Helicobacter pylori infection among diabetic and non-diabetic patients at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Globally, the burden of Diabetes Mellitus (DM) and Helicobacter pylori (H. pylori) infection is vast, both conferring significant morbidity and mortality risks. H. pylori, categorized as a class 1 carcinogen by WHO, has been identified as a common pathogen in DM, and has also been linked to altered glucose metabolism, increasing risk of gastric malignancy and DM complications. While it is thought that patients with DM are at increased risk of acquiring H. pylori, because of impairment in their humoral and cellular immunity, the results of several studies investigating this association are conflicting. Data on this association is limited in sub–Saharan Africa, including Kenya. Objectives: To determine the prevalence of H. pylori in patients with and without DM, and to describe any association between DM and H. pylori infection, in patients attending clinics at Moi Teaching and Referral Hospital (MTRH) Eldoret, Kenya. Methods: This hospital-based cross-sectional comparative study was conducted at outpatient clinics, MTRH, Eldoret, between December 2020 and April 2021. A total of 470 unmatched participants were enrolled. (232 with DM and 238 without DM). H pylori prevalence was compared between those with DM and those without DM using H. pylori antibody test. Null hypothesis was that the prevalence of H. pylori is similar in both groups. Two sampling techniques were employed: 1) systematic random sampling for the DM group and 2) simple random sampling for the non-DM group. Standardized interviewer administered questionnaires were used to collect demographic, socioeconomic and medical history data. H. pylori serum antibody tests were done and recorded for both groups. Categorical data were summarized using frequencies and continuous variables were summarized using means and medians with corresponding SD and IQR respectively. Bivariate analysis was conducted to test for association. Level of significance was set at p<0.05. This study was approved by the MTRH/Moi University Institutional Research and Ethics Committee (IREC). Results: Positive H. pylori antibody test was found in 142/470 (30.4%) of the participants. In the DM group, 68/232 (29.3%) had a positive H. pylori antibody test while in the non-DM group, 75/238 (31.5%) were positive (p=0.604; 95% CI). In both groups the prevalence of H. pylori was not associated with age, gender, level of education, body mass index, alcohol, smoking, increased number in household, presence of pets or domestic animals, type of waste disposal or type of toilet facility. For DM group, there was no difference in the prevalence of H. pylori between Type 1 and 2 DM (p=0.088; 95% CI). H. pylori seropositivity was not associated with duration of DM in this group. Conclusion: The prevalence of H. pylori infection is not increased in those with DM. There is no association between DM and H. pylori infection. This study failed to reject the null hypothesis. Recommendation: The same H. pylori screening guidelines for general population should be used in DM patients. Larger multicentre studies need to be conducted in different settings to corroborate the study findings.