Antibiotic resistance of helicobacter pylori from patients in Ile-Ife, South-west, Nigeria

Background: Helicobacter pylori has become recognized as a major cause of gastroduodenal diseases in man. Evidence indicates that once acquired; H. pylori persists; usually for life unless eradicated by antimicrobial therapy. Over the past few years; we have accumulated some knowledge of the epidemiology of H. pylori in Ile-Ife; South-West Nigeria. In one collaborative study; we detected H. pylori in 195 (73) patients referred for endoscopy at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). Furthermore we have observed a variegated gastric inflammatory response and atrophy including atrophic pangastritis but are yet to demonstrate MALToma in any of our patients. In addition we have demonstrated that dental plaque is a possible source of gastric H. pylori infection and such an endogenous source could account for difficulty in eradication leading to re-infection. Presently; infected patients are treated with standard combination therapy made up of amoxycilin and ciprofloxacin with a proton pump inhibitor /bismuth. Reports however have shown that the incidence of antimicrobial resistance in Helicobacter pylori is a growing problem and which has been linked with failures in treatment and eradication. Given this situation it has become necessary to have information about the susceptibility of isolates to particular antimicrobial agents before the selection of an appropriate treatment regimen. Objectives: More recently; we sought to study antimicrobial susceptibility of locally isolated H. pylori strains. Methods: We subjected 32 isolates to antimicrobial susceptibility testing against seven agents. Results: All the isolates showed multiple acquired antimicrobial resistance as they were all resistant to amoxicillin; clarithromycin; metronidazole; while 29/31; 27/31 showed resistance to rifampicin and tetracycline respectively. Five (15.6) of these isolates showed resistance to ciprofloxacin. Conclusions: Our findings suggest that H. pylori strains isolated within our study environment have acquired resistance to all the commonly pres-cribed antibiotics. On the basis of the findings it would be necessary to re-evaluate the eradication treatment regime in our setting

Helicobacter pylori in the dental plaque and gastric mucosa of dyspeptic Nigerian patients.

BACKGROUND: Presence of helicobacter pylori (H.Pylori) in the dental plaques may be associated with the presence of the same organism in gastric mucosa. OBJECTIVES: To assess and compare the prevalence of H. pylori in dental plaques and gastric mucosa of dyspeptic Nigerians. METHODS: Sixty-six consecutive patients undergoing endoscopy for investigation of dyspepsia were included in the study. A predesigned questionnaire was used to collect information on socio-demographic and other factors. Each patient also had clinical dental examination. Dental plaque scrapping was collected before endoscopy for helicobacter pylori culture, and at endoscopy, two gastric biopsy specimens were taken for culture and histology. RESULTS: The mean age (+/- SD) of the patients was 44.8 (+/- 17.4) years (range 5 to 80 years). The positivity rate of helicobacter pylori in gastric biopsy was 35 of 66 (53.0%) while the same for dental plaque was 46 of 66 (69.7%). The correlation (Spearman's) between gastric mucosa and dental plaque colonization with helicobactor pylori was significant (R = 0.30, P = 0.01). When concordant positivity of gastric biopsy culture and histology was taken as diagnostic, the sensitivity of dental plaque culture was found to be 82.9% and the specificity was 45.2%. CONCLUSIONS: This study revealed that helicobactor pylori has a high prevalence in the dental plaque of the population that we have studied and may therefore be of potential relevance in screening for such infection.