High prevalence of duodenal ulcer in a tertiary care hospital in the city of São Paulo, SP, Brazil.

CONTEXT: In spite of Helicobacter pylori infection being the etiological cause of peptic ulcer and its high prevalence in Brazil, the prevalence of peptic ulcer disease has been poorly studied. OBJECTIVES: To verify the peptic ulcer disease prevalence in patients of a tertiary care hospital. METHODS: Diagnostic findings from 1,478 consecutive endoscopies were correlated with the urease test results for H. pylori infection diagnosis and demographic data in a total of 3,779 endoscopies performed in 2005. The mean age of the patients was 51.14 ± 16.46, being 613 (41.5%) men. RESULTS: Peptic ulcer was diagnosed in 494 (33.4%) patients with a mean age of 54.86 ± 14.53, 205 (52%) were men, being 391 (26.5%) duodenal ulcer and 103 (7%) gastric ulcer. Normal endoscopy was found in 272 (18.4%) patients with a mean age of 38.4 ± 15.22, being 49 (18%) men. The comparison of peptic ulcer group with the patients that had normal endoscopy revealed that H. pylori infection [P = 0.005; OR = 1.70; 95% CI = 1.17-2.47], male gender [P<0.0001; OR = 5.53; 95%CI = 3.67-8.34] and older age [P<0.0001; OR = 1.08; 95%CI = 1.06-1.09] increased the risk of peptic ulcers. The overall H. pylori prevalence was 53% (786). CONCLUSIONS: Prevalence of duodenal ulcer is high in a Brazilian population that had H. pylori infection associated with older age and male gender as important determinants to gastrointestinal diseases outcome. Future prospective studies should confirm these findings.

High prevalence of duodenal ulcer in a tertiary care hospital in the city of São Paulo, SP, Brazil / Alta prevalência de úlcera duodenal num hospital terciário na cidade de São Paulo

CONTEXT: In spite of Helicobacter pylori infection being the etiological cause of peptic ulcer and its high prevalence in Brazil, the prevalence of peptic ulcer disease has been poorly studied. OBJECTIVES: To verify the peptic ulcer disease prevalence in patients of a tertiary care hospital. METHODS: Diagnostic findings from 1,478 consecutive endoscopies were correlated with the urease test results for H. pylori infection diagnosis and demographic data in a total of 3,779 endoscopies performed in 2005. The mean age of the patients was 51.14 ± 16.46, being 613 (41.5 percent) men. RESULTS: Peptic ulcer was diagnosed in 494 (33.4 percent) patients with a mean age of 54.86 ± 14.53, 205 (52 percent) were men, being 391 (26.5 percent) duodenal ulcer and 103 (7 percent) gastric ulcer. Normal endoscopy was found in 272 (18.4 percent) patients with a mean age of 38.4 ± 15.22, being 49 (18 percent) men. The comparison of peptic ulcer group with the patients that had normal endoscopy revealed that H. pylori infection [P = 0.005; OR = 1.70; 95 percent CI = 1.17-2.47][ign], male gender [P<0.0001; OR = 5.53; 95 percentCI = 3.67-8.34][ign] and older age [P<0.0001; OR = 1.08; 95 percentCI = 1.06-1.09] increased the risk of peptic ulcers. The overall H. pylori prevalence was 53 percent (786). CONCLUSIONS: Prevalence of duodenal ulcer is high in a Brazilian population that had H. pylori infection associated with older age and male gender as important determinants to gastrointestinal diseases outcome. Future prospective studies should confirm these findings.

CONTEXTO: Apesar da infecção pelo Helicobacter pylori ser causa de úlcera péptica e de sua alta prevalência no Brasil, a prevalência da úlcera péptica tem sido pouco estudada. OBJETIVOS: Verificar a prevalência da doença ulcerosa péptica em pacientes de um hospital terciário. MÉTODOS: Achados diagnósticos de 1.478 endoscopias consecutivas foram correlacionados com os resultados de testes de urease para diagnóstico de infecção pelo H. pylori e dados demográficos num total de 3.779 endoscopias realizadas em 2005. A média de idade dos pacientes foi 51,14 ± 16,46, sendo 613 (41,5 por cento) homens. RESULTADOS: A úlcera péptica foi diagnosticada em 494 (33,4 por cento) pacientes com média de idade de 54,86 ± 14,53, 205 (52 por cento) eram homens, sendo 391 (26,5 por cento) úlceras duodenais e 103 (7 por cento) úlceras gástricas. Endoscopia normal foi achada em 272 (18,4 por cento) pacientes com média de idade de 38,4 ± 15,22, sendo 49 (18 por cento) homens. A comparação do grupo de úlcera péptica com os pacientes que tinham endoscopia normal revelou que a infecção pelo H. pylori [P = 0,005; OR = 1,70; 95 por cento CI = 1,17-2,47][ign], gênero masculino [P<0,0001; OR = 5,53; 95 por cento CI = 3,67-8,34][ign] e idade mais avançada [P<0,0001; OR = 1,08; 95 por cento CI = 1,06-1,09] aumentaram o risco de úlceras pépticas. A prevalência de infecção pelo H. pylori no total foi de 53 por cento (786). CONCLUSÕES: A prevalência da úlcera duodenal é alta numa população brasileira de um hospital terciário que teve a infecção pelo H. pylori, idade avançada e gênero masculino como determinantes importantes de evolução para doença gastrointestinal. Estudos futuros prospectivos devem confirmar esses achados.

Association of LEC and tnpA Helicobacter pylori genes with gastric cancer in a Brazilian population.

BACKGROUND: H. pylori seroprevalence in Brazilians varies and is dependent on socioeconomic status, sanitation conditions and ethnicity; furthermore, H. pylori is not always associated with the incidence of gastric cancer, suggesting the role of more virulent strains. The purpose of this study was to analyze the association of more virulent H. pylori strains with gastric cancer. METHODS: DNA was extracted from gastric biopsies of thirty-four cases of gastric cancer (11 intestinal-type, 23 diffuse-type), and thirty-four of patients with endoscopic gastritis. The presence of cagPAI genes (cagA, cagA promoter, cagE, cagM, tnpB, tnpA, cagT and the left end of the cagII (LEC)) and babA were analyzed by PCR. RESULTS: Comparison of H. pylori isolates from gastric cancer and gastritis patients showed significant associations of tnpA and LEC with gastric cancer (73.5% [OR, 6.66; 95% CI, 2.30-19.25] and 58.8% [OR, 10.71; 95% CI, 3.07-37.28] of cases, respectively). Other cagPAI genes were detected in both groups at similar frequencies. CONCLUSIONS: tnpA and LEC of H. pylori cagPAI were associated with gastric cancer; nonetheless, these results were restricted within this group of patients and further studies are needed to confirm these results in a larger sample and determine their role in gastric carcinogenesis.

Endoscopic sphincterotomy before deployment of covered metal stent is associated with greater complication rate: a prospective randomized control trial.

OBJECTIVE: Endoscopic sphincterotomy (ES) may facilitate insertion of self expandable metal stent (SEMS) and also help avert the development of pancreatitis from stent-related occlusion of the pancreatic duct. On the other hand, ES is also independently associated with pancreatitis, bleeding, and perforation. We evaluated whether ES before SEMS placement was associated with a greater likelihood of stent migration and other complications in patients with malignant obstruction of the distal common bile duct. METHODS: Seventy-four patients with unresectable distal bile duct obstruction were prospectively randomized to biliary stenting following ES (group 1) and without ES (group 2). Main outcome measures included overall procedure complications rates including stent migration, stent occlusion, oxygen desaturation, bleeding, perforation, and pancreatitis. RESULTS: Covered SEMS were successfully deployed in all patients in both groups. Stent migration occurred in 6 patients (16%) in group 1 and 1 patient (3%) in group 2, P=0.075. Overall, complications occurred in 18 patients in group 1 and 4 patients in group 2, P=0.006. There was no pancreatitis in either group. CONCLUSIONS: Deployment of covered SEMS without prior ES in patients with distal common bile duct obstruction owing to pancreatic cancer is feasible and prevents the development of complications such as stent migration, bleeding, and perforation.