Alimentary tract and pancreas

Alimentarni trakt i pankreas

1Yasar Nazligul,

2Muharrem Btirenen,

1H. Ilyas Ozardali,

3Mustafa Ulukanligil,

1Bülent Tumkaya

Departments of 1Internal Medicine,

2Pathology2 and 3Microbiology,

Harran University Medical Faculty,

Sanliurfa, Turkey.

ARCH GASTROENTEROHEPATOL 2003; 22 (No 1 - 2): 12 – 17

Helicobacter pylori infection

in dyspepsia subgroups in

one region of Turkey

Infekcija Helicobacter-om pylori u podgrupama

dispepsija u jednom regionu Turske

(accepted April 6th 2003 )

Key Words:

Functional dyspepsia,

subgroups,

Helicobacter pylori.

Abstract

Purpose: Different subgroups exist among patients with functional dyspepsia (FD) based on predominant

symptoms. The aetiopathogenesis of symptoms is still unclear; however, Helicobacter

pylori (H. pylori) and several other factors have been implicated. We investigated H. pylori prevalence

in FD subgroups and compared with non-dyspeptic controls.

Methods: The study carried out on 174 patients with FD and 17 non-dyspeptic subjects, which

underwent upper gastrointestinal endoscopy. H. pylori identification was done by histology using

biopsy samples taken from antral mucosa.

Results: H. pylori was identified in 86 of 111 (77.5%) patients in ulcer like subgroup, 22 of 36

(61.1%) patients in dysmotility like subgroup, in 19 of 27 (70.4%) patients in unspecified subgroup,

in 12 of 17 (70.6%) in controls. H. pylori prevalence in patients with ulcer like dyspepsia was higher

than other subgroups and controls, but differences were not statistically significant.

Conclusion: Our data imply that Helicobacter pylori infection has not an important influence on

symptoms in patients with functional dyspepsia.

Sazetak

Cilj: Medju pacijentima sa funkcionalnom dispepsijom (FD) postoji vi{e razli~itih podgrupa koje su

formirane na osnovu preovladjuju}ih simptoma. Etiopatogenetski uzrok tegoba nije u potpunosti

jasan. Medjutim medju ostalim ~iniocima ~ini se da Helicobacter pylori (HP) ima zna~ajnu ulogu.

U ovoj studiji na{ cilj je bio da ispitamo prevalenciju HP u podgrupama FD te da dobijene rezultate

uporedimo sa kontrolnom nedispepti~kom grupom.

Metode: Ova studija je obuhvatila 174 pacijenta sa FD i 17 osoba nedispepti~kim tegobama koje su

iz drugih razloga bile podvrgnute proksimalnoj digestivnoj endoskopiji. Identifikacija HP je na~injena

na osnovu histolo{kih pregleda uzoraka antralne sluznice.

Rezultati: HP je bio otkriven u 86 od 111 (77.5%) pacijenata sa dispepsijom ulkusnog tipa, 22 od

36 pacijenata (61.1%) sa dispepsijom tipa dismotiliteta, i u 19 od 27 osoba (70.4%) sa nespecificiranom

FD. U kontrolnoj grupi 12 od 17 (70.6%) je bilo HP pozitivno. U ispitanika sa FD ulkusnog

tipa prevalencija HP je bila vi{a nego u drugim podgrupama FD, medjutim razlika nije bila statisti~ki

signifikantna.

Zakljucak: Rezultati na{eg ispitivanja ukazuju da infekcija sa HP nije od presudnog zna~aja na

simptome pacijenata sa FD.

Kljucne reci:

funkcionalna dispepsija,

podgrupe,

Helicobacter pylori.

INTRODUCTION

Dyspepsia has been defined as chronic or recurrent epigastric

pain or upper abdominal discomfort whith accompanied

symptoms such as nausea, early satiety, postprandial

fullness or bloating. Approximately half of all patients

with dyspepsia do not have definite structural or laboratory

explanation for their symptoms, and are labeled as having

functional dyspepsia (FD). The patients with FD are

subcategorized according to predominant symptoms into

ulcer like dyspepsia, dysmotility like dyspepsia and

unspecified dyspepsia (1-4).

The etiopathogenesis of FD is unclear; however, it has

been implicated various factors such as motility disorders,

gastric acid, visceral hypersensitivity, central nervous system

dysfunction, psychological factors, and H. pylori

infection (4-7).

The aim of the present clinical study was to investigate

H. pylori prevalence in FD subgroups and to compare with

non-dyspeptic subjects.

PATIENTS AND METHODS

One hundred seventy four patients (98 female, 76 male,

mean age 38.3 ± 13.8 years, range 15-77 years) with dyspeptic

symptoms for more than 3 months were studied. All

patients' dyspeptic symptoms were recorded before

endoscopy. Heartburn and acid regurgitation were not recognized

as dyspeptic symptoms (4). Exclusion criteria

were alcohol consumption, use of nonsteroid antiinflammatory

drugs, prior gastric surgery, previous H. pylori

eradication treatment, upper gastrointestinal malignancy,

oesophagitis, peptic ulcer, endoscopic duodenitis and

abnormality at biochemical analyses or upper abdominal

ultrasonography. Patients were classified according to predominant

symptom as follows; those with epigastric pain

(ulcer like dyspepsia), those with symptoms of early satiety

- nausea or postprandial fullness (dysmotility like dyspepsia),

those that were not fulfilling for above subgroups

(unspecified dyspepsia) (1-4).

Control group consisted of 17 non-dyspeptic subjects

(9 female, 8 male, mean age 42.9 years, range 25-71). They

were underwent upper gastrointestinal endoscopy for iron

deficiency anemia, weight loss or the fear of cancer, and

did not have any organic lesion.

During oesophagogastroduodenoscopy, two biopsy

specimens were taken from antral mucosa. Biopsy specimens

were fixed 10% formalin. Tissue sections were

stained with May Grunwald-Giemsa, and examined under

an optical microscope. H. pylori infection was diagnosed

with the observation of the curved, spiral-or-S shaped,

violet-blue stained organisms. Bacterial density were not

taken into account.

Statistical analyses were performed using the Kruskal-

Wallis test. Statistical significance was set at p < 0.05.

RESULTS

Distribution of FD patients to subgroups: There were

111 (63.8%) ulcer like FD, 36 (20.7%) dismotility like FD

and 27 (15.5%) unspecified FD patients comprising 174

patients in total. Age, sex, smoking and H. pylori positivity

of FD subgroups and control group are shown in Table

1. Groups were found to be similar similar according to

age, sex and smoking attributes (p>0.05). H. pylori positivity

didn't show a significant difference but it is highest

in ulcer like group and lowest in dismotility like group (in

order; 77.5%, 61.1%). The average age of patients with

ulcer like dyspepsia was lower, but not significant

(p >0.05).

DISCUSSION

H. pylori have a causal role in the development of peptic

ulcer. The eradication of this microorganism prevents

relapse of peptic ulcer. However, the controversial explanations

on H. pylori and functional dyspepsia are still lasting

(8).

Providing that H. pylori infection has a causal role in

development of dyspepsia symptoms, H. pylori prevalence

in patients with FD is expected to be higher than in non-dyspeptic

subjects, and dyspepsia symptoms must be relieved

by eradication therapies. In the present study we found that

H. pylori prevalence was not significantly different between

dyspepsia subgroups and non-dyspeptic persons. This was to

confirm Pereira-Lima group results that the frequencies of

H. pylori infection were similar in ulcer like, dismotility

like, unspecified dyspepsia groups and controls (9). In

Wilhelmsen study H. pylori infection was diagnosed in 34%

patients with FD and 36% controls; the patients had higher

psychological scores than normal control regardless of H.

pylori status (10). An investigation carried out on a large

Japanese population revealed that there was no significant

relationship between H. pylori infection and any type of FD;

symptoms frequency had a tendency to decline with age,

while the rate of H. pylori infection increased with age (11).

ERADYS Study Group did not demonstrate any substantial

benefit of eradicating H. pylori in patients with FD.

Eradication therapies can cause an improvement in antral

gastritis, but the emptying of solids and gastric acid secretion

were not modified (12,13).

The study of McColl and colleagues showed that dyspepsia

had resolved in 21% of patients treated with

omeprazole and antibiotic, 7% of the group were given

omeprazole alone one year after the completion of treatment

(14). The cure of H. pylori was seen to be effective in

reducing dyspepsia symptoms in employees with H. pylori

infection and functional dyspepsia in a Japanese industrial

corporation (15). High H. pylori IgG titers is stated as a

risk factor for the subgroup of FD, which is described as

frequent dyspepsia (> 6 episode/ recent one year) (16). A

multicentric study demonstrated that eradication led to

improvement of dyspeptic symptoms in approximately 9%

of patients (17)

It is possible that the contradictory results related to FD

and H. pylori may be arisen from the differences of the

study groups. The disease overlaps with its own subgroups

and other functional diseases of alimentary tract (3,18,19).

Therefore, it is difficult to homogenize the research groups

and to find a parallelism among groups of different studies.

Also the removal of gastroesophageal reflux symptoms

and eructation from the dyspepsia description reduced the

group similarities among studies.

The dyspepsia symptoms of some patients with functional

dyspepsia may be related to H. pylori infection, but

our data didn't show any relationship between the major

subgroups of functional dyspepsia and H.pylori infection.

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