Determination of dyspepsia causes in patients attending endoscopy dept. of Azadi teaching hospital in Duhok city

ABSTRACT

Both gastric and duodenal ulcers associated with were a major threat over the past two centuries, with a high morbidity, mortality and striking geographical variations in incidence and prevalence. H. Pylori discovery switched the notion from an acid-driven disease to an infectious disease, with reconciliation of previously suggested pathogenesis.This study was undertaken in order to investigate the causes of dyspepsia in patients undergoing endoscopy examination and to measure the anti H. pylori antibodies level in serum of these patients then to find any correlation between the titer of these specific antibodies and the severity of their dyspeptic symptoms. The study was conducted in microbiology lab. at Azadi teaching hospital. 90 patients suffering from symptoms of gastric upset were included in this study. Their age range from 10 to 66 year old, 46 female and 44 male. Endoscopy was done for each patient and the result of examination was reported and gastric juice aspirate taken from stomach by endoscopy was sent for direct examination for Giardia lamblia, monilia, pus cells, and RBC. 5 ml of whole blood was taken from each patient and serum collected after centrifu-gation and kept at -20*c to be used for detection of specific H.pylori IgM by ELISA and total serum IgA by single radial diffusion test. Abnormal endoscopy findings were found in 36 out of 90 patients Giardia lamblia was not found in any case. The results of ELISA test for specific IgM against Helicobacter pylori showed that 10 cases were positive which indicate acute Helicobacter pylori infections [7 female, 3 male] their age range from 10 to 60 years. Seven of them have abnormal endoscopy finding range from gastritis to gastric ulcer, this confirm that acute infection with Helicobacter pylori is responsible for the endoscopy abnormal findings. The other 3 patients although they are suffering from gastric symptoms they have negative endoscopy finding which need follow up by another endoscopy to monitor the appearance of gastric or duodenal lesion. The concentration of total serum IgA was measured by single radial diffusion. 17 patients had high level of total serum IgA, 8 of them with abnormal endoscopy finding and the other 9 with normal endoscopy finding. All ten patients with positive specific anti H .pylori IgM have normal level of total serum IgA. This study found anti H, pylori specific IgM confirmative for diagnosis of acute infection even in the absence of positive endoscopy finding. The measurement of total serum IgA is not helpful for diagnosis of acute or chronic infection and to be replaced by specific anti H. pylori IgA in serum