by age ranges: Adolescents (11 - 18 years old), Adults (19 - 59 years old), Elderly (>60 years old).
Table 2. Population of Chabeklumil, Sitalá, Chiapas showing clear symptoms for gastritis and/or colitis (G-C), and population without G-C by main risk factor.
symptoms of gastritis and/or colitis: we found that 55 men showed gastritis, while 28 had colitis, and 9 bear gastritis and colitis (Table 2). No significant differences were found in colitis and gastritis prevalence between females and males.
When females were questioned about life habits risk factors that could cause them gastritis/colitis, the answers were: irritant food and drink consumption > long fasting periods > stress (Table 2). Regarding males, the answers were: alcohol and tobacco consumption > irritant food and drink consumption > long fasting periods > stress (Table 2).
When females were compared with males, significant differences (P < 0.05) were found in risk factors such as drugs and alcohol consumption (women did not report consumption), fasting (females > males), and stress (females > males); no difference was obtained in consumption of irritant foods and beverages.
4. METHODOLOGICAL CONSIDERATIONS
It is important to mention that health professionals should be more involved in providing education to indigenous and poorer communities, with the goal to diminish disease risk factors favoring a better life quality.
5. DISCUSSION
Gastric diseases have been on the raise around the world, and their etiology is mainly associated to H. pylori infection [2,3,8,13]. However, even though half of the human population seems to carry the bacterium its incidence varies, from 20% - 50% in industrialized nations to 80% - 90% in developing countries [5,6,12], which means that gastric diseases do occur by H. pylori infection and/or other causes [7,9]. Moreover, there is controversy among the putative infection pathways for the bacterium to colonize the human stomach, since no clear evidence exists from oral-oral, fecal-oral or food-borne transmission [3,13,14].
In contrast, lifestyle factors such as income, education, diet, drugs consumption, and control over life are associated with health self-evaluation and chronic diseases [10, 14-18]. In this regard, Chiapas population is about 4,293,459, where 52% of them inhabit rural zones. It is worth to mention that 12 out of 62 indigenous ethnic groups in México are located in Chiapas, with about 1 million persons. These data show a panorama where extreme poverty conditions do exist in Chabeklumil, which involve analphabetism, low income wages, lack of water pipelines, lack of sewage, disperse health centers located far away from small towns, hard work in the field in order to earn some money, long fasting periods, long time sunshine exposure, and “macho” culture where alcohol and tobacco consumption are very frequent, and which preclude women to acquire a better living standard. In addition, a recent study in young Mexicans (17 - 24 years old) showed that Chiapas is one of México States with the lowest prevalence of metabolic syndrome and obesity, nutrition-associated conditions that could be related to poverty in this State [19].
All together, H. pylori infection which putatively is involved in 80% - 90% of gastric diseases in poor people [4,10,20], along with the living conditions that Chabeklumil inhabitants face routinely, might explain why the majority of the interviewed population have shown the signs and symptoms for gastritis and/or colitis; while others are already with initial symptoms of the diseases. In support of this contention, it has been shown that 1 week administration of a combination of omeprazole, amoxicillin, and clarithromycin eradicated H. pylori in higher than 70% of persons at risk for gastric illness, which means that both pharmacological treatment against the bacteria, and better living standard will improve population’s health regarding gastric diseases.
In our study females are most affected by risk factors for gastritis/colitis, which occur mainly due to lifestyle and “macho” culture, since them face a poor living standard, they work hard in the field, and start early in the day without consuming a meal, which they eat late in the day once arriving home. People in Chabeklumil eat/drink a lot of irritant food like hot pepper and coffee, which damage the gastrointestinal system leading to gastritis and colitis. Furthermore, men started to consume drugs at early ages, a condition also involved in developing gastritis.
6. CONCLUSION
Females are most affected by risk factors for gastritis/ colitis, which occur mainly due to lifestyle and “macho” culture. Women are precluded of a better living standard, since they work hard in the field, start early in the day without consuming a meal, and they eat/drink late a lot of irritant food like hot pepper and coffee. Furthermore, men started to consume drugs at early ages, a condition also involved in developing gastritis.
7. ACKNOWLEDGEMENTS
Authors wish to thank SEDESOL and authors (DCT-P, RV-M) for partial funding.
NOTES