Peptic disease and Helicobacter pylori are highly prevalent in patients with the indeterminate form of chagas’ disease: report of 21 cases

Abstract

Given that chagasic patients in the indeterminate form of this disease, can have abnormal motility of the digestive tract and immunologic abnormalities, we decided to assess the frequency of peptic disease and Helicobacter pylori (Hp) infection in these individuals. Twenty-one individuals, 13 males and 8 females, mean age 37.6 +/- 11.1 years, were examined. Biopsies of the duodenum, antrum, lesser and greater gastric curvature and esophagus were performed. The endoscopic findings were of chronic gastritis in 20 (95.2%) patients, duodenal ulcer in 3 (14.3%), gastric and duodenal ulcer in 3 (14.3%), gastric ulcer alone in 1 (4.8%), esophagitis in 5 (23.8%), and duodenitis in 5 (23.8%). The diagnosis of infection by the Hp was done by the urease test and histologic examination. Hp infection was found in 20 (95.2%) individuals: in 20 out of them in the antrum, in 17 in the lesser curvature, and in 17 in the greater curvature. Hp was not found in the esophagus and duodenum. The only individual with no evidence of infection by Hp was also the only one with normal endoscopic and histologic examinations. The histologic examinations confirmed the diagnoses of gastric ulcer as peptic, chronic gastritis in 20 patients, duodenitis in 14, and esophagitis in 9. In this series the patients had a high frequency of peptic disease, which was closely associated with Hp infection.

Histological and endoscopic features of the stomachs of patients with Chagas disease in the era of Helicobacter pylori

“…The high prevalence of co-infection with T. cruzi and H. pylori in our study (approximately 70%) and in other studies is not surprising because the transmission of both of these pathogens is associated with poor socioeconomic conditions [13][14][15][16][17] . Moreover, in Brazil, which is considered a developing country, the overall prevalence of H. pylori is high and varies from 55% to 87% according to the geographical region 30,31 .…”

“…We found a high prevalence of gastritis and H. pylori infection in both groups of chagasic and non-chagasic patients in the present study. Although two previous studies have reported similar fi ndings for a small group of chagasic patients 13,14 , this is the fi rst controlled study to demonstrate that H. pylori is the major cause of gastritis in patients with Chagas disease.…”

“…In the present study, the prevalence of gastric ulcers was also higher than duodenal ulcers among the chagasic patients; however, no signifi cant difference was observed compared with the control group. In contrast, two uncontrolled studies of patients with megaesophagus 11 and with the indeterminate 14 clinical form of Chagas disease showed a similar prevalence of gastric ulcers and duodenal ulcers. A critical comparison of the fi ndings of all of these studies is hampered because the study designs and the clinical forms of the evaluated chagasic patients are different.…”

“…After the discovery of H. pylori, two uncontrolled studies that evaluated a small group of patients with the digestive 13 and indeterminate 14 forms of Chagas disease reported a high prevalence rate of both gastritis and H. pylori infection (~95%) in these patients using histological diagnosis. Later, Pinazo et al 15 detected a high prevalence of H. pylori infection, which was diagnosed using the urea breath test, among Latin American immigrants living in Barcelona that had the digestive form of Chagas disease.…”

Seroprevalence of Helicobacter pylori infection in chagasic and nonchagasic patients from the same geographical region of Brazil

“…Later, some studies demonstrated a high prevalence of H. pylori infection in patients with Chagas disease [13][14][15][16] . As this small number of studies on T. cruzi and H. pylori co-infection had no control groups and/or included a low number of patients, we evaluated the prevalence of H. pylori infection among chagasic and non-chagasic subjects living in a region previously considered endemic for Chagas disease.…”