Absence of Helicobacter pylori is not protective against peptic ulcer bleeding in elderly on offending agents: lessons from an exceptionally low prevalence population

Prevalence of H. Pylori in Perforated Peptic Ulcer Disease at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia

BACKGROUND

Helicobacter Pylori is the most common cause of peptic ulcer disease with disputable association with perorated Peptic Ulcer disease (PPD). This study aims to determine magnitude of Helicobacter Pylori in PPD and the outcomes of treatment, at Saint Paul Hospital Millennium Medical College (SPHMMC).

METHOD

Between January 9, 2013 and February 7, 2018, all patients operated for PPD were recruited retrospectively. Data was extracted from patient's medical records using pretested questionnaire. Data analysis was done by SPSS version 20.

RESULT

During the 5 years, 46 patients fulfilling inclusion criteria were included in the study. H. Pylori test was positive for stool antigen in 10 (21.7%) and serology eleven (23.9 %) of patients. Overall, nineteen (41.3%) of patients had positive result regardless of the type of test used. Out of 46 patients, twenty-six (56.5%) patients were given eradication therapy and thirty-four (73.9%) patients were given PPI alone or as a part of eradication therapy. During their hospital stay, five (10.9%) patients developed deep and superficial surgical site infection and two (4.3%) of patients have died.

CONCLUSION

The prevalence of H. Pylori among PPD patients in this study is lower compared to most studies. Further prospective studies should be conducted in the future to understand association with H. Pylori and provide recommendations on eradication treatment.

Why do we still have Helicobacter Pylori in our Stomachs

The existence of any infectious agent in a highly acidic human stomach is contentious, but the chance finding of Helicobacter pylori is by no means an accident. Once H. pylori colonises the gastric mucosa, it can persist for a lifetime, and it is intriguing why our immune system is able to tolerate its existence. Some conditions favour the persistence of H. pylori in the stomach, but other conditions oppose the colonisation of this bacterium. Populations with high and extremely low prevalence of H. pylori provide useful insights on the clinical outcomes that are associated with this type of infection. Adverse clinical outcomes including peptic ulcer disease and gastric cancer depend on a delicate balance between a harmless inflammation and a more severe kind of inflammation. Is the only good H. pylori really a dead H. pylori? The jury is still out.

Clinical effects of endoscopic clipping in management of peptic ulcer bleeding

AIM: To explore the clinical effects of endoscopic clipping in the management of peptic ulcer bleeding.

METHODS: Eighty-six patients with peptic ulcer bleeding were divided into either an observation group (n = 43) or a control group (n = 43) based on the treatment method. The observation group was treated by endoscopic clipping, and the control group was treated by endoscopic local injection. The clinical effects and hemostatic effects on 1 and 3 d were compared between the two groups.

RESULTS: The improvement rate and total effective rate were significantly higher in the observation group than in the control group (62.79% vs 37.21%, 95.35% vs 76.74%, P < 0.05). The hemostatic rates on 1 and 3 d were significantly higher in the observation group than in the control group (90.70% vs 69.77%, 100.00% vs 74.42%, P < 0.05).

CONCLUSION: Endoscopic clipping for peptic ulcer bleeding is simple and easy to use, and is associated with a better hemostatic effect, a higher cure rate, and improved patient prognosis.

Identification of Helicobacter pylori infection in symptomatic patients in Surabaya, Indonesia, using five diagnostic tests

SUMMARY The prevalence of Helicobacter pylori infection in Indonesia is controversial. We examined the H. pylori infection rate in 78 patients in a hospital in Surabaya using five different tests, including culture, histology, immunohistochemistry, rapid urease test, and urine antibody test. Furthermore, we analysed virulence factors in H. pylori strains from Indonesia. The H. pylori infection rate was only 11.5% in all patients studied, and 2.3% of Javanese patients and 18.0% of Chinese patients were infected (P = 0.01). Although severe gastritis was not observed, activity and inflammation were significantly higher in patients positive for H. pylori than in patients negative for H. pylori. Among genotypes identified from five isolated strains, cagA was found in four; two were vacA s1m1. All cagA-positive strains were oipA 'on' and iceA1 positive. We confirmed both a low H. pylori infection rate and a low prevalence of precancerous lesions in dyspeptic patients in a Surabaya hospital, which may contribute to the low incidence of gastric cancer in Indonesia.