Peptic ulcer disease in south Ethiopia is strongly associated with Helicobacter pylori

Abstract

Helicobacter pylori infection was detected in 93% of 174 patients with a peptic ulcer compared with 63% of 116 patients with normal findings (chi 2 = 37.3; P < 0.001) in a cohort of 834 consecutive patients examined by gastroscopy in Yirga Alem Hospital in south Ethiopia. Fourteen patients were given 14 days' treatment with metronidazole 500 mg t.i.d., doxycycline 100 mg b.i.d. and bismuth subnitrate mixture 150 mg q.i.d. Of 10 patients who returned for follow-up, only 2 patients were free from H. pylori and cured. Nineteen strains of H. pylori from 19 consecutive patients in the same hospital were tested for resistance in vitro against metronidazole, doxycycline and ampicillin. All but 1 were highly resistant to metronidazole; 2 were fully and 14 intermediate resistant against doxycycline. All strains were fully sensitive in vitro to ampicillin. Thus, peptic ulcer was strongly associated with H. pylori in south Ethiopia, but eradication of the infection was hampered by antibiotic resistance.

Profil épidémiologique des ulcères gastro-duodénaux au centre hospitalier et universitaire Campus de Lomé (Togo)

“…Dans l'étude de Diouf et al [5] au Sénégal, les résultats de 49 patients étaient retrouvés et la recherche de l' Helicobacter pylori à l'examen histologique était positive chez 41 patients (83,6%). Ce qui est largement supérieur à la valeur de notre série de même qu'en Ethiopie où Henriksen et al [21] [30,31]. En Afrique, tout individu pris à l'âge adulte et quel que soit son niveau socio-économique a vécu une enfance dans un environnement propice à la contamination [32].…”

Évolution de la prévalence des ulcères gastroduodénaux dans le centre d’endoscopie digestive de l’hôpital Aristide-Le-Dantec de Dakar

“…Ces prévalen-ces sont compatibles avec celles trouvées dans les pays du Sud [16,17]. Elles sont en corrélation avec le faible niveau socio-économique, reflété par la taille des familles (dix en moyenne dans notre étude).…”

“…Par contre, plusieurs cas de multirésistance au métronidazole, à la clarithromycine et même à l'amoxicilline et à la tétracycline ont été rapportés dans certains pays africains [16,20].…”

Prevalence and Emergence of Drug Resistance in Helicobacter pylori: Review

“…However, the frequency of Helicobacter pylori in dyspeptic (63%) and nondyspeptic patients (49%) using Enzyme Immuno Assay and in dyspeptic patients (70%), and non-dyspeptic patients (54%) using immunoblot, in the blood group O (43%) followed by A (23.5%), B (22.5%) and AB (11%) (Tadege et al, 2005). The study in South Ethiopia shows, endoscopic findings and Helicobacter pylori status of 834 consecutive gastroscopy patients, 22% normal, 9% oesophagitis and oesophageal carcinoma, 31%gastritis, 7% pyloric ulcer, 6% pyloric cancer, 16% doudnal ulcer, 13% pyloric stenosis (Henriksen et al, 1999 (20.4%) respectively. In this study, Helicobacter pylori among TB patients were higher compared with the data for healthy controls from the same area.…”

“…However, prevalence of Helicobacter pylori antibiotic resistance is increasing worldwide, and is the main factor affecting the effectiveness of current therapeutic regimens (Weerasekara et al, 2014). Helicobacter pylori resistance to antibiotics is uneven worldwide, being lower in developed countries and higher in developing Countries, and also in Ethiopia (Henriksen et al, 1999), due to widespread and indiscriminate use of antibiotics (Egan et al, 2007). The main antibiotic resistance mechanisms for Helicobacter pylori is point mutations on the chromosome of bacteria that leads to changes in each drug's site of action and acquisition of foreign genes carried on mobile genetic elements can also play a role (Weerasekara et al, 2014), in addition to frequent use of antimicrobials (selection pressure), so that the resistant bacteria resist and survive the harsh environment and followed by spread of the resistance genes and transferred by mobile genetic elements among bacterial population (Khademi et al, 2015).…”