Prevalence of Helicobacter pylori infection in Peptic Ulcer Diseases in Manipur - a hospital based study

Dr Manoj Mishra (PGT), Dr Ksh Gomti (Prof)Department of Physiology,Regional Institute of Medical Sciences,Imphal, Manipur.

Introduction : H pylori

a gram – negative spiral bacteria causes chronic gastritis, peptic ulcer disease,

gastric mucosa-associated lymphoid tissue

(MALT) lymphoma, and gastric canceran estimated 50% of world’s population is

colonizedprevalence is decreasing in the Western world

but remains widespread in the developing worldInfection with H. pylori can be diagnosed with

cheap, simple, reliable, technique in the community level and hence can often be successfully treated timely

Aims and Objects :

To determine the prevalence of H. pylori infection in PUD patients attending RIMS hospital

To assess the association between H. pylori infection and variables like age, sex, occupation, diet, drugs and symptoms

Materials and Methods:Cross sectional studyA hospital based study, RIMS, Imphal,

ManipurDuration: Oct’ 2011- Nov’ 2012Study population : PUD patients with dyspeptic symptoms, blotting, epigastric pain, GERD, indication for endoscopy & referral to

surgical gastroenterology for MAS.

Exclusion criteria: Pts with any organic diseases H/o alcoholism Use of steroids / NSAID H/o H2 blockers Proton pump inhibitors Antibiotics intake 1week prior to study Age < 18 years

60 cases of PUD taken up in the study.

Study tools: (SD – BIOLINE) H. pylori test kit is used

(Sensitivity : 95.9%. Specificity : 89.6%.) It’s a rapid test for detection of antibody

IgG specific to H. pylori in human serum, plasma and whole blood.

Manufacturer : SD STANDARD DIAGNOSTICS PVT LTD

Haryana, India. 20 µl of whole blood is added to sample well,

3 drops of assay diluents added and test results interpreted at 10 minutes

Limitation of the test :

1. A negative result does not preclude the possibility of infection with H. pylori.

2. As with all diagnostic tests, a definitive clinical diagnosis should not be based on the result of a single test but should only be made by the physician after all clinical and laboratory findings have been evaluated.

Figure 1: Age prevalence of patients with Peptic Ulcer mean age : 41.61±14.97

18 - 27 28 - 37 38 - 47 48 - 57 58 - 67 68 - 77 78 - 870

5

10

15

20

25

30

20

25

15

23.3

15

1.7

Age in interval

perc

en

tag

e

Table 1. Distribution of patients according to gender:

Sex No. of patients Percentage (%)

Male 37 61.7

Female 23 38.3

Total 60 100

Table2. Distribution of patients according to religion :Religion No. of patients Percentage

(%)

Hindu 39 65

Christian 14 23.3

Muslim 7 11.7

Total 60 100

Table3. Distribution of Patients according to Occupation :Occupation No. of patients Percentage (%)

Laborers 8 13.3

Farmers 5 8.3

Social workers 7 11.6

Housewives 10 16.6

Students 2 3.3

Government servants

9 15

Businessmen 14 23.3

Teachers 5 8.3

Total 60 100

Table4. Distribution of Patients according to Symptoms :Symptoms No. of patients Percentage (%)

Abdominal pain 33 55

Nausea 4 6.7

Vomiting 2 3.3

Nausea, vomiting, loss of appetite

11 18.3

Haematemesis 5 8.3

Malaena 3 5

Fullness of abdomen

2 3.3

Total 60 100

Table 5. Past treatment drug history

Past treatment No. of patients Percentage (%)

Taken antibiotics, PPI or H2 blocker > 1 wk back

42 70

Not taken antibiotics, PPI or H2 blocker > 1 wk back

18 30

Total 60 100

Table 6. Results of Helicobacter pylori antibody test :H. Pylori antibody (SD BIOLINE)

No. of patients Percentage (%)

Positive 12 20

Negative 48 80

Total 60 100

H. Pylori positive status : * significant

H. pylori + n (%) - n (%) Total (%) P value

1 Age <47 5 (8.3) 31 (51.6) 36 (60) 0.13

>47 7 (11.6) 17 (28.3) 24 (40)

2 Sex Male 8 (13.3) 29 (48.3) 37 (61.6) 0.48

Female 4 (6.6) 19 (31.6) 23 (38.3)

3 Religion Hindus 9 (15) 30 (50) 39 (65) 0.51

Others 3 (5) 18 (30) 21 (35)

4 Occupat’n Sedentary 10 (16.6) 18 (30) 28 (46.6) 0.007*

Hard work

2 (3.3) 30 (50) 32 (53.3)

5 Diet Veg 3 (5) 16 (26.6) 19 (31.6) 0.52

Non - veg 9 (15) 38 (63.3) 41 (68.3)

6 Drug taken >1w 4 (6.6) 38 (63.3) 42 (70) 0.003 *

Not taken>1w

8 (13.3) 10 (16.6) 18 (30)

7 Symptoms Abdominal pain

7 (11.6) 26 (43.3) 33 (55) 0.79

Others symptoms

5 (8.3) 22 (36.6) 27 (45)

Discussion : 60 cases of PUD have been screened. 12 cases have been detected positive for H. pylori. (Mean age ± SD) is 41.61±14.97 The prevalence of H. pylori is significantly low (20%)

as compared to study by V. Kate et al (87%) in Chennai and by GH. Jeelani et al (76%) in highly endemic Kashmir.

However, eradication of H. pylori is still strongly suggested for the positive cases. Awareness program to be carried out to the public at all levels.

Weel.J.F.L, et al reported that different virulent and non virulent strains of H. pylori exist and that only virulent strains of H. pylori are ulcerogenic.

Conclusion :The prevalence of H. pylori - 20%The positivity may be due to sedentary life,

abstaining anti ulcer drugs, dietary habits, socio-economic status and environment.

The advantageous aspect is the simplicity of the rapid antibody test kit technique, using whole blood which is cheap, reliable and accurate with spot diagnosis at bedside as the screening test of choice.

References :

GH. Jeelani Romshoo, et al. Prevalence of Helicobacter pylori infection in peptic ulcer patients of highly endemic Kashmir valley – a preliminary study.

V. Kate, et al. Prevalence of Helicobacter pylori infection in disorders of the upper gastrointestinal tract in south India.

Johannes G, et al. Pathogenesis of Helicobacter pylori Infection.

Jones R, et al. An evaluation of near patient testing for H. pylori in general practice.

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On … 21.12. 2012 !

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