An Assessment of Faecal Occult Blood Test and H. pylori infection in Patients with Uninvestigated Dyspepsia in Primary Health Cares in Abakaliki, Nigeria
E Ugwuja, N Ugwu
dyspepsia, faecal occult blood, infection, ulcer
E Ugwuja, N Ugwu. An Assessment of Faecal Occult Blood Test and H. pylori infection in Patients with Uninvestigated Dyspepsia in Primary Health Cares in Abakaliki, Nigeria. The Internet Journal of Laboratory Medicine. 2007 Volume 3 Number 1.
Test for faecal occult blood (FOB) is commonly used to evaluate patients with intestinal disorders. An assessment of FOBT and infection with
Dyspepsia or more accurately, uninvestigated dyspepsia, a symptom complex arising in the upper gastrointestinal tract  has been described as a common complaint among individuals seeking medical care as well as people in the general population . The symptom complex includes: upper abdominal/epigastric pain or discomfort, post-prandial fullness, bloating, belching, early satiety, anorexia, nausea, retching, vomiting, heartburn and regurgitation . In absence of any underlying pathologies, such as peptic ulcer, gastroesophageal reflux, pancreatitis, biliary tract disease or others, dyspepsia is defined as functional or idiopathic dyspepsia. Data on dyspepsia prevalence, nearly all arising from studies in few developed geographical areas and countries, are of the order of 1-4% of all consultations in all primary care medicine . However, estimates of adults affected by dyspepsia are as high as 20-40% [3, 4]. Variation in prevalence rates of dyspepsia has been partially related to difference in defining dyspepsia in the study population . Although studies have shown that dyspepsia is associated with some physiological abnormalities [6,7,8,9],
Materials And Methods
The study area is defined by longitude 8 o E and latitude 6 o N, elevated at 380ft above sea level. The vegetation characteristic is that of the tropical rain forest with an average annual rainfall of about 1,600mm and an average atmospheric temperature of 30 o C. There are two distinct seasons, the wet and the dry seasons; the former takes place between April and October, while the latter occurs from November to March. The main occupation of the people is subsistence farming (mainly yam and cassava) with some animal husbandry and other professions and/ or activities such as civil service, trading, artisans, and stone quarrying.
This study was conducted at the Department of Chemical Pathology, Ebonyi State University, Abakaliki. The proposal for this study was approved by the Research and Ethics Committee of Ebonyi State University Teaching Hospital, Abakaliki. Participants were consecutive referrals from general practitioners (GPs) in Abakaliki metropolis who came for laboratory investigations as part of evaluation for various dyspeptic complaints. The clinical presentation, diagnosis, drug treatment and duration of symptoms were noted. Before enrolment, informed consent of the participants were sought and obtained. Patients that satisfied the conditions of not being on proton pump inhibitors, H-2 receptor blocker and non-steroid anti-inflammatory drugs (NSAIDs) for the past one month (4wks) were enrolled. Excluded from the study were patients with any known clinical conditions that may interfere with the result of this study, refusal to give consent or patients that have been on treatment with non-steroid anti-inflammatory drugs (NSAIDs) four weeks prior to enrolment. In all, a total of two hundred and sixty two (262) patients (117 males and 145 females) aged 5.5 to 56 years were found to be eligible for the study. At entry into the study each participant was interviewed to obtain sociodemographic data such as age, sex, level of education and occupation. Stool samples were collected into chemically clean wide mouthed plastic containers for faecal occult blood test and routine stool microscopy. Venous blood were obtained into dry glass test tubes for clotting and retraction to take place, after which samples were centrifugation at 2000g for two minutes and the serum separated for the determination of specific immunoglobulin G (IgG) to
Faecal occult blood test was done by rapid one-step immunoassay technique for qualitative determination of human haemoglobin in faeces (Occult Blood Brand, CAL-TECH Diagnostics, INC. Chino, California, USA), while routine stool microscopy was done by both direct wet mount and formol concentration techniques for identification of intestinal parasites .
Data were analysed for mean, proportion (expressed as percentage), and odd ratio. 95% confidence intervals were calculated where appropriate. Test for statistical significance was done by Chi square at 95% level of significance (p < 0.05).
In the 262 patients studied, presenting symptoms include, heartburn [n= 45 (17%)], abdominal pain [n= 68 (26%)], bloating [n= 91 (35%)], vomiting [n= 58 (22%)]. The duration of symptoms ranged 6 months to 2 years (mean = 1.1 years).
Table 1 shows the age and sex distribution of patients. The patients' ages ranged from 5.5 to 56 years (mean = 38.6 ± 5.2 years) and most were from low socioeconomic background (data not shown). Although females formed greater proportion of the patients, there was no significant sex difference (p > 0.05). Majority of the patients presenting with dyspepsia were in the age range 50 years and below.
A total of 163 (62.2%) patients were positive for faecal occult blood test of which 77 (47.2%) were males and 86 (52.2%) were females, although there was no statistically significant difference (95% CI: -0.184-0.064) between the sexes (table 2). Similarly, there was no significant difference in
From table 3, the prevalence of
Considerable interest exists in the use of non-invasive testing in place of endoscopy in determining the management protocol for patients presenting with upper gastrointestinal symptoms . The use of faecal occult blood test is common among general practitioners in the primary health cares; however, its role in evaluating patients with dyspepsia has not been documented. In the present study, dyspeptic patients with positive faecal occult blood test were more likely than were patients with negative results to be anti-
The authors are grateful to the management and staff of Junico Biomedical Laboratories for their logistic support.
Ugwuja, E. I. Department of Chemical Pathology, Faculty of Clinical Medicine, Ebonyi State University, P.M.B 053, Abakaliki, Nigeria. E-mail: email@example.com Phone: +2347035122010.