Abstract:
Background: Helicobacter pylori (H. pylori) infection is associated with upper
gastrointestinal diseases including peptic ulcer disease, gastritis, gastric
adenocarcinoma and mucosal associated lymphoid tissue lymphoma. H. pylori is a
fastidious organism and thus difficult to culture especially after prolonged time between
sample extraction and start of the culture.
Objective: To determine the H. pylori prevalence and culture rate following 20 to 24
hour transportation in normal saline at Moi Teaching and Referral Hospital.
Methods: This was a cross-sectional descriptive study. Participants 18 years and above
referred for endoscopy due to dyspepsia were consecutively enrolled until the desired
sample size was achieved. Participants underwent endoscopy during which biopsies
were taken, two each from the gastric antrum and corpus. Rapid urease test (RUT) for
H. pylori was done on one sample each from the antrum and corpus. For the samples
that tested positive, their pair samples were put in normal saline and packed in ice in a
cooler box and sent for H. pylori culture within 20 to 24 hours on brain heart infusion
agar and subsequent antibiotic susceptibility testing. Data was analyzed using STATA
Version 13 SE.
Results: Between April 2014 and February 2015, 634 patients were screened of which
156 were enrolled to the study and subsequently underwent endoscopy, gastric biopsy
and RUT. The enrolled participants had a median age of 41 (IQR: 28-58) years; and
comprised of 64 (41%) males. The main indication for endoscopy was epigastric pains,
seen in 151 (97%) of patients. Eleven (7%) participants had previously been
investigated for upper gastrointestinal disease by barium meal 4 (2.7%), endoscopy 2
(1.3%) and serological H. pylori testing 5(3.2%). Forty two (27%) of participants had
previously received treatment for dyspepsia with either a proton pump inhibitor,
histamine receptor type 2 blocker or anti H. pylori antibiotics. At endoscopy, frequent
abnormal findings included gastritis 123 (79%), oesophagitis and duodenitis with
30(19%) each. These endoscopic findings were not mutually exclusive. Eighty three
(53%) had a positive RUT. Culture was done on 69 samples that reached the laboratory
within 24 hours. H. pylori was isolated in 9 (13%) samples. All the 9 strains of H. pylori
isolated were resistant to metronidazole.
Conclusion: The prevalence of H. pylori by RUT was more than 50% of patients. The
culture rate of H. pylori following 20 to 24 hour delay was low. All the H. pylori strains
isolated were resistant to metronidazole.
Recommendations: Patients with dyspepsia should be tested for H. pylori and treated
as per standard guidelines. Culture of H. pylori after 20-24 hour transportation in
normal saline is not useful. A comparative study to determine the optimal transportation
time and transport media is recommended. A larger study to validate utility of
metronidazole in the treatment of H. pylori at MTRH is recommended