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

Spectrum and pattern of distribution of findings in patients with dyspepsia undergoing oesophago-gastro-duodenoscopy at a Tertiary Hospital in Ibadan, south west, Nigeria

Introduction: Dyspepsia is a symptom complex with varied underlying etiologies. The underlying etiology determines the precise treatment and prognosis though Helicobacter pylori infection plays a central role. The aim of this study was to describe the spectrum and pattern of distribution of findings in patients with dyspepsia undergoing oesophago-gastroduodenoscopy at the University College Hospital, Ibadan.Methods: A retrospective analysis of computerized database patients with dyspepsia who underwent oesophago-gastro–duodenoscopy from 2015 to 2019.Results: A total of 1,373 procedures were done and dyspepsia was the indication in 736 (53.2%) comprising 317 (43.1%) male and 405 (55%) female (P< .001). The age ranged from 18 to 100 with a mean of 50 ± 15 years. The age group 40–59 years had the highest representation (P = .00). The esophageal mucosa was normal in 592 (80.4%) while 45 (6.1%) and 36 (4.9%) patients had esophagitis and esophageal candidiasis, respectively. In the stomach, 230 (31%) patients had normal mucosa while 433 (57.5%) and 40 (5.4%) patients had gastritis and gastric ulcers, respectively. Antrum was the most commonly involved site by the gastritis and ulcers in 236 (55.8%) and 24 (60%) patients, respectively. The mean age of those with non-ulcer dyspepsia was 49.8 ± 15 while that of those with organic dyspepsia was 55.7 ± 13.7 years (P= .01). Furthermore, there was a significant correlation between the age group and organic dyspepsia (P = .00). The first part of the duodenum was normal in 594 (80.7%) while bulbar duodenitis was seen in 106 (14.4%).Conclusion: In our practice, OGD in patients with dyspepsia is either normal or yielded few abnormalities. The most common abnormalities were gastritis, duodenitis, esophagitis and gastric ulcers. Gastritis and ulcers were antral predominant and gastric ulcers were more common than duodenal ulcers. There was a significant relationship between increasing age and organic dyspepsia

Helicobacter pylori strains from a Nigerian cohort show divergent antibiotic resistance rates and a uniform pathogenicity profile

Antibiotic resistance in Helicobacter pylori is a factor preventing its successful eradication. Particularly in developing countries, resistance against commonly used antibiotics is widespread. Here, we present an epidemiological study from Nigeria with 111 isolates. We analyzed the associated disease outcome, and performed a detailed characterization of these isolated strains with respect to their antibiotic susceptibility and their virulence characteristics. Furthermore, statistical analysis was performed on microbiological data as well as patient information and the results of the gastroenterological examination. We found that the variability concerning the production of virulence factors between strains was minimal, with 96.4% of isolates being CagA-positive and 92.8% producing detectable VacA levels. In addition, high frequency of bacterial resistance was observed for metronidazole (99.1%), followed by amoxicillin (33.3%), clarithromycin (14.4%) and tetracycline (4.5%). In conclusion, this study indicated that the infection rate of H. pylori infection within the cohort in the present study was surprisingly low (36.6%). Furthermore, an average gastric pathology was observed by histological grading and bacterial isolates showed a uniform pathogenicity profile while indicating divergent antibiotic resistance rates

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

Comparative diagnostic efficacy of serum squamous cell carcinoma antigen in hepatocellular carcinoma

Background: Hepatocellular carcinoma (HCC) is a common liver malignancy in Nigeria. Hepatitis B and C viruses, alcohol and Aflatoxin B are among the various aetiologies. More work needs to be done in the search for markers that will aid early detection of this condition as it is uniformly fatal once advanced. Alphafetoprotein (AFP) remains the most widely used tumour marker of HCC detection in spite of its known shortcomings. The objective of this study was to determine the efficacy of serum squamous cell carcinoma antigen (SCCA) , in comparison to alphafetoprotein in the detection of HCC. Method: Sixty patients with HCC and thirty apparently healthy controls attending the Medical Outpatient Department(MOPD) of the University College Hospital Ibadan(UCH) Nigeria were selected for the study. Questionnaire was used to collect clinical data while AFP, SCCA levels, serum HBsAg and anti-HCV were determined using ELISA method- (Diagnostic Automation Inc. Canada). Abdominal ultrasound scan was also done. Result: Thirty one (51.7%) out of 60 selected cases were positive for HBsAg while six (20%) out of 30 controls were positive for HBsAg(p = 0.004). Out of the 60 cases selected for this study, only 2 (3.3.%) cases were positive for hepatitis C virus, while only 1(3.3%) out of 30 control was positive for hepatitis C virus(p = 0.74). The mean AFP value for cases with HCC was 393.21 ng/ml ±386.97 compared to the control group which was 5.60 ± 13.03 ng/ml (p value 0.001). The mean SCCA level was 0.64 ± 0.56 ng/ml and 0.71 ± 0.65 ng/ml for cases and controls respectively (p = 0.631). Conclusion: Alphafetoprotein remains a good tumour marker for the diagnosis of HCC. Serum squamous cell carcinoma antigen(SCCA) has no discriminatory power and may not be useful as a tumour marker for Nigerians with hepatocellular carcinom

Nutritional status and eating patterns of preschool children in a community in south-west Nigeria

Background: Malnutrition, an important global health problem, affects large numbers of children in developing countries hence making child malnutrition a major concern in these regions. The body’s capability to utilize appropriately adequate nutrient intake –quality and quantity, in order to meet its metabolic needs of health and fitness describes the concept of nutritional status.Objective: This study assessed the nutritional status of preschool children and their eating patterns.Methods: The study design was a cross-sectional survey carried out in a semi-urban community in south-western Nigeria. The sample consisted of 220 preschool children. A pretested questionnaire was used to assess the eating patterns of the children. Anthropometric measurements were carried out to determine the nutritional status of the children. Data generated was analyzed using Statistical Package for Social Sciences (SPSS) software. Cross tabulation and Chi square test were used to examine relationships between variables. Statistical significance was established at p < 0.05.Results: The overall prevalence of malnutrition in this study was low with stunting, underweight and wasting recording 8.1%, 7.7% and 1.9%, respectively thereby making stunting the most common malnutrition indicator in the study area. A large proportion (78.2%) of the children ate more than three times daily while 96.4% of the children constantly had regular specified number of meals daily.Conclusion: It is imperative that parents promote healthy eating habits in their children. This would go a long way in improving the health outcome of the child.Keywords: Nutritional status, eating pattern, preschool children, meal intak

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 plus or minus 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

A clinicopathological study of dyspeptic subjects in Lagos, Nigeria

The clinicopathological and endoscopic features of dyspepsia have not been well studied in Nigeria due to the high cost of gastroscopes and lack of the relevant expertise. This study was designed to highlight these features and possible risk factors. This prospective study was conducted on adult dyspeptic patients who fulfilled the study criteria from November 2007 to December 2008 at a University hospital in Lagos, Nigeria. Demographic and clinical presentation including possible risk factors were obtained through a questionnaire administered by an interviewer followed by an upper gastrointestinal endoscopy and gastric biopsy. Of the 123 subjects who took part in the study, 100 gave their consent to an upper gastrointestinal endoscopy and biopsy. The male:female ratio was 1:1, mean age was 44.98 (SD 15.4) years and the modal age group was 38-47years. The prevalence of dyspepsia was 29% and epigastric pain was the most common presentation. Endoscopic findings were superficial mucosal lesion (21%), peptic ulcer (16%), features of gastroesophageal reflux disease (10%), and gastric cancer (2%), as well normal findings (44%). Non-steroidal antiinflammatory drug (NSAID) use as a risk factor had a significant association with positive endoscopic findings; relative risk for development of positive endoscopic findings was 1.5% (P =0.03). Histology showed rates of chronic gastritis to be 91% and normal values 9%. The most common type of gastritis was the non-specific form (59.3%), followed by <em>H. Pylori</em>-associated gastritis (36.3%). The topography of gastritis was mainly pangastritis (68.1%) and antral predominant in 23.1%. The prevalence of<em> H. pylori</em> by histology was 41%. The presence of <em>H</em>. <em>pylori</em> was not associated with severity, location or duration of symptoms. H. pylori was, however, found to be a significant contributor to the development of positive endoscopic findings (P=0.01; OR 2.92 95% CI 1.50-3.17). Alarm symptoms were found to be important markers of malignancy. Dyspeptic illness is common,with peak incidence in the 4th decade of life and no gender predilection. Epigastric pain has the most discriminatory value with alarm symptoms in cases of gastric cancer. Risk factors such as NSAID use and <em>H. pylori</em> infection had a very significant impact on endoscopic findings while presence of <em>H. pylori</em>, smoking and alcohol consumption were associated with increased risk of developing chronic gastritis