RESUMO
Helicobacter pylori represents one of the most common infections worldwide. It has been established as an etiologic factor in the development of peptic ulcer disease and chronic gastritis; and associated firmly with development of gastric neoplasia, including gastric adenocarcinoma and gastric mucosa-associated lymphoid tissue lymphoma. Several extra digestive pathologies have been linked to H. pylori infection including cardiovascular, cutaneous, autoimmune, esophageal and other diseases such as sideropenic anaemia, growth retardation, and extragastric MALT-lymphoma. The aim of this work is to evaluate the contribution of H. pylori infection to the uncommon; digestive and extra-digestive; manifestations of patients in GIT clinics in some Arabian countries. A total of 623 H. pylori positive patients from three Arabian countries including 225 Egyptian patients, 188 Kuwait patients and 210 Saudi patients were studied and evaluated for all the possible manifestations of this infection. Evaluation was done by history, medical examination, routine and specific laboratory investigations, endoscopic and histopathological diagnosis. Follow-up after eradication was done to evaluate the response and improvement of such manifestations. This study included 339 males and 274 females distributed in the three countries. Recurrent H. pylori infection was found in 10.9% of all patients and was significantly more common in Saudi patients and associated with significantly higher incidence of thyroid dysfunction and pancreatitis. Mouth ulcers, vertigo, diabetes, gastric polyps and low serum iron were significantly more common in Egyptian patients than other population. Constipation, history of atypical chest pain, pancreatitis, thyroid dysfunction and ALT elevation were significantly more common in Saudi patients than other populations. Presence of GERD and migraine were found significantly more common in both Saudi and Kuwaiti than Egyptian patients. Diabetes mellitus was one of the commonest associated manifestations in this study and was found in 16.5% of all patients. Duodenal ulcer was found significantly more common in younger age group. Autoimmune haemolytic anaemia was found the only disease associated with significantly higher Cag A positivity. Constipation was also common in this population [11.9% of all patients] and was directly correlated with the presence and severity of gastritis. Pancreatitis was directly correlated with history of past infection, gastric ulcer, GIT malignancy, gastric outlet obstruction, arthritis and skin rash. Low serum iron and hemoglobin were more significant in patients with peptic ulcer disease and GIT malignancy. After eradication of infection, marked improvement during follow-up was noticed in patients with skin rash [28/37], mouth ulcer [37/59], and constipation [51/73] while mild to moderate improvement was noticed in those with migraine [11/260] and vertigo [19/49]. Also, highly significant increase in serum iron and hemoglobin levels [p<0.001] was found in all patients after eradication of infection when analyzed altogether and as separate groups without iron supplementation. The most sensitive and specific diagnostic tests for H. pylori in this cohort was the microscopic examination, followed by rapid urease test; both depend on gastric biopsies. It is concluded from this study that H. pylori infection is present in most Arabian countries nearly with similar, but of somewhat variable extent, manifestations whether digestive or extradigestive. The associated extradigestive manifestations described cannot be attributed to H. pylori in all cases, but it is recommended to screen for this infection and eradicate it particularly if there are additional upper GIT complaints. The presence of GERD should not affect the decision of treatment of this infection. Finally, diagnosis and treatment of H. pylori might be considered in the workup in the management of diseases with autoimmune pathogenesis such as ITP, autoimmune haemolytic anaemia, skin diseases, thyroid dysfunction, diabetes mellitus, and others