Abstract

Introduction: Helicobacter pylori (H. pylori) related chronic gastritis is a major health problem worldwide, specially in the developing countries. The prevalence of H. pylori infection has been reported to vary between and even within countries. There are limited data on this infection in Western Nepal. Our objective was to study the prevalence of H. pylori infection and its association with presenting complains and upper gastrointestinal diseases.


Methods: Medical records of patients undergoing gastrodudenoscopy and biopsy for various upper gastrointestinal symptoms from 1st of January 2015 to 30th of June 2017 were reviewed for presence of H. pylori infection, demographics, indications for gastrodudenoscopy, and histopathology findings. T-test, Chi-square test, and Fisher exact test were applied.


Results: Two hundred fifty six patients (135 male and 121 female) with a mean age of 47 (SD = 16.5) underwent gastroscopic biopsy and had an overall H. pylori prevalence of 24.6%. H. pylori infection was most commonly noted between 41 to 60 years of age. Gender did not seem to be significantly associated (p = 0.82) but gastrointestinal bleed was significantly associated with H. pylori infection (p = 0.006). The most common histopathological diagnosis was gastritis followed by gastrodudenitis; however, none of the diagnosis were found to be significantly associated with H. pylori infection.


Conclusion: The overall prevalence of H. pylori infection was 24.6% and was most common between 40 to 60 years of age. Heart burn was the most common symptom and gastrointestinal bleed was the only significantly associated symptom with H. pylori infection.

INTRODUCTION:

Helicobacter pylori (H. pylori) infection is a common condition with an estimated half of the world's adult population having been exposed to this organism.[1] H. pylori is an important and a common bacterial pathogen infecting upper gastrointestinal (GI) track and causing various symptoms due to inflammation of the GI track. Prevalence of this infection varies worldwide being as low as completely negative to higher than 80 percentage in developing countries.[2,3] The prevalence rates are higher in developing nations.[3,4] Microbiologically, H. pylori are gram negative, spiral, and flagellated bacilli found under the mucous layer in gastric pits adjacent to the gastric epithelial cells.[5,6] Endoscopic biopsy based tests like rapid urease testing (RUT) and histopathology can be done to identify H. pylori. However, histopathology is considered the gold standard and carry high sensitivity and specificity of more than 90%. But such facilities may not be available in resource poor setting areas of the world; therefore, in low resource communities with high H. pylori prevalence, empirical treatment could be more practical then diagnostic tests.[7,8] Non-invasive tests such as urea breath test, serological immunoglobulin G, A, and M serology, stool antigen test, and saliva antibody test are not easily available in our country.

There are many studies on this topic but there are limited information about the prevalence of H. pylori in Western Nepal. The present study evaluates the prevalence of H. pylori infection among patients undergoing gastrodudenoscopy for various upper GI symptoms.

METHODS:

This observational, cross-sectional, and analytical study was carried out at Endoscopic unit and Department of Pathology of Lumbini Medical College Teaching Hospital (LMCTH). Ethical clearance was obtained from Institutional Review Committee (IRC) of the institute. Secondary data were collected from 1st of August 2017 to 31st of October 2017. Data were collected retrospectively from the medical records of all patients who underwent gastrodudenoscopy from 1st of January 2015 to 30th of June 2017.

Inclusion criteria:

All patients who underwent gastrodudenoscopy for various upper GI symptoms and had histopathological examination of antral gastric mucosa were included in the study. GI symptoms for which gastrodudenoscopy was done included dyspepsia, dysphagia, heart burn, recurrent vomiting, GI bleeding, weight loss, and poor appetite.

Exclusion criteria:

Cases with incomplete data or in whom tissue was inadequate for histopathological opinion were excluded from the study. Cases taking proton pump inhibitor or who just completed anti-H. pylori treatment were also excluded.

Procedure of gastrodudenoscopy and histopathology:

Gastrodudenoscopy was performed as an outdoor clinic procedure using Fujinon™ 201H (2vA323) or 2500 (2V5640575) forward-viewing Esophago-gastro-duodenoscope. Gastric antral mucosal biopsy was taken for histopathological examination and sent to the Department of Pathology of the hospital in 10% formalin solution. Four micro thick paraffin sections were stained for H. pylori detection. Slides were stain with hematoxylin and eosin. Giemsa stain was also used for better yield. All the slides were examined by consultant pathologist. Diagnosis of H. pylori was made in presence of H. pylori organism in the histopathological slides (Fig: 1). Absence of H. pylori in the slides ruled out H. pylori infection.

Fig 1:.

Giemsa stain section showing H. pylori (black arrow) in clumps (1000x)