Demographic, Endoscopic and Histopathologic Features Among Stool H. pylori Positive and Stool H. pylori Negative Patients With Dyspepsia

Abstract

BackgroundDyspepsia is a common presentation for many patients in gastroenterology clinics. Helicobacter pylori (H. pylori) infection is endemic in many countries around the world and its relation to dyspepsia has long been questioned. This study aimed at comparing demographic, endoscopic and histologic features among dyspeptic patients with and without stool H. pylori antigen positivity.MethodsOne hundred and fifty-one consecutive patients with dyspepsia were divided into group I (n = 80) and group II (n = 71) according to positive or negative H. pylori stool antigen testing, respectively. All patients were subjected to history taking, clinical examination, laboratory investigations, abdominal ultrasonography, H. pylori stool antigen detection, and upper gastrointestinal tract endoscopy with four gastric mucosal biopsies for histopathologic examination.ResultsStool H. pylori antigen negative group included more smokers and consumed much more fast and spicy food than the positive group. The most common endoscopic findings of both groups were gastritis, reflux esophagitis, gastric erosions, peptic ulcer, mucosal nodularity and hiatus hernia and were encountered in 100%, 74.2%, 23.2%, 15.2%, 13.9%, and 13.2% respectively with non-significant difference between both groups except for gastric erosions that were significantly higher in stool H. pylori negative group (P < 0.001). Histologic evidence of gastritis was reported in 100% and 92.9% of patients in group I and group II, respectively. Chronic active gastritis with neutrophil infiltration was significantly higher in group I (P < 0.001). H. pylori bacilli were histologically detected in 83.7% and 47.9% of patients in group I and group II, respectively (P < 0.001).ConclusionAll patients with dyspepsia in this study had endoscopic evidence of gastritis. Most of these patients had histologic evidence of gastric mucosal inflammation. Consequently, it may be advisable to perform endoscopy on these patients and obtain gastric mucosal biopsies.

Are Histopathological Changes of H. pylori Infection in Young Dyspeptic Patients Necessitate Endoscopy?

“…Histopathological examination proved the presence of H. pylori in gastric mucosa of only 77% of infection positive patients, somewhat similar to Mohamed Hasan et al, a study which discovered it histologically in 83.8% of stool antigen-positive [25]. This may be attributed to patchy colonisation of the microorganism.…”

“…The histopathological changes of gastric mucosa, which are the most important axis in this paper, are variable among most studies. In a study of Mohamed Hasan et al, gastritis had been identified histologically in 100% of H. pyloripositive population [25]. Non-atrophic (superficial) gastritis was detected in the majority of H. pyloriinfected individual with no risk of transformation to peptic ulcer or adenocarcinoma [26] while chronic atrophic gastritis is often associated with metaplasia with increased risk of adenocarcinoma [27].…”

Which Gastric Microbiota Associated with &lt;i&gt;H. pylori&lt;/i&gt; in Dyspeptic Patients with Gastritis

“…Third, the 98% pathology rate reported in dyspeptic patients. In fact this finding had been reported by one paper from our institution [15] which concluded that all dyspeptic patients had endoscopic and pathologic abnormality even in absence of positive H. pylori testing. When both groups of our study are compared there was a significant difference in chronic gastritis with erosive mucosa in dyspeptic patients than non-dyspeptic patients which emphasizes the findings of Emara et al, 2017 [15] who found pathologic gastric mucosa in all patients with dyspepsia, probably due to inclusion of patients from the same locality.…”

“…However, Egypt had high prevalence rates of infection that approaches 70% -90% in elderly population [14]. We usually rely on non-invasive use of H. pylori antigen in stool in daily medical practice [15].…”

Helicobacter pylori infection and risk of salmonella infection

“…H pylori infection: is defined in this study when the patient was positive or negative for H pylori antigen in stool provided that he did not receive any PPI or antibiotics in the last 4 weeks prior to the examination. [15,16]…”