Raja Rajan, K (2013) A study of prevalence of helicobacter pylori in acid peptic disease and its sequelae. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Helicobacter pylori or Campylobacter pylori as earlier known, is possibly the most common human infection. It has been strongly linked to numerous gastro intestinal disorders ranging from non-ulcer dyspepsia to gastric malignancies. There is a wide geographical and ethnic distribution in the infection rate. Certain ethnic groups such as Africans and Hispanics have a much higher rate of infection. In general, people belonging to developing nations have a higher infection rate as compared to their counterparts in developed nations. The epidemiology of Helicobacter pylori infection in India is different from those in developed countries. The main difference lies in the early age of colonization, overt manifestation and high chances of re-infection with the bacteria. It was believed for a long time in the field of medicine that gastroduodenal ulceration was due to high levels of stress but it is now proven that it is this bacterium that lies at the core of causation of acid peptic disorder, gastric malignancies and gastrointestinal lymphoma. AIM OF THE STUDY: The present study undertaken aims at 1. Determining the prevalence of Helicobacter pylori infection in patients with Acid peptic Disease and its resultant sequelae. 2. Emphasizing the association of Helicobacter pylori with complications of peptic ulcer disease and the need for instituting anti H.pylori treatment for symptomatic cases. MATERIALS AND METHODS: Study Design: Descriptive Study. Period: January 2011 – December 2012. 100 Patients visiting the outpatient Department and those admitted as inpatients in Government Rajaji Hospital, Madurai with complaints of dyspepsia and abdominal pain consistent with Acid Peptic Disease or its resultant acute or chronic sequelae were selected at random. Institutional Ethical Committee Clearance was obtained and Informed Consent was obtained from the study subjects prior to subjecting them to any interrogation or investigation. METHOD: Instant- ViewR H.pylori Whole Blood/Serum Cassette Test manufactured by Alfa Scientific Designs Inc. was used for serological testing of patients to detect IgG antibodies to Helicobacter pylori. This commercially available kit has sensitivity of 95.1% and specificity of 94.1%. (Information supplied by the manufacturer). The whole blood test and serum test has comparably equivalent results. Upper Gastrointestinal Endoscopy was used to investigate the patients for the pathological process. RESULTS: 100 Patients, 50 male and 50 female who had symptoms of acid peptic disease or its sequelae or dyspepsia, who attended the outpatient Department of Government Rajaji Hospital, Madurai or those who had been admitted as inpatients in Government Rajaji Hospital, Madurai were selected at random and Serological Testing for IgG anti-Helicobacter pylori antibodies was done using a Instant View Qualitative Lateral Flow Immunochromatography Kit which is commercially available and also subjected to endoscopy whenever possible. Generalized abdominal pain was the most common complaint with which the patients presented (57%) followed by complaints of Epigastric Pain (14%). Hemetemesis and Malena were the least common presentation in our study (1%). The duration of complaints in majority of the cases were for less than 6 Months (48%) followed by Less than a week (37%) Most of these acute presentations were from Ulcer Perforation which a well known sequlae of Peptic Ulcer Disease. CONCLUSION: Helicobacter pylori is one of the most successful colonizers of the human stomach of almost half the world’s population. But only a small fraction of individuals develop H.pylori associated diseases. From this study, the conclusions that can be drawn are as follows: • Non –Invasive testing by serology is a sensitive and specific modality of testing for mass screening purposes. This is because of its good performance characteristics and technical simplicity. • Culture, microscopy and Rapid Urease Tests are the ‘gold standard’ in diagnosing H.pylori infection. • Patients with endoscopically proven peptic ulcers have a 87.8% positivity in H.pylori serology testing. • Among acute presentation of perforative peritonitis, upto 59.5% are H.pylori positive. • 60% of Distal Gastric Carcinoma are seropositive. • Among those with Non-Ulcer dyspepsia, only 22% were positive. • Treatment of Helicobacter pylori should be initiated at the earliest in positive cases. Eradication drastically reduces the recurrence of ulcers. • Symptomatic management of gastritis with PPI alone without evaluation and eradication of H.pylori leads to proximal migration of the organism and proximal gastric cancers increase in incidence. • It is always best to start with a regimen which has either Amoxicillin or Clarithromycin but never both in the same course. This prevents development of double resistance. • 2 weeks therapy is far better than 1 week course. • Eradication should be assessed 4 to 6 week after completion of therapy. • Serology is not the ideal test to evaluate eradication. Eradication is to be proven by Urease Breath Test , Rapid Urease Test or by Stool Antigen assay. • Persistent infection heralds resistance and requires susceptibility testing and treatment with second line or other rescue regimen. Helicobacter pylori infection is an ‘Ice Berg’ disease. The need of the hour is a well-targeted monotherapy that has least chance of leading to anti-microbial resistance. Helicobacter pylori is one of the most extensively studied bacteria in the history of human evolution and microbiology and yet it still remains the most difficult to comprehend and interpret. The Basic question of whether Helicobacter is a friend or foe still remains to be answered.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | helicobacter pylori ; acid peptic disease ; sequelae. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 05 Jun 2018 02:48 |
| Last Modified: | 05 Jun 2018 02:48 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/8203 |
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