Dyspepsia and Helicobacter pylori infection: Analysis of 200 Kuwaiti patients referred for endoscopy

Dietary and Lifestyle Factors Associated with Dyspepsia among Pre-clinical Medical Students in Ajman, United Arab Emirates

Introduction:

Dyspepsia is a common gastrointestinal diseases worldwide with a prevalence ranging from 7 to 40%. Dyspepsia, more commonly known as heartburn or indigestion, is defined as one or more of the following symptoms: postprandial fullness, early satiation (the inability to finish a normal size meal), or epigastric pain or burning for at least 3 months in the past year. Dyspepsia has been studied extensively, but little is known of factors associated with dyspepsia among medical students.

Objectives:

The purpose of this study was to analyze the prevalence of dyspepsia and to evaluate the association between lifestyle and dietary factors associated with dyspepsia among pre-clinical medical students in Ajman, United Arab Emirates.

Methods:

A cross-sectional survey study was conducted among pre-clinical medical students at Gulf Medical University, Ajman and collected basic demographic data, dyspepsia prevalence, dietary factors, and lifestyle factors. Data was analyzed using Microsoft Excel and SPSS software. Descriptive statistics were used to summarize the participant characteristics. Chi-square tests were used to test the association between dietary and lifestyle factors and dyspepsia. Logistic regression was used to measure the association of predictors (dietary and lifestyle factors) on the odds of having dyspepsia, independently. Multinomial logistic regression was used to examine the full association of predictors on the odds of having dyspepsia.

Results:

The resulting sample was 176 pre-clinical medical students, with a mean age of 20.67 ± 2.57 years. A total of 77 (43.8%) respondents reported having dyspepsia while 99 (56.2%) did not. There was a significant association between smoking and dyspepsia (p<0.05), as well as a marginally significant association between inadequate sleep and dyspepsia (p<0.10). There was no significant association with alcohol or analgesic use on dyspesia. Dietary habits showed no association with dyspepsia.

Conclusion:

Dyspepsia was reported by 43.8% of the repondents. These findings emphasize the importance of improving lifestyle and dietary factors associated with dyspepsia and raising awareness of reducing risk factors associated with dyspepsia. Further studies are needed on dyspepsia in a larger cohort of students in order to fully understand the complexity of this problem and be able to generalize the findings to other cohorts.

Prevalence of symptoms of gastroesopahgeal reflux in a cohort of Saudi Arabians: a study of 1265 subjects

BACKGROUND/AIMS

In this study, we aimed to determine the prevalence of gastroesophageal reflux disease (GERD) in the general population of the capital city of Riyadh and to assess its association with other factors including age, smoking, body mass index (BMI), asthma, as well as the presence of other co-morbid diseases.

MATERIALS AND METHODS

We used the Gastroesophageal Reflux Disease Questionnaire (GerdQ) for diagnosing GERD, based on a GerdQ score of 8 or more. Riyadh was divided into four quadrants, and from each area, a single shopping mall was chosen randomly to conduct our surveys. Data collected included age, sex, history of smoking, history of asthma or any other medical condition, dietary habits, monthly household income, history and frequency of heartburn, epigastric pain, regurgitation of food, nausea, sleep disturbance from heartburn, the use of common over-the-counter antacids for the control of their symptoms, and their height and weight.

RESULTS

Over a 4-week period from the 19 December 2012 to 17 January 2013, a total of 1265 individuals were included in the survey. The mean age was 29.97 ± 11.58 years. Females formed 67.81% of the respondents and 62.73% had one or more episodes of heartburn per week. Based on a cutoff GERDQ score of 8, the prevalence of GERD in the surveyed population was 45.4%. GERD was more prevalent in older individuals (mean age 31.9 vs. 30.0 years, P < 0.001) and in those with a higher BMI (27.29 vs. 26.31 kg/m 2 , P = 0.02). There was no difference between males (45.43%) and females (45.13%) (P = 0.92); there was a trend of a higher prevalence in smokers (51.63% vs. 44.41%), but it did not reach statistical significance (P = 0.09).

CONCLUSION

Symptoms suggestive of GERD as determined by the translated GerdQ are prevalent among this study population.

Systematic review of the symptom burden, quality of life impairment and costs associated with peptic ulcer disease

BACKGROUND

Management of peptic ulcer disease has improved over the past few decades. However, the widespread use of nonsteroidal anti-inflammatory drugs and low-dose acetylsalicylic acid means that the burden of peptic ulcer disease remains a relevant issue.

METHODS

We systematically searched PubMed and EMBASE for articles published 1966-2007 that reported symptoms, impairment of well-being or health-related quality of life, and costs associated with peptic ulcer disease.

RESULTS

Thirty studies reported the prevalence of patient-reported gastrointestinal symptoms in individuals with endoscopically diagnosed symptomatic peptic ulcer disease. Average prevalence estimates, weighted by sample size, were 81% (95% confidence interval [CI], 77%-85%) for abdominal pain (11 studies), 81% (95% CI, 76%-85%) for pain specifically of epigastric origin (14 studies), and 46% (95% CI, 42%-50%) for heartburn or acid regurgitation (11 studies). On average, 29% (95% CI, 25%-34%) of patients with peptic ulcer disease presented with bleeding, often as the initial symptom (11 studies). Patients with peptic ulcer disease had significantly lower health-related quality of life than the general population, as measured by the Psychological General Well-Being index (P <.05; 7 studies) and the Short-Form-36 questionnaire (P <.05; 2 studies). Direct medical costs of peptic ulcer disease based on national estimates from several countries were USD163-866 per patient. The most costly aspects of peptic ulcer disease management were hospitalization and medication. Complicated peptic ulcer disease is particularly costly, estimated to be USD1883-25,444 per patient.

CONCLUSION

Peptic ulcer disease significantly impairs well-being and aspects of health-related quality of life, and is associated with high costs for employers and health care systems.

Prevalence of Helicobacter pylori infection among new outpatients with dyspepsia in Kuwait

Background

Testing and treatment for Helicobacter pylori has become widely accepted as the approach of choice for patients with chronic dyspepsia but no alarming features. We evaluated H. pylori status among outpatients with uninvestigated dyspepsia in Kuwait.

Methods

A prospectively collected database for 1035 patients who had undergone ¹³C-urea breath tests (UBT) for various indications was reviewed for the period from October 2007 to July 2009. The status of H. pylori in dyspeptic patients was determined by UBT.

Results

Among the 362 patients who had undergone UBT for uninvestigated dyspepsia, 49.7% were positive for H. pylori (95% CI = 44%-55%) and the percentage increased with age (35.8% at 20-29 years, 95% CI = 25.4% - 47.2%; 59.3% at 30-39 years, 95% CI = 48.5% - 69.5%) (P = 0.013). The prevalence of H. pylori was 42.6% among Kuwaitis (95% CI = 35%-50%) and 57.6% (95% CI = 49.8%-65%) among expatriates (p = 0.004). The prevalence among males was 51.3%, while in females it was 48.6%.

Conclusions

Almost half of the patients with dyspeptic symptoms in Kuwait were positive for H. pylori, though the prevalence varied with age and was higher among expatriates. The American Gastroenterology Association guidelines recommending testing and treatment for H. pylori for patients with uninvestigated dyspepsia should be endorsed in Kuwait.

Detection of Helicobacter Pylori Infection in Dyspeptic Patients by Different Sero-Bacteriological Methods

To evaluate invasive (biopsy related) tests and noninvasive (serological) tests in the diagnosis of H.pylori, ninety-two adults (54 male, 38 female) presenting with dyspepsia were studied after classification into two groups on the basis of endoscopical diagnosis; 46 patients with erosive diseases (gastroduodenal ulcers or gastroduodenal erosions) and 46patients with non-erosive diseases (gastritis or gastroduodenitis). Sera were testedfor anti-H.pylori IgG and IgM by an immunochromatography card test and ELISA respectively. Three antral biopsies were taken for biopsy urease test (BUT), bacterial culture and histological examination. Stool samples were obtained from only 30 dyspeptic cases for H.pylori antigen detection (HpSA) by an ELISA method.

H. pylori was detected in 81 of 92 cases; these were positive by one or more of the gold standard tests (culture, histology and biopsy-urease test). Histological examination yielded the highest frequency of microorganism detection (71.7%), followed by BUT (68.5%) and then bacterial culture (26.1%). In erosive disorders the BUT gave the highest frequency ofpositivity (78.3%),followed by histological examination (67.4%), and then bacterial culture (41.3%) but in non-erosive disorders histological examination gave the highest positive results (76.1%) followed by BUT (58.7%) and bacterial culture (10.9%). The overall sensitivities of BUT, histology and bacterial culture of H.pylori were 77.8%, 81.5% and 29.6% respectively. Serologically the anti-H.pylori IgG test yielded the highest frequency of positive results (80.4%), followed by HpSA test (66.7%) and the least positive was anti-H.pylori IgM test (65.2%). In the light of the gold standard tests used (biopsy-related tests), the validity of anti-H.pylori IgG test, anti-H.pylori IgM test and HpSA test were determined; the sensitivities being 79%, 65.4% and 75% respectively and their specificities were 9.1%, 36.4% and 66.7% respectively. The positive and negative predictive values, the positive and negative likelihood ratios of serological tests were also evaluated.

Conclusion: The most sensitive invasive test (biopsy related) and noninvasive (serological) tests were histological examination and IgG immunochromatography card tests respectively.

Distribution of vacA and cagA genotypes of Helicobacter pylori in Kuwait

There is considerable geographical variation in the distribution of allelic types of Helicobacter pylori. This first study from Kuwait determined the prevalence of cagA and vacA genotypes among 117 unselected patients attending a gastroenterology center. We found that whereas vacA s1 and s2 types were equally likely to be present in biopsies obtained from patients of Middle-Eastern origin, African Arabs were predominantly infected with s2 type and South-Asians the s1 type. South Asians most frequently carried the cagA positive genotype with Bangladeshis showing the highest prevalence rate of 87%.