Functional Dyspepsia, Peptic Ulcer, and Helicobacter pylori Infection in a Rural Community of South Asia: An Endoscopy-Assisted Household Survey

INTRODUCTION

Functional dyspepsia (FD), although commoner than organic dyspepsia (OD) in-hospital studies, community data, particularly from rural areas, are lacking. We performed a rural community study in Bangladesh with the primary aims to evaluate (i) the prevalence of uninvestigated dyspepsia (UD), FD, and OD and (ii) the risk factors for UD.

METHODS

This house-to-house survey was performed using a translated-validated enhanced Asian Rome III questionnaire and endoscopy with Helicobacter pylori tests, including genotyping.

RESULTS

Of 3,351/3,559 responders ([94.15%], age 40.41 ± 16.05 years, female 1924 [57.4%]), 547 (16.3%) had UD (female 346 [18%] vs male 201 [14%]; P = 0.002); 201 (6%), 88 (2.6%), and 258 (7.7%) had postprandial distress (PDS), epigastric pain syndromes (EPS) and PDS-EPS overlap, respectively. On multivariate analysis, age >50 years (adjusted odds ratio [AOR] 1.34 [1.07-1.68]), female sex (AOR 1.42 [1.17-1.74]), being married (AOR 1.57 [1.21-2.07]), lower family income (AOR 1.79 [1.43-2.26]), nonsteroidal anti-inflammatory drug use (AOR 7.05 [2.11-23.55]), previous acute gastroenteritis (AOR 5.42 [1.83-16]), and psychological distress (AOR 5.02 [2.87-8.76]) were risk factors for UD. Of 346/547 (63.25%) undergoing endoscopy, 232 (67.05%) and 114 (32.95%) had FD and OD (peptic ulcers [PU] 99 [28.61%] and erosive esophagitis 13 [3.76%]). About 53% of FD subjects had EPS-PDS overlap, 32% had PDS, and only 15% had EPS. H. pylori was detected in 266/342 (78%) dyspeptics (FD 173/230 [75.2%], vs OD 92/114 [82.1%], P = 0.169).

DISCUSSION

Sixteen percent, 11% and 5% of rural Bangladeshi Asian adults had UD, FD, and PU, respectively. One-third of UD subjects had OD, mostly PU.JOURNAL/cltg/04.03/01720094-202104000-00016/inline-graphic1/v/2021-04-15T161418Z/r/image-tiff.

Fermented milk containing Lactobacillus paracasei and Glycyrrhiza glabra has a beneficial effect in patients with Helicobacter pylori infection: A randomized, double-blind, placebo-controlled study

BACKGROUND

Lactobacillus paracasei and Glycyrrhiza glabra have been reported as having beneficial effects on Helicobacter pylori infection. We aimed to assess the efficacy and safety of fermented milk containing L paracasei HP7 and G glabra in patients with H pylori infection.

METHODS

This multicenter, prospective, randomized, double-blind, placebo-controlled clinical trial was conducted in 2 hospitals from April to December 2017. Patients with H pylori infection were randomized into either the treatment group (fermented milk with L paracasei HP7 and G glabra) or placebo group (fermented milk only) once daily for 8 weeks. The primary endpoint was the gastric load of H pylori measured by C-urea breath test (UBT). Secondary endpoints were histologic and clinical improvement.

RESULTS

A total of 142 patients were randomly allocated to the treatment (n = 71) or placebo groups (n = 71). Compared to baseline data, the quantitative value of C-UBT at 8 weeks was significantly reduced in the treatment group (from 20.8 ± 13.2% to 16.9 ± 10.8%, P = .035), but not in the placebo group (P = .130). Chronic inflammation improved significantly only in the treatment group (P = .013), whereas the neutrophil activity deteriorated significantly only in the placebo group (P = .003). Moreover, the treatment group had significant improvement in gastrointestinal symptoms (P = .049) and quality of life (P = .029). No serious adverse events were observed.

CONCLUSION

The combination of fermented milk containing L paracasei and G glabra reduced H pylori density and improved histologic inflammation. However, their mechanisms of action should be elucidated in further studies.

Association between Poor Sleep Quality and Subsequent Peptic Ulcer Recurrence in Older Patients with Mild Cognitive Impairment: Examining the Role of Social Engagement

This study aims to examine whether perceived poor sleep quality predicts subsequent recurrence of peptic ulcer disease (PUD) in older patients with mild cognitive impairment following Helicobacter pylori eradication and to investigate whether social engagement status alters this association. Of 1,689 older patients with H. pylori-infected PUD recruited from eight Grade-A hospitals in the People's Republic of China between 2011 and 2014, H. pylori was eradicated and PUD cleared in 1,538 patients by the end of 2014; 1,420 of these were followed for up to 36 months. The Kaplan-Meier method was used to compare the proportion of PUD recurrence, as confirmed with esophagogastroduodenoscopy, among older patients with different levels of sleep quality and social engagement statuses. Multivariate Cox-proportional hazards models were performed to examine the association between sleep quality and PUD recurrence, and the role of social engagement in altering this relationship. The results showed that PUD recurrence was more prevalent in poor (10.8%) compared with good sleepers (5.5%). However, increased and continued social engagement reduced the proportion to 7.2% and 8.2% among poor sleepers, respectively. Poor sleep quality was associated with subsequent PUD recurrence (hazard ratio [HR] 1.965 (1.002, 3.518)). However, no significant difference was observed between good and poor sleepers who reported increased (HR 1.428 (0.736, 2.380)) and continued (HR 1.273 (0.915, 2.492)) social engagement, suggesting that increased and continued social engagement prevented the effect of poor sleep quality on PUD recurrence. To conclude, poor sleep quality is associated with subsequent PUD recurrence. However, increased and continued social engagement may moderate this association.

Helicobacter pylori moderates the association between 5-MTHF concentration and cognitive function in older adults

Objective

To explore potential interactions between folate-cycle factors and Helicobacter pylori seropositivity in the prediction of cognitive function.

Methods

We used data obtained from the 1999–2000 continuous National Health and Nutrition Examination Survey produced by the United States’ Centers for Disease Control and Prevention. Using Ordinary Least Squares regression, we tested for associations between multiple folate-cycle factors, Helicobacter pylori seropositivity, and cognitive function assessed by the digit symbol coding subtest of the Wechsler Adult Intelligence Scale-III. We then tested for interactions between each of the folate-cycle factors and Helicobacter pylori in the prediction of cognitive function.

Results

Although Helicobacter pylori seropositivity, 5-methyltetrahydrofolate, vitamin B-12, and homocysteine were not associated with performance on the digit symbol coding task, Helicobacter pylori seropositivity interacted with 5-methyltetrahydrofolate concentration to predict performance on the digit symbol coding task. The Helicobacter pylori seropositive group performed worse on the digit symbol coding task as 5-methyltetrahydrofolate concentration decreased.

Conclusion

The interaction between Helicobacter pylori seropositivity and reduced folate-cycle factor 5-methyltetrahydrofolate might impair aspects of cognitive function.

Brain-gut axis in the pathogenesis of Helicobacter pylori infection

Helicobacter pylori (H. pylori) infection is the main pathogenic factor for upper digestive tract organic diseases. In addition to direct cytotoxic and proinflammatory effects, H. pylori infection may also induce abnormalities indirectly by affecting the brain-gut axis, similar to other microorganisms present in the alimentary tract. The brain-gut axis integrates the central, peripheral, enteric and autonomic nervous systems, as well as the endocrine and immunological systems, with gastrointestinal functions and environmental stimuli, including gastric and intestinal microbiota. The bidirectional relationship between H. pylori infection and the brain-gut axis influences both the contagion process and the host’s neuroendocrine-immunological reaction to it, resulting in alterations in cognitive functions, food intake and appetite, immunological response, and modification of symptom sensitivity thresholds. Furthermore, disturbances in the upper and lower digestive tract permeability, motility and secretion can occur, mainly as a form of irritable bowel syndrome. Many of these abnormalities disappear following H. pylori eradication. H. pylori may have direct neurotoxic effects that lead to alteration of the brain-gut axis through the activation of neurogenic inflammatory processes, or by microelement deficiency secondary to functional and morphological changes in the digestive tract. In digestive tissue, H. pylori can alter signaling in the brain-gut axis by mast cells, the main brain-gut axis effector, as H. pylori infection is associated with decreased mast cell infiltration in the digestive tract. Nevertheless, unequivocal data concerning the direct and immediate effect of H. pylori infection on the brain-gut axis are still lacking. Therefore, further studies evaluating the clinical importance of these host-bacteria interactions will improve our understanding of H. pylori infection pathophysiology and suggest new therapeutic approaches.

Ongoing symptoms after eradication of Helicobacter pylori: psychiatric disorders may accompany

BACKGROUND/AIMS

The precise mechanism of functional dyspepsia is yet to be elucidated. Helicobacter pylori infection and psychiatric disorders are implicated in the etiology. We aimed to determine the prevalence of psychiatric co-morbid disorders in patients with Helicobacter pylori-positive functional dyspepsia and the impact of existing psychiatric disorders on symptomatic response following eradication treatment.

MATERIAL AND METHODS

Patients with Helicobacter pylori-positive functional dyspepsia and no previous diagnosis of any psychiatric disorder were included in the study. All patients' symptoms were evaluated with a visual analog scale and Likert scale. The Composite International Diagnostic Interview was applied to all patients by an experienced psychiatric nurse.

RESULTS

At least one psychiatric disorder was diagnosed in 22 of 54 patients. The most common disorder was depression, found in 13 patients. Symptomatic response to treatment was significantly higher in functional dyspepsia patients with no psychiatric disorder compared to those with at least one psychiatric co-morbid disorder (84% vs. 50%; p=0.007).

CONCLUSION

Psychiatric co-morbid disorders are common in patients with functional dyspepsia and affect symptomatic response to Helicobacter pylori eradication treatment. Psychiatric disorders should be considered in patients who fail to achieve sufficient symptomatic relief after Helicobacter pylori eradication treatment.

Predictors of depression in patients presenting with dyspeptic symptoms in a GI clinic

BACKGROUND

The association between dyspepsia, H. pylori and psychological distress has remained a topic of intense debate over the past several decades. In Pakistan, where depression is highly prevalent and dyspepsia is possibly present in a high percentage of population, little data exist about these common health problems. This study was conducted to determine the frequency and predictors of depression among patients presenting with dyspeptic symptoms in the Gastrointestinal (GI) Clinic of a tertiary care hospital in Pakistan.

METHODS

Two hundred and sixty-nine consecutive patients were enrolled in the study based on their presenting symptoms in the GI clinic at Shifa International Hospital, Islamabad. Subjects with prior history of peptic ulcer disease (PUD), gallstones and HCV infections were excluded from the study. Demographic and socioeconomic variables as well as dyspeptic symptoms and important causes of dyspeptic symptoms were recorded. Depression was analysed based on the Urdu version of Beck's Depression Inventory-II (BDI-II). The data were analysed using SPSS-10 for univariate and multivariate analyses.

RESULTS

Mild depression was associated with lower education status (p < 0.001), lesser income (p < 0.018), and lower socioeconomic status (0 < 0.009) as well as rural residence (p < 0.026). Smoking, alcohol-use, H. pylori infection, gender and dyspepsia were not found to have any association with depression. On multivariate analysis, education and income group remained significantly associated with mild depression. Clinically significant depression was found to be associated with lower education and rural residence.

CONCLUSION

Depression among dyspeptic patients was found to be associated with socioeconomic status rather than dyspeptic symptoms or important risk factors associated with dyspeptic symptoms.

Relationship between alcohol consumption and active Helicobacter pylori infection

BACKGROUND

Helicobacter pylori (H. pylori) is a cause of chronic gastritis and maybe responsible for functional dyspepsia in a subset of patients. Many risk factors, such as alcohol consumption and smoking, may contribute to the colonization and infection of H. pylori in humans. However, studies on the relationship between H. pylori infection and drinking or smoking have produced conflicting results.

OBJECTIVE

The aim of this study was to examine whether consumption of alcohol or smoking is associated with active H. pylori infection in functional dyspepsia patients.

METHODS

H. pylori infection was confirmed by CLOtest and histology on at least two biopsies. Active chronic gastritis was diagnosed using the updated Sydney system. In addition to gender and age, information on drinking and smoking habits was collected using a standard questionnaire. Functional dyspepsia was diagnosed according to the Rome II diagnostic criteria.

RESULTS

H. pylori infection was positive in 27.3% of the 139 functional dyspepsia patients. Both age and gender were not significantly associated with H. pylori infection. A multiple logistic model found that alcohol consumption (OR = 9.05, 95% CI: 1.05-77.98) and pathology (active gastritis) (OR = 595.39, 95% CI: 81.43-4353.33) were associated with H. pylori infection. Active gastritis was associated with alcohol consumption (OR = 2.89, 95% CI: 1.03-8.02), smoking (OR = 2.72, 95% CI: 1.22-6.05) and age (OR = 1.03, 95% CI: 1.01-1.06).

CONCLUSIONS

In patients with functional dyspepsia, there is no significant association between active H. pylori infection and smoking. However, alcohol consumption appears to be associated with H. pylori infection.

[Peculiarities of quality of life in children with chronic gastroduodenitis]

AIM OF INVESTIGATION

To study quality of life (QL) peculiarities in children with chronic gastroduodenitis, Helicobacter pylori positive, in different stages of the disease.

METHODS

Quality of life in 60 children (average age--13.06 +/- 1.2 years) with chronic gastroduodenitis was investigated with using adopted SF-36 questionnaire in period of exacerbation of the disease, in 6 weeks after treatment and in period of remission (in 6 months after treatment). 22 healthy children (average age--12.74 +/- 1.14 years) had been taken as a comparison group.

RESULTS

Quality of life in children with chronic gastroduodenitis in exacerbation period was significantly worse (p < 0.05) than in healthy children. The more affected scores were the Role physical (RP), Bodily pain with the scores of healthy children. Presence astenic signs in period of remission (in 6 months after treatment) led to worsening of quality of life; the scores were the same and partly worse then before treatment. Applying of neurometabolic therapy improved psycho-emotional status and quality of life.

CONCLUSIONS

Quality of life in children with chronic gastroduodenitis was changed with the period of diseases. Initially low scores had tendency to improvement after treatment. In remission period quality of life was mainly depended on peculiarities of psycho-emotional status. Astenic signs led to worsening of quality of life in children with remission of chronic gastroduodenitis. Neurometabolic treatment in this period improved both psycho-emotional status and quality of life.

[Quality of life in patients with duodenal ulcer]

AIM

To examine influence of duodenal ulcer (DU) on quality of life (QL) and changes in QL after different DU treatments.

MATERIAL AND METHODS

QL in DU was assessed with Russian version of SF-36 questionnaire in 66 DUpatients with Helicobacter pylori (HP) aged 16-80 years (mean age 44.6 +/- 17.3 years).

RESULTS

DU healing was achieved after 2 weeks of therapy with ranitidine (300 mg/day), amoxicilline (2000 mg/day), metronidasole (1000 mg/day), and famotidin (40 mg/day), amoxicilline (2000 mg/day, clarithromycin (1000 mg/day) in 69.2 and 94.9% cases (p = 0.04), after 4 weeks--88.2 and 96.8%, rrespectively (p = 0.52). Hospital stay was 16.1 +/- 2.1 and 22.2 +/- 3.4 (p < 0.05), respectively. Exacerbation of DU leads to deterioration of QL according to all the SF-36 scales. Four weeks of therapy produced a statistically significant (p < 0.05) improvement of QL by all the scales. In failure of HP eradication QL worsened.

CONCLUSION

QL is low in exacerbation of DU associated with HP. Antihelicobacter therapy improves QL of DUpatients. QL investigations help to select most effective therapy.

Test and treat Helicobacter pylori before endoscopy

BACKGROUND

Helicobacter pylori may have major implications for patients' wellbeing and future health. If a patient is found to be H. pylori positive it is important that the infection is eradicated because of the risk of associated peptic ulcers and gastric cancers. There are, however, great demands on NHS gastroenterology and endoscopy services and following the introduction of recent guidelines for dyspepsia some of these issues may be addressed. The literature suggests that a strategy of test and treat before endoscopy referral will benefit patients and be cost-effective.

CONCLUSION

There is evidence that, over a period of time, it is more prudent to test and treat H. pylori first and then review the patient's condition before endoscopy is performed (if no other symptoms are identified).

Personal view: 'don't ask, don't tell'--the undesirable consequences of incidental test results in gastroenterology

A gastroenterologist is frequently approached to perform an endoscopic procedure after an incidental test has resulted in an unexpected positive finding. Should the incidental test result be ignored or automatically followed by an endoscopic procedure? The present analysis strives to characterize the common pattern of such scenarios and resolve their underlying dilemma. A model of game theory is used as a mathematical tool to develop general management strategies. Three clinical scenarios are used as examples to demonstrate this approach. The model is based on how doctors rank the various outcomes with which they are confronted by the incidental test results. The ranks of different outcomes are listed in a decision matrix that is converted into a two-by-two, non-zero, ordinal game. All scenarios of incidental test results emerge as a similar type of game that is best played by both parties adhering to the same set of strategies: 'Don't do the test' and 'don't respond to whatever test result it yields'. These two strategies lead to a Nash equilibrium for a non-zero game, where neither party can improve its payoff any further by choosing a different strategy. Although the equilibrium does not provide the individual players with their best possible payoff, it yields the best overall outcome available to both parties given the economic and medical constraints of the situation.

[Alternative schemes of eradication therapy and ways of overcoming acquired resistance of Helicobacter pylori to the treatment]

The author believes that eradication of Helicobacter pylori (HP) should be strictly justified and confined to cases with confirmed diagnosis of HP. Ineffective HP eradication leads to acquired resistance of HP to anti-chelicobacter therapy. How to overcome this resistance is shown.

[The physician's attitude towards infection by Helicobacter pylori in clinical practice]

AIM

To study the attitude of general practitioners and internists towards the infection with helicobacter pylori.

METHODS USED

Interviews were conducted among 170 physicians. Proportions were compared using the Z test.

RESULTS

Out of 170 interviewed, 152 questionnaires were completed correctly: 80.9% were general practitioners and 19% internists. All of the GPs and 84.6% of internists chose the oral-fecal as the route of transmission. Gastric ulcer was thought to be associated by 60.8% of GPs and 72.4% of internists. The least well known association was with MALT lymphoma (8.1%). Biopsy was reported as the best way to make diagnosis (54 and 72.4%). GPs reported they would treat recurring ulcers as Helicobacter pylori, while internists would treat them since the first episode. Sixty point 2 percent (60.2%) of GPs and 69% of internists are using inadequate schemes for treating Hp infections. The combination of omeprazol, amoxicillin, bismuth salts or clarithromycin was the most frequently used.

CONCLUSIONS

Current knowledge regarding Helicobacter pylori infection among GPs and internists is not sufficiently understood.

Attention to metabolic hunger and its effects on Helicobacter pylori infection

A significant decrease in the bacterial count of small intestinal mucosa has been observed in children with recurrent diarrhea or abdominal pain in the time that has elapsed from the previous meal. Humans may be trained to recognize metabolic feelings of hunger that are associated with a steady and slightly lower glycemia than baseline, between 4.7 and 3.9 mmol/L (intervention). An eating habit associated with a decrease in preprandial glycemia prevented diarrhea relapses, and was expected to impair intestinal microflora growth, including Helicobacter pylori in the stomach. The development of Helicobacter pylori infection might be prevented during childhood, and recovery from infection may be expected with intervention. The improvement in attention to metabolic feelings consisted of acquiring a predictive ability of glycemia by distinction between unsolicited hunger feelings (metabolic hunger) and those associated with external cues. Matching intake to the inbetween energy needs served to predict the subsequent emergence of the metabolic hunger. The matching was further compensated for the early or late emergence of metabolic hunger at the subsequent meals. Fruit and vegetables were increased to avoid abrupt glycemia lowering. This intervention was trained in 5-month periods. Subjects (209, 44, and 58) completed their training during 4-year periods between 1982 and 1994, and were enrolled in a prospective, controlled, randomized, interventional, preventive, and cohort study. The "prevention" hypothesis was tested in a subgroup of 86 healthy infants who were recalled in the years 1996 to 1998. A "recovery" study of approximately a 1-year intervention was investigated in 47 healthy subjects between ages 5 and 25, who were positive for anti-H. pylori and had no need for an immediate antibiotic treatment at entry. The following behavioral factors were recorded in a 7-day home diary and calculated: the fraction of meals induced by metabolic hunger out of 21 main mealtimes; average preprandial glycemia (DAP glycemia); daily intakes, activity; and bedtime hours. The decrease in preprandial glycemia was the objective measure of compliance with the recognition of "metabolic" hunger. Anthropometric measures and blood tests were obtained for nutritional and functional verifications. Average preprandial glycemia was 8.5 and 8.6% lower in the intervention groups than the control groups in the "prevention" and "recovery" studies, respectively, at the end of follow-up (p<0.05 and <0.001, respectively). A 4.7% seroprevalence of H. pylori infection was observed in the intervention group, with 30.2% in the control group at a mean age of 10 years after approximately an 8-year follow-up in the "prevention" study (p<0.0005). The seroprevalence decreased to 9 of 24 (37.5%) under intervention as opposed to 20 of 23 controls (87%) in the recovery study (p<0.002). A significant positive correlation was found between DAP glycemia and the anti-H. pylori serum antibody concentration (r = 0.52; p = 0.0002). A decrease in the level of immune stimulation by H. pylori infection was observed due to the intervention, which may have a preventive and therapeutic role on the infection.

Effect of population screening and treatment for Helicobacter pylori on dyspepsia and quality of life in the community: a randomised controlled trial. Leeds HELP Study Group

BACKGROUND

Infection with Helicobacter pylori is the main cause of peptic-ulcer disease. Treatment of this infection might lower the prevalence of dyspepsia in the community and improve quality of life. We investigated this possibility in a double-blind randomised controlled trial.

METHODS

Individuals aged 40-49 years were randomly selected from the lists of 36 primary-care centres. A researcher interviewed participants with a validated dyspepsia questionnaire and the psychological general wellbeing index (PGWB). H. pylori status was assessed by the carbon-13-labelled urea breath test. Infected participants were randomly assigned active treatment (omeprazole 20 mg, clarithromycin 250 mg, and tinidazole 500 mg, each twice daily for 7 days) or identical placebo. Participants were followed up at 6 months and 2 years.

FINDINGS

Of 32,929 individuals invited, 8455 attended and were eligible; 2324 were positive for H. pylori and were assigned active treatment (1161) or placebo (1163). 1773 (76%) returned at 2 years. Dyspepsia or symptoms of gastro-oesophageal reflux were reported in 247 (28%) of 880 in the treatment group and 291 (33%) of 871 in the placebo group (absolute-risk reduction 5% [95% CI 1-10]). H. pylori treatment had no significant effect on quality of life (mean difference in PGWB score between groups 0.86 [-0.33 to 2.05]).

INTERPRETATION

Community screening and treatment for H. pylori produced only a 5% reduction in dyspepsia. This small benefit had no impact on quality of life.

The very model of a modern etiology: a biopsychosocial view of peptic ulcer

OBJECTIVE

Research on ulcer psychosomatics has plummeted since the early 1970s, to the applause of many who argue that ulcer is simply an infectious disease. The purpose of this article is to discuss the relevance of ulcer psychogenesis in the age of Helicobacter pylori.

METHODS

A critical literature review was conducted.

RESULTS

There is a substantial and methodologically sound body of prospective studies linking stress with the onset and course of peptic ulcer. Psychosocial factors can be estimated to contribute to 30% to 65% of ulcers, whether related to nonsteroidal antiinflammatory drugs, H. pylori, or neither. The observed association between stress and ulcer is accounted for, in part, by recall bias, misreported diagnoses, and confounding by low socioeconomic status (a source of stress and of ulcer risk factors, such as H. pylori and on-the-job exertion) and by distressing medical conditions (which lead to use of nonsteroidal antiinflammatory drugs). Of the residual, true association, a substantial proportion is accounted for by mediation by health risk behaviors, such as smoking, sleeplessness, irregular meals, heavy drinking, and, again, nonsteroidal antiinflammatory drugs. The remainder results from psychophysiologic mechanisms that probably include increased duodenal acid load, the effects of hypothalamic-pituitary-adrenal axis activation on healing, altered blood flow, and impairment of gastroduodenal mucosal defenses.

CONCLUSIONS

Peptic ulcer is a valuable model for understanding the interactions among psychosocial, socioeconomic, behavioral, and infectious factors in causing disease. The discovery of H. pylori may serve, paradoxically, as a stimulus to researchers for whom the concepts of psychology and infection are not necessarily a contradiction in terms.

Dyspepsia in relation to Helicobacter pylori infection and psychosocial work stress in white collar employees

OBJECTIVE

We undertook an investigation of the relationship between psychosocial work stress and Helicobacter pylori (H. pylori) infection with dyspepsia.

METHODS

We conducted a cross-sectional study among 189 employees of a health insurance company in the city of Ulm, Germany.

RESULTS

A clear association between work-related psychosocial factors and the occurrence of dyspeptic symptoms during the past 3 months was evident. Persons who were considered to have a critical style of coping with work demands suffered more often from dyspeptic symptoms. Current infection with H. pylori was not associated with prevalence of dyspeptic symptoms. These results were also confirmed by adjustment for age, gender, smoking status, education, and use of antiinflammatory drugs within the past 3 months, by means of multivariate analysis. The odds ratio (OR) for having a dyspepsia symptom score in the upper tertile versus the 1st or 2nd was 3.22 (95% confidence interval [CI], 1.56-6.65), given that the employee was considered to have a critical style of coping with work demands. The OR for having a dyspepsia symptom score in the upper tertile given H. pylori infection was 1.23 (95% CI, 0.44-3.46), indicating no association of current H. pylori infection with dyspeptic symptoms.

CONCLUSIONS

A critical style of coping with work demands may be an important determinant for dyspepsia-like symptoms. Therefore, in the absence of an underlying disease, specific intervention programs should be targeted at the behavior of the affected individual (e.g., stress-reduction programs) rather than on the treatment of specific symptoms or infection with H. pylori.

Yield of routine endoscopy beyond the duodenal bulb

The authors determined the clinical yield, endoscopic time, and patient tolerance of routine upper endoscopy beyond the duodenal bulb. From May through October 1994, all patients undergoing routine esophagogastroduodenoscopy (EGD) were recruited for study. Each procedure was timed from start to finish by the endoscopy nurse, and, in addition, the time of the postbulbar examination was recorded. The endoscopy nurse assessed the patient's comfort level when the endoscope was advanced into the duodenal bulb and again at the postbulbar region. A total of 250 EGDs were performed. There were 152 males and 98 females, with a mean age of 57.1 (range, 23-91) years. Indications for the procedure were as follows: gastroesophageal reflux disease symptoms 82, epigastric pain 64, dysphagia 46, Barrett's surveillance 25, anemia 23, other research study 16, and other 61. The mean time for the procedure was 11 min and 54 s, whereas the mean time for the postbulbar examination was 46.6 s. Patients tolerated endoscope insertion well both before and during examination of the postbulbar duodenum. The only postbulbar finding that affected clinical management was a postbulbar ulcer in a patient without other ulcers who was positive for Helicobacter pylori. Although routine endoscopic examination beyond the duodenal bulb involves minimal time and is well tolerated by patients, the yield of pathologic findings is low (3.6%) and the yield of findings that alter clinical management even lower (0.4%). In patients without prior GI surgery undergoing routine EGD for indications other than suspected small bowel pathology or active upper GI bleeding, examination of the postbulbar duodenum can be considered an elective part of the procedure.

Organic and psychosocial risk factors for duodenal ulcer

Duodenal ulcer (DU) is a common medical disorder which frequently becomes chronic. The factors involved in the aetiology of DU are poorly understood. Evidence for the contribution of psychosocial factors to the onset of DU is reviewed in the context of evidence of organic factors, genetic and environmental, with special reference to new evidence of infectious agents in the aetiology of DU. Recent progress in understanding of biological forces of duodenal ulcer disease has lead to a substantially revised view of psychosomatic factors. Although these may be of significance, their relative contribution to aetiology is likely to be modest.

Quality of life and relapse of duodenal ulcer before and after eradication of Helicobacter pylori

BACKGROUND

The aim of the study was to compare relapse rates and quality of life before and after eradication of Helicobacter pylori in a group of patients with documented recurrent duodenal ulcer disease.

METHODS

Seventy-four patients with three endoscopically verified duodenal ulcers during the past 2 years received triple treatment consisting of bismuth subnitrate, oxytetracycline, and metronidazole for 14 days. Quality of life was measured with the Psychosocial Adjustment to Illness Scale (PAIS-SR) and H. pylori status with the 14C-urea breath test.

RESULTS

After triple treatment H. pylori was eradicated in 96%, and the ulcer was healed in all. Ulcer relapse was reduced from 100% before to 1.4% during a mean observation time of 111 weeks. The H. pylori reinfection rate was 2.4% during the 1st year. The patients were more satisfied with the health care system and had better sexual relationship and less psychologic distress 1 year after eradication of H. pylori than before.

CONCLUSIONS

For patients with recurrent duodenal ulcer, eradication of H. pylori with triple treatment leads to a significantly reduced ulcer relapse rate and improved quality of life.

Helicobacter pylori in functional dyspepsia and normal controls

BACKGROUND

The aim of this study was to examine whether Helicobacter pylori status can identify a specific subset of patients with functional dyspepsia (FD) and erosive prepyloric changes (EPC).

METHODS

Anamnestic, somatic, and psychologic data were collected from 87 patients with functional dyspepsia and 77 normal control persons. Presence of H. pylori infection was assessed by the 14C-urea breath test.

RESULTS

H. pylori infection increased with age. Thirty-four per cent of the patients were H. pylori-positive, compared with 36% of the control persons. The patients had higher scores than the normal control persons on psychologic measures regardless of H. pylori status. Of 27 variables analyzed, age was the only factor that discriminated between H. pylori-positive and -negative patients.

CONCLUSIONS

For most patients with FD and EPC the presence of H. pylori infection is probably a consequence of age, and it does not seem to help us in the search for factors that can identify a subset of patients within our group of FD patients.

[The psychological characteristics of dyspepsia. A controlled study with gastroscopic follow-up]

It's known that some psychologic factors could be implicated in dyspepsia. Therefore, the psychologic aspects of 38 dyspeptic patients (17 males, 21 females, aged 18-65 years), who underwent digestive endoscopy, were evaluated by means of Rorschach and MMPI test. Patients with previous peptic ulcer history, with chronic ethanol or NSAID intake, operated on digestive tract and patients with behavioural problems were excluded. The results of psychological tests enhanced two main groups: anxiety patterns (17 patients--49%) and normal patterns (21 patients--55%). Endoscopic and histological findings moreover showed: "anxious" group--12 patients with chronic gastritis (HP+ 50%), 5 patients with normal endoscopy; "normal" group--16 patients with chronic gastritis (HP+ 87.5%), 5 patients with normal endoscopy. This study suggests that in about 50% of dyspeptic patients anxious pattern is present. Moreover chronic gastritis is more frequently associated to Helicobacter pylori in non-anxious patients.