Helicobacter pylori infection: past, present and future

The discovery of Helicobacter pylori (H. pylori) by Warren and Marshall in 1982 was preceded by nearly a hundred year of inconspicuous publications in regard to spiral bacteria, achlorhydria, gastritis, gastric urease, and antimicrobial therapy for peptic ulcers. The infection has now been implicated in the etiopathogenesis of chronic gastritis, peptic ulcer disease (PUD), gastric carcinoma, and gastric mucosal associated lymphoid tissue (MALT) lymphoma. The understanding of the etiopathogenesis of dyspepsia and the approach to its management continues to evolve such that PUD and MALT lymphoma are now being considered as infectious diseases in which elimination of the causative agent cures the conditions. Various diagnostic tests with good diagnostic accuracies have been developed and effective multiple antimicrobial therapies are now available for the eradication of the infection. Despite the substantial progress made, there still exits a considerable gap to be filled. A significant number of information generated from studying the bacterial characteristics and host response to the infection has not yet been translated into clinical practice. A major challenge is the absence of a specific antibiotic monotherapy for effective treatment of the infection.Pan African Medical Journal 2016; 2

Prevalence of erectile dysfunction and possible risk factors among men of South-Western Nigeria: a population based study

Introduction: Erectile dysfunction (ED) is currently one of the most common sexual dysfunctions worldwide but it is usually underestimated because it is not a life threatening condition. The associated stigma makes men who have it to suffer in silence. This study was conducted to determine the prevalence of erectile dysfunction and the possible associated risk factors among Nigerian men. Methods: The study was a descriptive cross-sectional population based survey among men aged 30-80 years in Ogbomoso, South-west, Nigeria. A multistage random sampling method was used. The instrument used was the International Index of Erectile Function Questionnaire-5 (IIEF-5). Unadjusted odds ratios of possible risk factors were calculated by univariate analyses. Binary logistic regression analysis was used to eliminate the effect of possible confounders on the risk factors to get the adjusted odds ratios. Results: The general prevalence of ED in this study was 58.9%. Sixty-seven (47.2%), 16 (11.3%) and 59(41.5%) respondents had mild, moderate and severe ED respectively. Age, hypertension, use of anti-hypertensive drugs, diabetes mellitus and heart disease all had significant unadjusted associations with ED, but their adjusted associations were not statistically significant. Diabetes mellitus maintained a positive statistically significant relationship with ED after adjustment for potential confounders [OR= 8.31(95% CI 1.02 - 67.65), P= 0.048]. Conclusion: The prevalence of ED is high among south-western Nigeria male adults. Physicians, especially primary care ones, need to pay more attention to the sexual history of their patients in order to diagnose and manage ED more frequently.Pan African Medical Journal 2016; 2

Prevalence of gastrointestinal symptoms and related drug use among pregnant women of South-Western Nigeria

Background: Gastrointestinal (GI) symptoms are quite common in pregnancy but there is paucity of data in regard to their frequencies in the south-western part of Nigeria. This study was conducted to determine the prevalence of various gastrointestinal symptoms and related drug use among south-western Nigerian women.Methods: A cross-sectional multicenter study involving three centers in two states of south-western Nigeria from March to August 2014. A composite questionnaire consisting of demographic data, anthropometric indices, obstetrics information, a list of gastrointestinal symptoms and drug usage was administered to 420 consecutive healthy pregnant women at various gestational ages. Data were analysed and presented as means ±S.D, frequencies and percentages.  Relationships between categorical variables were explored with chi-square test. A 5% significance level (p < 0.05) was considered significant.Results: Respondents had age range of 18-43years and a mean of 27.26 (±4.98). The commonest gastrointestinal symptom was nausea (46.9%), followed by vomiting (45.0%) and then anorexia (36.2%). Excessive salivation, heart burn, constipation, regurgitation, and bloating had frequencies of 35.5%, 28.3%, 20.7%, 19.0% and 18.3% respectively. Epigastric pain was the least frequent among the symptoms (16.9%).The association between the parity of respondents and each of the GI symptoms was not statistically significant. But associations between educational status and excessive salivation and anorexia were statistically significant (P-value of 0.018 and 0.023 respectively). Subjects with heartburn had the highest drug usage (23.5%), followed by those with vomiting (22.8%). Subjects with excessive salivation (2%) had the least drug intake.Conclusions: Gastrointestinal symptoms are common among pregnant women of south-western Nigeria. There is need for the physician to be abreast with the prevalence of the common pregnancy related GI problems in the particular locality of practice and the appropriate way to manage them.

PREVALENCE OF HEPATITIS C VIRUS ANTIBODY AMONG UNDERGRADUATES IN OGBOMOSO, SOUTH-WESTERN NIGERIA

Background: This study was conducted to determine the prevalence of hepatitis C virus antibody (anti-HCV), among a healthy university undergraduate population in south-western Nigeria. Materials and Methods: Relevant medical information of students who underwent the post-admission screening exercise for the year 2012, at the Ladoke Akintola University of Technology (LAUTECH), Health Center, Ogbomoso were extracted from the laboratory log book. All tests were done using rapid anti-HCV test kit by Health - Chem diagnostics, USA. A total of 1,572 students were included in the study. The mean age was 19.61 (± 2.75) years while the age range was 15- 50 years. A total of 821 (52.20%), of the subjects were males while 751 (47.80%) were females. More than ninety nine percent (99.90%) of the subjects were aged 15-30 years, whereas those aged ≥31 years were comparatively few (0.60%). Results: Of the 1572 students, 6 tested positive, giving an overall prevalence of 0.40%. Three (0.37%) of the 821 male subjects tested positive while 3(0.40%) also of the 751 female subjects tested positive. Age-group 21-30 years had the highest prevalence of anti - HCV (0.50%), followed by age-groups ≤ 20 years with 0.30% prevalence. None of the subjects in age-groups 31-40 and ≥ 41 years tested positive. Conclusion: These observed differences were not statistically significant. The prevalence of Hepatitis C Virus is low among the young healthy undergraduate population in the south - western region of Nigeria

The Helicobacter pylori Genome Project : insights into H. pylori population structure from analysis of a worldwide collection of complete genomes

Helicobacter pylori, a dominant member of the gastric microbiota, shares co-evolutionary history with humans. This has led to the development of genetically distinct H. pylori subpopulations associated with the geographic origin of the host and with differential gastric disease risk. Here, we provide insights into H. pylori population structure as a part of the Helicobacter pylori Genome Project (HpGP), a multi-disciplinary initiative aimed at elucidating H. pylori pathogenesis and identifying new therapeutic targets. We collected 1011 well-characterized clinical strains from 50 countries and generated high-quality genome sequences. We analysed core genome diversity and population structure of the HpGP dataset and 255 worldwide reference genomes to outline the ancestral contribution to Eurasian, African, and American populations. We found evidence of substantial contribution of population hpNorthAsia and subpopulation hspUral in Northern European H. pylori. The genomes of H. pylori isolated from northern and southern Indigenous Americans differed in that bacteria isolated in northern Indigenous communities were more similar to North Asian H. pylori while the southern had higher relatedness to hpEastAsia. Notably, we also found a highly clonal yet geographically dispersed North American subpopulation, which is negative for the cag pathogenicity island, and present in 7% of sequenced US genomes. We expect the HpGP dataset and the corresponding strains to become a major asset for H. pylori genomics

Prevalence of helicobacter pylori among Nigerian patients with dyspepsia in Ibadan

Introduction: Determination of the true prevalence of Helicobacter pylori (H. pylori) is difficult in a hyper-endemic area like Nigeria with use of serological tests because of their low discriminatory power between previous and current infections. The use of biopsy based methods will go a long way to mitigate this problem. We investigated the prevalence of H. pylori in dyspeptic patients and its relationship with gastroduodenal pathologies using gastric biopsy histology and rapid urease test. Methods: Eighty-six consecutive adult patients with dyspepsia underwent upper gastrointestinal endoscopy using forward-viewing endoscopes. Antral biopsy specimens were collected for histology and rapid urease test. Diagnosis of H. pylori infection was made if both or either of the tests was positive. Results: Of the 86 subjects, there were 39 (45.3%) males and 47(54.7%) females. The age range was 23 to 85 years with a mean of 49.19±13.75 years. Diagnosis of H. pylori was made in 55(64%) patients. Gastritis was the commonest endoscopic finding (60.5%), serious gastroduodenal pathology (gastric ulcer, duodenal ulcer and gastric cancer) were documented in only 12 (14%) patients. Thirty three (63.5%) of the 55 patients with gastritis had H. pylori infection while 7(58.3%) of the 12 patients with serious gastroduodenal lesions had the infection. Thirteen (72.2%) of the 18 patients that had normal endoscopic findings were H. pylori positive. Conclusion: The prevalence of H. pylori among dyspeptics using biopsy based methods is high in the South-Western part of Nigeria. It is therefore important to test and treat H. pylori among Nigerians with dyspepsia

Multiple hepatic hemangiomas in a Nigerian man

Hepatic hemangiomas are benign tumors of the liver which are often found incidentally. We present a 34-years-old man with a two-month history of upper abdominal pain and incidental finding of multiple hepatic masses. The patient sought medical attention at several healthcare facilities where he posed a diagnostic dilemma before he was referred to us. Computed tomographic scan revealed four hypodense hepatic nodules of varying sizes. The nodules demonstrated peripheral enhancement with progressive centripetal filling till they were totally filled during the delayed phase. Abdominal ultrasonography confirmed the four hepatic lesions. The largest lesion was in the left lobe measuring 73×72 mm while the smallest was in the right lobe (24×20 mm). All the masses demonstrated increased vascularity on color Doppler imaging. The paucity of reported cases of hepatic hemangioma in Nigeria, the multiplicity of the tumor and the giant size of one of them make this case remarkable and reportable

Prevalence of Irritable Bowel Syndrome, Psychological Ill-Health and Health-Seeking Behavior in a Population of Nigerian Medical Students

Background: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder with considerable morbidity and profound negative impact on quality of life. It has been observed that patients with psychological disturbances relate more frequently with the symptoms of IBS, and they have more debilitating illness than control populations. We examined the prevalence of IBS among a population of Nigerian medical students and its association with two common psychological conditions (anxiety and depression). Methods: In a descriptive cross-sectional study, we enrolled 321 consenting medical students aged 20 to 50 years. A 34-item self-reporting questionnaire consisting of sociodemographic data, the Rome III IBS questionnaire, the Hospital Anxiety and Depression Scale and two IBS-related health-seeking behaviour questions was administered to the participants. Statistical analysis was done with the IBM-Statistical Package for Social Sciences (SPSS), version 20. Results: A total of 320 participants were included in the analyses. The mean age of the participants was 26.3 ±4.1 years. The prevalence of IBS among the medical students was 14.4%, and IBS-M was the predominant subtype (58.7%). IBS had a significant relationship with the female gender [OR =2.19 (95% CI, 1.14 – 4.22), P =0.019] and anxiety [OR 1.18 (95% CI, 1.061.32), P =0.003]. The disease showed no significant association with other risk factors considered. IBS health-seeking behaviour was significantly associated with depression [OR = 8.89(95% CI, 1.66 - 47.51), P\u3c0.001]. Conclusion: IBS is moderately prevalent among our study population, and it is positively associated with the female gender and anxiety

Prevalence of Irritable Bowel Syndrome, Psychological Ill-Health and Health-Seeking Behavior in a Population of Nigerian Medical Students

Background: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder with considerable morbidity and profound negative impact on quality of life. It has been observed that patients with psychological disturbances relate more frequently with the symptoms of IBS, and they have more debilitating illness than control populations. We examined the prevalence of IBS among a population of Nigerian medical students and its association with two common psychological conditions (anxiety and depression). Methods: In a descriptive cross-sectional study, we enrolled 321 consenting medical students aged 20 to 50 years. A 34-item self-reporting questionnaire consisting of sociodemographic data, the Rome III IBS questionnaire, the Hospital Anxiety and Depression Scale and two IBS-related health-seeking behaviour questions was administered to the participants. Statistical analysis was done with the IBM-Statistical Package for Social Sciences (SPSS), version 20. Results: A total of 320 participants were included in the analyses. The mean age of the participants was 26.3 ±4.1 years. The prevalence of IBS among the medical students was 14.4%, and IBS-M was the predominant subtype (58.7%). IBS had a significant relationship with the female gender [OR =2.19 (95% CI, 1.14 – 4.22), P =0.019] and anxiety [OR 1.18 (95% CI, 1.061.32), P =0.003]. The disease showed no significant association with other risk factors considered. IBS health-seeking behaviour was significantly associated with depression [OR = 8.89(95% CI, 1.66 - 47.51), P\u3c0.001]. Conclusion: IBS is moderately prevalent among our study population, and it is positively associated with the female gender and anxiety