Prevalence of Helicobacter pylori among dyspeptic patients in a tertiary care centre in South Kerala, India
Nimmy Paul, Jyothi Rajahamsan, Ramani Bai Joseph Theodore
Keywords :
Gastric biopsy, Helicobacter pylori, rapid urease test
Citation Information :
Paul N, Rajahamsan J, Theodore RB. Prevalence of Helicobacter pylori among dyspeptic patients in a tertiary care centre in South Kerala, India. 2016; 18 (2):105-109.
Background:Helicobacter pylori (HP) is the most common bacterial infection in humans. It affects > 50% of world population and remains the major aetiological agent of ailments of upper gastrointestinal (GI) tract of humans. HP eradication prevents pre-neoplastic changes of gastric mucosa and regression of gastric mucosa-associated lymphoid type lymphoma. For these reasons and many others, it is worthwhile testing patients with dyspepsia for HP, who might benefit from eradication therapy.
Objective: To study the prevalence of HP infection among dyspeptic patients in a tertiary care centre in South Kerala.
Materials and Methods: Gastric biopsy specimens were collected from referred patients with dyspepsia from Southern districts of Kerala (Thiruvananthapuram, Kollam and Pathanamthitta) attending the Gastroenterology Outpatient Department, who underwent upper GI endoscopy, during a one-year period from December 2009 to November 2010. The serum samples were collected for doing HP IgG enzyme-linked immunosorbent assay test. The biopsy specimens were used for doing rapid urease test (RUT) and culture was done in patients showing urease positivity and/or high level of IgG antibody titre.
Results: The study was conducted on 250 consecutive dyspeptic patients, with an age range of 7-73 years. Significant IgG titres (>37.5 IU/ml) were detected in 89 cases (35.6%), while the RUT was positive in 30 cases (12%). Subjects were considered positive for HP infection by combined IgG antibody and/or urease test positivity and negative when both the tests were negative. In this study, ninety patients (36%) were positive for HP infection, and 160 (64%) were negative. Culture was done in patients showing urease positivity and/or high level of IgG antibody titre and proportion of culture positivity among this group was 34%.
Conclusion: Seroprevalence of HP infection in South Kerala was found to be low (35.6%). Low infection rates were seen in children, similar to that in developed countries, and it is likely that the prevalence of HP may fall in the coming years. Due to the lower percentage of HP infection in this area, a test and treat policy is applicable as in many developed countries.
Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984;1:1311-5.
Current European concepts in the management of Helicobacter pylori infection. The Maastricht consensus report. European Helicobacter pylori study group. Gut 1997;41:8-13.
An international association between Helicobacter pylori infection and gastric cancer. The Eurogast study group. Lancet 1993;341:1359-62.
Tomb JF, White O, Kerlavage AR, Clayton RA, Sutton GG, Fleischmann RD, et al. The complete genome sequence of the gastric pathogen Helicobacter pylori. Nature 1997;388:539-47.
Datta S, Chattopadhyay S, Balakrish Nair G, Mukhopadhyay AK, Hembram J, Berg DE, et al. Virulence genes and neutral DNA markers of Helicobacter pylori isolates from different ethnic communities of West Bengal, India. J Clin Microbiol 2003;41:3737-43.
Bhasin DK, Sharma BC, Ray P. Drug resistance in Helicobacter pylori strains in India. Indian J Gastroenterol 2000;19:529-32.
National Institute of Clinical Excellence. Dyspepsia: Managing adults in primary care. London, England: National Institute of Clinical Excellence; 2004.
Graham DY. Can therapy even be denied for Helicobacter pylori infection? Gastroenterology 1997;113 6 Suppl: S113-7.
van Doorn LJ, Henskens Y, Nouhan N, Verschuuren A, Vreede R, Herbink P, et al. The efficacy of laboratory diagnosis of Helicobacter pylori infections in gastric biopsy specimens is related to bacterial density and vacA, cagA, and iceA genotypes. J Clin Microbiol 2000;38:13-7.
Takenaka R, et al. Helicobacter pylori Eradication Prevents Intestinal-Type Gastric Cancer Development in Patients with H. pylori-Related Peptic Ulcers, but not Diffuse-Type Cancer. Abstract Presented at the DDW Meeting in Chicago IL; 16 May, 2005.
Salih BA. Helicobacter pylori infection in developing countries: The burden for how long? Saudi J Gastroenterol 2000;15:201-7.
Malfertheiner P, Megraud F, O'Morain C, Bazzoli F, El-Omar E, Graham D, et al. Current concepts in the management of Helicobacter pylori infection: The Maastricht III consensus report. Gut 2007;56:772-81.
Perez-Perez GI, Taylor DN, Bodhidatta L, Wongsrichanalai J, Baze WB, Dunn BE, et al. Seroprevalence of Helicobacter pylori infections in Thailand. J Infect Dis 1990;161:1237-41.
de Martel C, Parsonnet J. Helicobacter pylori infection and gender: A meta-analysis of population-based prevalence surveys. Dig Dis Sci 2006;51:2292-301.
Bardhan PK. Epidemiological features of Helicobacter pylori infection in developing countries. Clin Infect Dis 1997;25:973-8.
Lin SK, Lambert JR, Schembri MA, Nicholson L, Korman MG. Helicobacter pylori prevalence in endoscopy and medical staff. J Gastroenterol Hepatol 1994;9:319-24.
Dore MP, Malaty HM, Graham DY, Fanciulli G, Delitala G, Realdi G. Risk factors associated with Helicobacter pylori infection among children in a defined geographic area. Clin Infect Dis 2002;35:240-5.
Covacci A, Censini S, Bugnoli M, Petracca R, Burroni D, Macchia G, et al. Molecular characterization of the 128 kDa immunodominant antigen of Helicobacter pylori associated with cytotoxicity and duodenal ulcer. Proc Natl Acad Sci U S A 1993;90:5791-5.
Stone MA. Non-invasive testing for Helicobacter pylori. Postgrad Med J 1999;75:74-7.
Midolo P, Marshall BJ. Accurate diagnosis of Helicobacter pylori. Urease tests. Gastroenterol Clin North Am 2000;29:871-8.
Sivaprakash R, Rao UA. Indegenous, simple, sensitive and cost effective urease test in the diagnosis of Helicobacter pylori for the developing world. Indian J Med Microbiol 1994;12:111-5.
Mai UE, Shahamat M, Colwell RR. Survival of Helicobacter pylori in the aquatic environment. In: Menga H, Gregor M, Tytgat GN, Marshall BJ, editors. Helicobacter pylori, 1990, Proceedings at the Second International Symposium on Helicobacter pylori. Berlin: Springer-Verlag; 1989. p. 91-4.
Karnes WE Jr., Samloff IM, Siurala M, Kekki M, Sipponen P, Kim SW, et al. Positive serum antibody and negative tissue staining for Helicobacter pylori in subjects with atrophic body gastritis. Gastroenterology 1991;101:167-74.
Iwahi T, Satoh H, Nakao M, Iwasaki T, Yamazaki T, Kubo K, et al. Lansoprazole, a novel benzimidazole proton pump inhibitor, and its related compounds have selective activity against Helicobacter pylori. Antimicrob Agents Chemother 1991;35:490-6.
McNulty C, Teare L, Owen R, Tompkins D, Hawtin P, McColl K. Test and treat for dyspepsia - But which test? BMJ 2005;330:105-6.