ABSTRACT
Background: Dyspepsia is one of the common complaints in all sectors of the Indian population. It is diagnosed in the presence of symptoms thought to originate from gastroduodenal region and if there is no organic cause to explain dyspeptic symptoms on upper gastrointestinal endoscopy, the patient is labeled as functional dyspepsia (FD). Helicobacter pylori, a Gram-negative bacilli harboring in the acidic gastric environment has been said to be the causative agent, but this association has not been proved in Indian population. Hence, this study was conducted to find out the prevalence of H. pylori in FD. Methods: After the approval from Institutional Ethics Committee, patients presenting with symptoms of dyspepsia of both sex, within age group of 18-60 years and any dietary habit were enrolled in the study. After a detailed history and complete general and systemic examination, patients were subjected to gastroduodenoscopy. On endoscopy, if no lesion was observed, then the patient was labeled as FD. The severity of dyspepsia symptoms was assessed by seven-point global overall symptom (GOS) scale. Patients were then screened for H. pylori infection by both invasive (rapid urease, Gram staining, and culture) and non-invasive tests (C-14 urea breath test). Results: The prevalence of H. pylori in FD was found to be 63.38%. Among 90 H. pylori positive FD patients, 56% were male, 58.89% were below the age of 40 years, and 53.33% belonged to middle income group. The average GOS score for dyspepsia symptoms was 6.01±0.64. Epigastric pain and mild gastritis were the most common presenting symptom and endoscopic finding, respectively. Conclusion: Our results suggest that H. pylori is an important causative factor for dyspeptic symptoms in patients of FD. Hence, all the FD patients must be investigated for H. pylori and treated promptly.
ABSTRACT
PURPOSE: The C-14 urea breath test (C-14 UBT) is the most specific noninvasive method to detect Helicobacter (H) pylori infection. We investigated if the C-14 UBT can reflect the presence and degree of H. pylori detected by gastroduodenoscopic biopsies (GBx). MATERIALS AND METHODS: One hundred fifty patients (M:F=83:67, age 48.6+/-11.2 yrs) underwent C-14 UBT, rapid urease test (CLO test) and GBx on the same day. For the C-14 UBT, a single breath sample was collected at 10 minutes after ingestion of C-14 urea (137 KBq) capsule and counting was done in a liquid scintillation counter for 1 minute, and the results were classified as positive ( 200 dpm), intermediate (50~199 dpm) or negative (<50 dpm). The results of CLO tests were classified as positive or negative according to color change. The results of GBx on giemsa stain were graded 0 (normal) to 4 (diffuse) according to the distribution of H. pylori by the Wyatt method. We compared C-14 UBT results with GBx grade as a gold standard. RESULTS: In the assessment of the presence of H. pylori infection, the C-14 UBT global performance yielded sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 92.5%, 88.4%, 97.1%, 88.4% and 91.3%, respectively. However, the CLO test had sensitivity, specificity, PPV, NPV and accuracy of 83.2%, 81.4%, 91.8%, 81.4% and 82.7%, respectively. The quantitative values of the C-14 UBT were 45+/-27 dpm in grade 0, 707+/-584 dpm in grade 1, 1558+/-584 dpm in grade 2, 1851+/-604 dpm in grade 3, and 2719+/-892 dpm in grade 4. A significant correlation (r=0.848, p<0.01) was found between C-14 UBT and the grade of distribution of H. pylori infection on GBx with giemsa stain. CONCLUSION: We conclude that the C-14 UBT is a highly accurate, simple and noninvasive method for the diagnosis of ongoing H. pylori infection and reflects the degree of bacterial distribution.