Dyspepsia, a collection of upper gastrointestinal symptoms, is thought to be a global concern.1 Its prevalence ranges from 15% to 40% and it is known to have a significant impact on health care services.2 Population-based studies from different communities have revealed various risk factors for developing dyspepsia, such as socioeconomic status,3 gender,4 smoking,3 non-steroidal anti-inflammatory drugs (NSAIDS)5 and Helicobacter pylori infection.3 To date, however, the role of ethnicity in the risk of developing dyspepsia has been poorly studied. This is a result of epidemiological surveys, either from the West Asia or from East Asia, that have been conducted in populations consisting of primarily single or dominant ethnic groups.6

Recognized aetiological factors for dyspepsia are known to vary among ethnic groups, particularly when examined among Asians. The prevalence of H. pylori infection, for example, known to be associated with dyspepsia,3 is significantly higher among Asian ethnic groups than among Western caucasians.7 Furthermore, among Asian populations of varied ethnic origins, H. pylori prevalence rates are known to vary widely.8 Peptic ulcer disease, another condition known to cause dyspepsia, is recognized to have significant clinical and pathological differences between Asian and Western patients.9 Body mass index, known to be associated with an increased risk of developing dyspepsia,10 may additionally contribute to differences in ethnic prevalence of dyspepsia.

In a previous study comparing clinical and endoscopic features in representative populations, we have described significant differences between Malaysian and British patients with dyspepsia. Adults from the U.K. with dyspepsia had significantly higher levels of gastro-oesophageal reflux disease (GERD) symptoms (71% vs. 41%) and erosive oesophagitis (26.8% vs. 5.8%) compared with their Malaysian counterparts.11 Although it was likely that socioeconomic and environmental factors may have accounted for some of the differences observed, we postulated that ethnic differences between Caucasians and Asians may have been responsible. This fact was further supported by the observation that ethnic Indians within the multi-racial Malaysian population studied had more erosive oesophagitis than ethnic Chinese or Malays.