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THE ENDOSCOPIC FINDINGS IN SYMPTOMATIC PATIENTS WITH RELIABLE NONINVASIVE LABORATORY - PROVEN HELICOBACTER PYLORI INFECTION
THE ENDOSCOPIC FINDINGS IN SYMPTOMATIC PATIENTS WITH RELIABLE NONINVASIVE LABORATORY - PROVEN HELICOBACTER PYLORI INFECTION
Bakhtyar Faiq Salim a
Bakhtyar Faiq Salim a
a Department of Medicine, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
Submitted: 2/1/2019; Accepted: 1/12/2020; Published: 21/12/2020
DOI Link: https://doi.org/10.17656/jsmc.10270
ABSTRACT
Background
Patients with reliable laboratory-proved H. pylori infection manifest gastritis on upper GI endoscopy and such gastritis is associated with various benign, pre-malignant, and malignant gastrointestinal disorders, but the frequency and the magnitude of such association are not clarified well in the literature.
Objectives
To show the endoscopic findings in symptomatic patients with proven H. pylori infection by non-invasive laboratory reliable tests namely urea breath test and stool Antigen testing and to show the relation between these endoscopic findings and the common associated finding namely duodenal, gastric ulcerations, and Gastro-esophageal reflux disease (GERD).
Methods
A cross-sectional descriptive study was carried out from August 2018 to January 2019. The study sample consisted of 314 patients who had symptoms of Helicobacter pylori and were referred to Kurdistan center for gastroenterology and Hepatology (KCGH) in Sulaimani, Iraqi Kurdistan, Iraq. All of the patients were proved to have H. pylori diagnosed with either urea breath test in 196 cases or stool antigen test in 118 cases. All of them had undergone endoscopy. Gastritis types and associated pathologies were diagnosed by high definition endoscopy and agreed upon by an expert Board qualified endoscopist. Histopathological confirmation was not carried out. Although there is inter-observer variability in the endoscopic diagnosis of gastritis, the patients being diagnosed by sensitive laboratory methods before endoscopy limits this variability, and it is well known that the most common cause of gastritis is H. pylori infection
Results
The 314 symptomatic patients with lab-proven H. pylori infections were more middle-aged adults and more females than males. Most of these patients (97%) showed endoscopic evidence of gastritis. Antral and or fundal gastritis whether nodular or not, are more associated with duodenal ulceration while pangastritis and antral erosions are more associated with gastric ulcers. GERD is associated with gastritis alone without peptic ulceration, but it is more severe when there is duodenal ulceration and even more severe when the duodenal ulcers are complicated by gastric outlet obstruction, partial or complete.
Conclusion
Doing upper GI endoscopy for dyspeptic patients with lab-proven H. pylori infection to detect associated benign anad pre-malignant upper GI pathologies to plan the appropriate treatment and its duration. The test and treat strategy for symptomatic H. pylori infected patients without a red flag recommended by international guidelines may be suboptimal in areas with a high frequency of H. pylori infection like ours.
KEYWORDS
H. pylori; Gastritis; Peptic ulcer disease; GERD.
References
1. Brown LM. Helicobacter pylori: Epidemiology and Routes of Transmission; Epidemiologic Reviews;2000; Vol. 22, No 2.
2. Taylor DN, Blaser MJ . The epidemiology of Helicobacter pylori infection;Epidemiologic reviews, 01 Jan 1991, 13:42-59.3. Eusebi LH, Zagari RM, Bazzoli F. Epidemiology of Helicobacter pylori Infection; Helicobacter, Volume19, Issues1;2014.
4. Laine L, Cohen H, Sloane R, Marin-Sorensen M. Interobserver agreement and predictive value of endoscopic findings for H. pylori and gastritis in normal volunteers; endoscopy; Volume 42, Issue 5, November 199.
5. Takahiro Kato ;Nobuaki Yagi ,Tomoari Kamada etal. Diagnosis of Helicobacter pylori infection in gastric mucosa by endoscopic features: A multicenter prospective study; Digestive endoscopy; Volume25, Issue 5; 2013.
6. JP Gisbert, F De La Morena, V Abraira . Accuracy of Monoclonal Stool Antigen Test for the Diagnosis of H. pylori Infection: A Systematic Review and Meta-Analysis;The American journal of gastroenterology;2006
7. Shouler L, Goldfain G, Lamouliatte H. Diagnosis of Helicobacter pylori Infection: Noninvasive Methods Compared to Invasive Methods and Evaluation of two New Tests ;The American journal of, 2001.
8. Alan F.Cutler, Suzanne Havstad‡etall. Accuracy of invasive and noninvasive tests to diagnose Helicobacter pylori infection;Gastroenterology; Volume 109, Issue 1, July 1995.
9. D VAIRA, N VAKIL. Blood, urine, stool, breath, money, and Helicobacter pylori; Gut 2001;48:287–289.
10. Ozlem Aydin, Reyhan Egilmez, Tuba Karabacak, etall. Interobserver variation in histopathological assessment of Helicobacter pylori gastritis;World J Gastroenterol. 2003 Oct 15; 9(10): 2232–2235.
11. Ahad Eshraghian. Epidemiology of Helicobacter pylori infection among the healthy population in Iran and countries of the Eastern Mediterranean Region: A systematic review of prevalence and risk factors; World J Gastroenterol;2014 Dec 14; 20(46): 17618–17625.
12. HsinChiabcMing-JongBairbdMing-ShiangWu, etall. Prevalence of Helicobacter pylori Infection in High-school Students on Lanyu Island, Taiwan: Risk Factor Analysis and Effect on Growth; Journal of the Formosan Medical Association; Volume 108, Issue 12, December 2009.
13. Sahar Honarmand-Jahromy, Farideh Siavoshi, Reza Malekzadeh, etall. Reciprocal impact of host factors and Helicobacter pylori genotypes on gastric diseases;World J Gastroenterol;2015 Aug 21; 21(31).
14. Laure Brigitte Kouitcheu Mabeku, Michelle Larissa etall. Potential risk factors and prevalence of Helicobacter pylori infection among adult patients with dyspepsia symptoms in Cameroon; BMC Infect Dis. 2018; 18: 278.
15. Baicun Hou, Meifang Zhang, Miao Liu etall. Association of active Helicobacter pylori infection and anemia in elderly males; BMC Infect Dis. 2019; 19: 228.
16. Mary E. Kable, Lori M. Hansen, Cathy M. Styer, etall. Host Determinants of Expression of the Helicobacter pylori BabA Adhesin; Sci Rep. 2017; 7: 46499.
17. Denisse Bravo, Anilei Hoare, Cristopher Soto, etall. Helicobacter pylori in human health and disease: Mechanisms for local gastric and systemic effects; World J Gastroenterol. 2018 Jul 28; 24(28): 3071–3089.
18. Bor-Shyang Sheu, Ming-Shiang Wu, Cheng-Tang Chiu,etall. Consensus on the clinical management, screening-to-treat, and surveillance of Helicobacter pylori infection to improve gastric cancer control on a nationwide scale; Helicobacter. 2017 Jun; 22(3): e12368.
19. Mihara M1, Haruma K, Kamada T, Komoto K, etall. The role of endoscopic findings for the diagnosis of Helicobacter pylori infection: evaluation in a country with high prevalence of atrophic gastritis. Helicobacter. 1999 Mar;4(1):40-8.
20. Theodore Rokkas. The role of Helicobacter pylori infection in functional Dyspepsia; Annals of Gastroenterology (2012) 25, 176-177.
21. KAZUYOSHI YAGI; ATSUO NAKAMURA ;ATSUO SEKINE,etall. Characteristic endoscopic and magnified endoscopic findings in the normal stomach without Helicobacter pylori infection;JGH; Volume17, Issue1.
22. Larry H.LaiMB ChB (GI Fellow)Joseph J.Y.Sung,. Helicobacter pylori and benign upper digestive disease; Best Practice & Research Clinical Gastroenterology Volume 21, Issue 2, April 2007, Pages 261-279.
23. Matthew PWilliams;Roy EPounder. Helicobacter pylori: from the benign to the malignant. The American Journal of Gastroenterology; Volume 94, Issue 11, Supplement 1, November 1999, Pages S11-S16.
24. Masaki Miyamoto; Ken Haruma; Masaharu Yoshihara. Nodular Gastritis in Adults Is Caused by Helicobacter pylori Infection; Digestive Diseases and Sciences ; May 2003, Volume 48, Issue 5, pp 968–975.
25. Tomoyuki Koike, ShuichiOhara, HitoshiSekine, . Helicobacter pylori infection inhibits reflux esophagitis by inducing atrophic gastritis; Journal of the Formosan Medical Association; Volume 108, Issue 12, December 2009,929-936.
26. Hackelsberger, Andreas; Günther, Thomas; etall. Prevalence and Pattern of Helicobacter pylori Gastritis in the Gastric Cardia; American Journal of Gastroenterology. Dec 1997, Vol. 92 Issue 12, p2220-2224.
27. JCY Wu, JJY Sung, EKW Ng. Prevalence and distribution of Helicobacter pylori in gastroesophageal reflux disease: a study from the East; AJGE;1999.
28. Raymond SY Tang, Justin CY Wu. Managing peptic ulcer and gastroesophageal reflux disease in elderly Chinese patients – focus on esomeprazole; Clin Interv Aging. 2013; 8: 1433–1443.
29. Uday C Ghoshal,Dipti Chourasia. Gastroesophageal Reflux Disease and Helicobacter pylori: What May Be the Relationship? J Neurogastroenterol Motil. 2010 Jul; 16(3): 243–250.
30. WernerSchwizer,Ronald A.HinderMD,Tom R.DeMeester. Does delayed gastric emptying contribute to gastroesophageal reflux disease? The American Journal of Surgery; Volume 157, Issue 1, January 1989, 74-81.
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