Helicobacter Pylori Prevalence and culture rate among patients with Dyspepsia at Moi Teaching and Referral Hospital, Eldoret, Kenya

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