Does helicobacter pylori share in superior mesenteric artery syndrome?

ABSTRACT

An association between superior mesenteric artery syndrome [SMAS] and peptic ulcer disease has been observed, the reason was unclear. Therefore we studied Helicobacter Pylori [HP] by rapid urease test [CLO] in endoscopic antral and duodenal biopsies of 21 dyspeptic patients with SMAS. All were asthenic, 18 females and 3 males, aged 19.48 +/- 2.8 years suffering from postprandial epigastric pain, distention, nausea and vomiting. Diagnosis of SMAS was made by barium meal with single and double contrast study under the screen to show the vascular compression of the third part of duodenum and by ultrasonography to measure the aortomesenteric space in comparison with 10 healthy controls. Patients with SMAS had typically narrow aortomesentric space compared with controls [2.5 +/- 0.29 Vs 15.8 +/- 3.22 mm, P 0.001]. Nineteen [90.5%] patients had associated endoscopic acid peptic disease [6 had duodenal ulcer with antral gastritis and 13 had duodenitis with or without antral gastritis. Only 2 patients [9.5%] had normal endoscopy. Eighteen patients [85.7%] had positive [+ve] CLO for HP; 6 had +ve both antral and duodenal biopsies and 12 had only +ve duodenal biopsy. Only 3 patients were negative [-ve] for HP. Of the 19 patients having endoscopic acid peptic disease, 18 showed +ve CLO, only one had a-ve test. The 2 endoscopically normal patients showed -ve CLO. We conclude that HP could be a reason for the associated acid peptic disease with SMAS. There is a rationale for anti-HP therapy in the management plan of dyspeptic patients with SMAS