Prevalence of Helicobacter Pylori Infection and Endoscopic findings in Patients with Dyspepsia at Moi Teaching and Referral Hospital

Abstract

Background: H. pylori is known to be a highly prevalent infection among persons in developing countries. It is firmly established as the etiologic agent for acute and chronic gastritis and a predisposing factor in peptic ulcer disease, gastric carcinoma and B-cell mucosa-associated lymphoid tissue (MALT) lymphoma. Despite this significant morbidity and mortality associated with it, data in developing countries is lacking on several aspects of this infection. Data on prevalence among patients with dyspepsia is especially lacking at MTRH. Objectives: To determine the prevalence of H. pylori infection among patients with dyspepsia referred for upper gastrointestinal endoscopy at MTRH, to describe endoscopic findings among patients with dyspepsia and to define the socio- demographic status of the patients with H. pylori infection. Study Design: A descriptive cross sectional study. Setting: Moi Teaching and Referral Hospital endoscopy unit, Eldoret, Kenya. Patients and Methods: Those enrolled were adult patients referred for upper endoscopy and who had dyspepsia and had given informed consent. Those who had taken proton pump inhibitors, H2 receptor blockers, bismuth salts or antibiotics or those in whom endoscopy was unsuccessful were excluded. Patients meeting the inclusion criteria had their demographic data taken. They then underwent upper gastrointestinal endoscopy and endoscopic findings were noted. Mucosal biopsies were taken from the body and antrum of the stomach and then used for rapid urease test for H. pylori. The rapid urease test used was Esokit® Hp test. Data was analyzed with SPSS and p-value of 0.05 was considered significant in all analyzes. Frequency tables were generated for categorical variables. Chi-square test with goodness of fit was used to assess any association between variables among H.pylori positive and negative arms. Results: A total of 126 patients were studied, 65 (51.6%) were male and 61 (48.4%) were female. 78 (61.9%) were between 25 and 54 years of age. Among all patients, 66 (52.3%) of them were H. pylori positive. 53.8% (35) of males were H. pylori positive compared to 50.8% (31) of females. Most common abnormal finding were noted to be gastritis in 69.8% (88) of patients followed by duodenitis in 33.3% (42) and peptic ulcer disease in 30.1% (38) of patients. Only 4% (5) of patients had normal findings. Among the 38 patients with peptic ulcer disease 73.7% (28) were H. pylori positive. Conclusion: This study showed that more than half of patients with dyspepsia are H. pylori positive and prevalence is lower than in previous studies. Gastritis remains the most common endoscopic finding among patients with dyspepsia and also among those with H. pylori. Peptic ulcer disease had the strongest association with H. pylori infection. Recommendation: Given high number of H. pylori negative patients in this study, a study on other causes of dyspepsia is recommended. Dyspepsia should be used as a sole reason to treat for H. pylori. Given the high association between H. pylori and peptic ulcer, it is recommended that all patients with peptic ulcer disease be treated for H. pylori.