S Mustapha, U Pindiga, H Yusuph, B Goni, Y Jibrin
dyspepsia, endoscopy, helicobacter pylori, northern nigeria
S Mustapha, U Pindiga, H Yusuph, B Goni, Y Jibrin. Helicobacter Pylori Infection Among Dyspeptic Patients At A Tertiary Hospital In Northern Nigeria. The Internet Journal of Infectious Diseases. 2010 Volume 9 Number 2.
Helicobacter pylori (H. pylori) is a helix-shaped Gram-negative microaerophilic bacterium. It is the principal cause of chronic gastritis and peptic ulcer disease and a major contributor to gastric carcinoma and mucosa- associated lymphoid tissue (MALT) lymphoma. Approximately 50% of the world population is infected, making it the most widespread infection in the world1. However, only about 10-20% of infected persons become symptomatic2. Although infection with H. pylori occurs worldwide, prevalence varies greatly among nations and among population groups in the same nation. It is more common in developing countries where the prevalence is over 80% among middle-aged adults as compared to 20- 50% in developed countries3. In Nigeria, H. pylori prevalence rates of 73-84% were reported among dyspeptic patients4-6. The overall prevalence of H. pylori is strongly correlated with socioeconomic conditions and prevalence tends to increase with age1. The lower rate of infection in developed countries is largely attributed to higher hygiene standards and widespread use of antibiotics. Although the exact route of transmission of H. pylori is uncertain, person to person transmission by either the oral-oral or faecal-oral route is most likely. Consistent with transmission by these routes, the organism has been isolated from faeces, saliva and dental plaque of some infected people7.
H. pylori infection can be diagnosed by non-invasive methods or by endoscopic biopsy of gastric mucosa. The non-invasive methods include the urea breath test, serologic tests, stool antigen assays and urine ELISA. However, the most reliable method for detecting H. pylori infection is through testing of endoscopically obtained gastric mucosal biopsy with rapid urease test, histology and culture8.
Dyspepsia is a common presenting complaint in clinical practice, and since most of the diseases associated with H. pylori, such as peptic ulcer disease, gastritis and gastric cancer commonly present with dyspepsia, it is imperative to investigate patients presenting with dyspepsia for H. pylori infection. The aim of this study, therefore, was to determine the common upper gastrointestinal lesions and the prevalence of H. pylori among dyspeptic patients seen at the Federal Medical Centre, Gombe in north-eastern Nigeria.
Materials And Methods
This retrospective study was carried out at the Federal Medical Centre Gombe in north-eastern Nigeria. Records of 192 dyspeptic patients who underwent upper gastrointestinal endoscopy were reviewed. Endoscopy was performed using Pentax FG-29W forward-viewing flexible oesophagogastroduodenoscope. At least three antral mucosal biopsies were taken using endoscopic biopsy forceps. The specimens were preserved in 10% formalin and sent to the Histopathology Department where routine tissue processing and paraffin embedding were done. The specimens were then cut into 3µm sections and stained with routine haematoxylin and eosin. Modified Giemsa stain was employed to demonstrate the presence of H. pylori.
The SPSS statistical package (version 15.0) was used for statistical analysis. Chi-square test was used to compare means of proportions and a p value of ≤0.05 was considered significant.
A total of 192 patients underwent endoscopy. Ninety eight (51.9%) were males while 94 (48.1%) were females. Their ages ranged from 20 to 73 years with a mean of 40.4 (±SD 12.5) years, the age group with the highest frequency being 20-39 years (Table 1). One hundred and forty eight patients (77.1%) were positive for H. pylori. There was no significant difference between the H. pylori status of male and female patients (77.3% versus 75.4%) [p >0.05]. Table 2 shows the age-wise distribution of H. pylori infection among the patients. The most common endoscopic lesion was gastritis which was seen in 81 (42.2%) of the patients, followed by oesophagitis (34.9%) and duodenitis (21.9%). Duodenal ulcer was recorded in 12 (6.3%) of the patients, while 10 (5.2%) and 6 (3.2%) had benign gastric ulcer and gastric cancer respectively (Table 3). The frequency of H. pylori among patients with gastritis was 91.4%, while it was 85.7%, 83.3% and 70% respectively among patients with duodenitis, duodenal ulcer and gastric ulcer respectively, and 100% among patients with gastric cancer.
Table 1: Age and sex distribution of dyspeptic patients who had endoscopy at FMC Gombe
Table 2: Frequency of H. pylori infection among different age groups of dyspeptic patients seen at FMC Gombe
Table 3: Endoscopic Findings and H. pylori status of dyspeptic patients seen at FMC Gombe
Since H. pylori was first cultured by Warren and Marshall in 1983, much has been learned about its clinical aspects and its epidemiology.9 Knowledge of the epidemiology of this infection comes mainly from prevalence studies. Investigation of the incidence of H. pylori infection has been limited due to difficulties in identifying the case at the onset. In general, H. pylori infection is more frequent in developing countries than in developed nations. In developed countries, H.
In this study the prevalence rate of 77.1% for H. pylori was relatively high. The finding is consistent with other similar studies in Africa.4-6, 11 Jemilohun
Our study showed that despite the high prevalence of H. pylori infection in this part of Nigeria, the prevalence of serious gastroduodenal pathologies (GU, DU and gastric cancer) was low as these lesions were documented in only 14.7% of all the patients. This is consistent with findings of previous studies conducted in the same region4, 11. This indicates that other factors, possibly genetic and dietary, also play a role in the pathogenesis of these disorders in this environment.
However, similar studies conducted in developed countries reported low prevalence rate for H
This study examined the prevalence of H. pylori infection in a group of symptomatic Nigerian patients. It begs a practical question: Is the infection rate high enough to treat symptomatic patients empirically? We believe the answer is yes. This strategy saves money, time, and clinic resources. It avoids the problems of patients not returning for appointments, which is very common in a setting like ours.