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Mnichil Z, Nibret E, Hailegebriel T, Demelash M, Mekonnen D. Prevalence and associated risk factors of Helicobacter pylori infection in East Africa: a systematic review and meta-analysis. Braz J Microbiol 2024; 55:51-64. [PMID: 38040991 PMCID: PMC10920553 DOI: 10.1007/s42770-023-01190-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/16/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Helicobacter pylori is the main cause of chronic gastritis, peptic ulcer, lymphoma, and gastric cancer in humans. The prevalence and factors associated with H. pylori infection are varied across countries. Thus, a comprehensive review has not been done on prevalence and associated factors in East Africa. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence and identify factors associated with H. pylori infection in East Africa. METHODS Articles written in English language were retrieved from PubMed, Scopus, and Science Direct. Relevant articles were selected and screened using Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Publication bias was assessed qualitatively and qualitatively using funnel plot symmetry and Egger's test, respectively. Heterogeneity was assessed using the I2 measure. Data were analyzed using Stata software, version 14, and the "metan" command. RESULTS A total of 231 articles were retrieved from nineteen countries in East Africa. Of these, 70 articles were eligible for the review. The pooled prevalence of H. pylori in East Africa was 50.98% (95% CI: 45.05-56.90). The prevalence of H. pylori infection ranged from 7.7 to 94.5% in East African countries. The highest pooled prevalence was from Sudan (61.3%, 95% CI: 52.6-69.9), and the lowest prevalence was reported from Uganda (40.7%, 95% CI: 33-48.3). Persons with no formal education (OR: 2.03; 95% CI: 1.22-2.83), lack of hand washing habit after toilet (OR: 2.24; 95% CI: 1.45-3.02), having a history of dyspepsia (OR: 2.25; 95% CI: 1.31-3.18), living in rural areas (OR = 1.80; 95% CI: 0.38-3.23), and having unclean water source (OR = 1.5; 95% CI:0.45-3.45) were all associated with higher risk for H. pylori infection. CONCLUSION More than half of the populations of East African countries were positive for H. pylori infection. Rural residence, source of water, and alcohol consumption were significantly associated with H. pylori infection. Therefore, healthcare workers could provide health education on the aforementioned risk factors, and the government and other stakeholders could improve the source of drinking water in East Africa.
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Affiliation(s)
- Zebasil Mnichil
- Yilmana Densa Woreda Education Office, West Gojjam Zone, Bahir Dar, Ethiopia
| | - Endalkachew Nibret
- Department of Biology, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
- Institute of Biotechnology (IOB), Bahir Dar University, Bahir Dar, Ethiopia
| | - Tamirat Hailegebriel
- Department of Biology, College of Science, Bahir Dar University, Bahir Dar, Ethiopia.
- Institute of Biotechnology (IOB), Bahir Dar University, Bahir Dar, Ethiopia.
| | - Maritu Demelash
- South Mecha Woreda Education Office, West Gojjam Zone, Bahir Dar, Ethiopia
| | - Daniel Mekonnen
- Institute of Biotechnology (IOB), Bahir Dar University, Bahir Dar, Ethiopia
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Yousif Alamen Abdalla H, Alhaboob Arabi N, Musaad AM, E Elsheikh A, Alrashidi N. Esophagogastroduodenoscopy in Patients With Dyspepsia: A Retrospective Study at a Tertiary Hospital. Cureus 2023; 15:e36520. [PMID: 37090398 PMCID: PMC10120605 DOI: 10.7759/cureus.36520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Background Recurrent upper abdominal pain or dyspepsia is one of the patients' most common chief complaints. This study correlates the symptoms of dyspepsia to esophagogastroduodenoscopy findings among Sudanese patients attending Soba University Hospital. Methods A retrospective observational study was conducted at Soba University Hospital from April 2019 to April 2020. Patients were selected according to inclusion and exclusion criteria. Each patient filled out a standardized data collection form with data on their demographics, symptoms, and endoscopic findings. A P-value of < 0.05 was considered statistically significant. Results The study included 142 patients, where 57.7% (n=82) were females, and 59.9% (n=85) of the study participants were of normal body mass index. In contrast, 57% of the study participants had a symptom duration of less than six months. Approximately 95.1% (n=135) suffered from heartburn, 80.3% (n=114) suffered from epigastric fullness, and 96.5% (n=137) suffered from epigastric pain. Seventy-eight point two percent (78.2%; n=111) who suffered from epigastric pain mentioned that it increased in intensity with food, 85.9% (n=121) who suffered from epigastric pain mentioned that it decreased in intensity with food, 54.2% (n=76) of the study participants suffered from regurgitation, 59.9% (n=85) of the study participants suffered from weight loss, 52.1% (n=73) of the study participants were using non-steroidal anti-inflammatory drugs (NSAIDs), 41.7% (n=59) of the study participants had normal esophagogastroduodenoscopy findings, followed by 35.9% (n=51) who had duodenitis or gastritis during the endoscopic assessment. Conclusion The study showed that esophagogastroduodenoscopy is not recommended in young patients without alarm symptoms who can be managed conservatively. However, every patient with alarming symptoms should have an esophagogastroduodenoscopy. Also, the study revealed that females and old-aged patients had higher rates of dyspeptic symptoms.
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Affiliation(s)
| | | | | | - Anas E Elsheikh
- Surgery, Faculty of Medicine, Soba University Hospital, Khartoum, SDN
| | - Nasser Alrashidi
- Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Al-Qassim, SAU
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Qu LS, Gubi MM. Digestive endoscopy in Tanzania. Arab J Gastroenterol 2022; 23:228-229. [PMID: 36347764 DOI: 10.1016/j.ajg.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/30/2022] [Accepted: 09/03/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Li-Shuai Qu
- Digestive Endoscopy Center, Mnazi Mmoja Referral Hospital, Stonetown, Zanzibar Archipelago, Tanzania; China Medical Team, Affiliated Hospital of Nantong University, Jiangsu Province, China.
| | - Mariam Mohamed Gubi
- Digestive Endoscopy Center, Mnazi Mmoja Referral Hospital, Stonetown, Zanzibar Archipelago, Tanzania
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Assefa B, Tadesse A, Abay Z, Abebe A, Tesfaye T, Tadesse M, Molla A. Peptic ulcer disease among dyspeptic patients at endoscopy unit, University of Gondar hospital, Northwest Ethiopia. BMC Gastroenterol 2022; 22:164. [PMID: 35382748 PMCID: PMC8980767 DOI: 10.1186/s12876-022-02245-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/24/2022] [Indexed: 01/19/2023] Open
Abstract
Background Dyspepsia is a common complaint in upper gastrointestinal disorders. It is described as predominant epigastric pain lasting for at least one month. Globally, peptic ulcer disease occurs in 3.5–32% of patients with dyspepsia. Helicobacter pylori (H. pylori) infection and non-steroidal anti-inflammatory drugs/aspirin use are the widely known risk factors for peptic ulcer disease. There was no recent document on H. pylori infection rate among patients with peptic ulcer disease in Ethiopia. This study aimed to determine magnitude and associated factors of peptic ulcer disease among dyspeptic patients in Northwest Ethiopia. Methods An institutional-based cross sectional study was conducted at the University of Gondar hospital, Northwest Ethiopia. A convenience sampling method was used to recruit 218 study subjects. A pre-designed semi-structured questionnaire was used to extract clinical information. Olympus flexible fiber-optic endoscope (Olympus, GIF-E 600, Olympus Corp., Hamburg, Germany) was used to confirm the presence of peptic ulcer disease. Diagnosis of active H. pylori infection was made using the fecal H. pylori Antigen 25 T Card Test (Anamol Lab., Pvt. Ltd., Palghar, India). The Data were entered into EPI Info version 4.6.0.2, and then exported to SPSS version 20 for analysis. Explanatory variables associated with peptic ulcer disease were analyzed by applying logistic regression model. P value < 0.05 was used to declare significant association.
Result A total of 218 dyspeptic patients who underwent upper gastrointestinal endoscopic evaluations were included in the study. The mean (+ SD) age of patients was 42 ± 16.4 years. Forty nine percent (95% CI 42.4–56.2) of dyspeptic patients had active H. pylori infection. Peptic ulcer disease was diagnosed in 35% (95% CI 31.4–39.2) of patients with dyspepsia. H. pylori infection (AOR = 6.298, 95% CI 2.965–13.378, P value < 0.001) and NSAIDs/ASA use (AOR = 6.252, 95% CI 2.925–13.362, P value < 0.001) were identified as risk factors for peptic ulcer disease. Conclusion Medical treatment of peptic ulcer disease should target treatment of H. pylori infection and cautious use of non-steroidal anti-inflammatory drugs/aspirin.
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Affiliation(s)
- Belete Assefa
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abilo Tadesse
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Zenahebezu Abay
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alula Abebe
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsebaot Tesfaye
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Tadesse
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Molla
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mbiine R, Nakanwagi C, Kituuka O. High rates of gastroesophageal cancers in patients with dyspepsia undergoing upper gastrointestinal endoscopy in Uganda. Endosc Int Open 2021; 9:E997-E1000. [PMID: 34222620 PMCID: PMC8211477 DOI: 10.1055/a-1480-7231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background and study aims Dyspepsia is the most common presenting symptom in the gastrointestinal clinic of Mulago National Referral hospital. The etiology is essentially not fully described in our patient population. This study was therefore conducted to establish the causes of dyspepsia based on endoscopic diagnosis among patients with dyspepsia seeking care at the National Referral hospital of Uganda. Patients and methods This retrospective study conducted in the endoscopy unit of Mulago hospital reviewed 356 patient endoscopy reports spanning January 2018 to July 2020 with a focus on those with a referral indication of dyspepsia. Age and sex were the independent variables of interest while the endoscopy findings as reported by the endoscopist were the outcome variable of interest. Results Of the 356 endoscopy reports reviewed, 159 met the inclusion criterion of dyspepsia as the indication. Participant mean age was 47.7 years (± 16.53) with the majority (25.79 %) in the fifth decade while the male to female ratio was 1. The majority of patients had organic dyspepsia (90.57 %) while the commonest finding was gastritis 69 (43.4 %). Gastroesophageal cancers represented (18) 11.32 % of all findings. There was a positive association between age > 50 years with gastroesophageal cancers (7.639) as well as age < 50 years and functional dyspepsia (2.794); however, all these were not statistically significant ( P = 0.006 and ( P = 0.095, respectively). Conclusions Organic/structural dyspepsia comprises over 90 % of investigated dyspepsia with 11 % comprising cancer among patients seeking endoscopy at the National Referral Hospital of Uganda.
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Affiliation(s)
- Ronald Mbiine
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
| | - Cephas Nakanwagi
- Endoscopy Unit, Mulago National Referral Hospital, Kampala, Uganda
| | - Olivia Kituuka
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
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Latif A, Karim S, Ali H, Hussain M, Mujtaba G, Majid S. The Burden of Duodenal Ulcers Among Dyspeptic Patients. Cureus 2021; 13:e15113. [PMID: 34159016 PMCID: PMC8212788 DOI: 10.7759/cureus.15113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Dyspepsia is a common presenting complaint of various upper gastrointestinal disorders. Duodenal ulcer is one of the rare endoscopic findings in patients with dyspepsia, but it can present with upper gastrointestinal bleed. The aim of this study was to determine the frequency of duodenal ulcers among dyspeptic patients undergoing esophagogastroduodenoscopy (EGD). SUBJECT AND METHODS All patients who fulfilled the inclusion criteria were recruited during the period of six months, i.e., from July to December 2020 in the Department of Gastroenterology, Liaquat National Hospital and Medical College, Karachi. After obtaining informed and written consent, history, and clinical examination, the EGD was performed to assess the outcome, i.e., frequency of duodenal ulcers. RESULTS A total of 156 patients with dyspepsia were included. Eighty-seven (55.8%) were male and 69 (44.2%) were female with the mean age of 36.96+11.71 years. The most common symptom at presentation was epigastric burning seen in 76 patients (48.7%) followed by postprandial fullness in 59 patients (37%). Duodenal ulcers were noted in 18 patients (11.5%) and were significantly associated with alcohol intake, smoking, epigastric pain, postprandial fullness with p-values of 0.001, 0.001, 0.001, and 0.013, respectively. CONCLUSION Duodenal ulcer is an uncommon endoscopic finding in patients with dyspepsia; it is seen in younger age, smokers, alcohol use, and patients presenting with epigastric pain and postprandial fullness.
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Affiliation(s)
- Abdul Latif
- Gastroenterology and Hepatology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Shahid Karim
- Gastroenterology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Hamid Ali
- Gastroenterology and Hepatology, The Indus Hospital, Karachi, PAK
| | | | - Ghulam Mujtaba
- Gastroenterology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Shahid Majid
- Gastroenterology, The Indus Hospital, Karachi, PAK
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Adane H, Atnafie SA, Kifle ZD, Ambikar D. Evaluation of In Vivo Antiulcer Activity of Hydro-Methanol Extract and Solvent Fractions of the Stem Bark of Ficus thonningii (Moraceae) on Rodent Models. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6685395. [PMID: 33928161 PMCID: PMC8053060 DOI: 10.1155/2021/6685395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/17/2021] [Accepted: 03/31/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The stem bark of Ficus thonningii is used by Ethiopian traditional healers and the community for the treatment of peptic ulcer disease. Thus, the current study was aimed at evaluating the antiulcer effect of hydro-methanol extract and solvent fractions of F. thonningii. METHODS The stem bark of F. thonningii was collected and shed dried. Then, the stem bark was extracted by 80% hydro-methanol solvents and dried. The part of the dried hydro-methanol extract was further fractionated with n-hexane, chloroform, and distilled water. Dose-dependent pylorus ligation, curative indomethacin-induced, and time-dependent ethanol-induced ulcer models were evaluated for the hydro-methanol extract and solvent fractions. Statistical analysis was done by using the Statistical Package for the Social Sciences (SPSS) version 24. The analyses were carried out using one-way analysis of variance (ANOVA), followed by Tukey's multiple comparison tests. The result was considered significant when p < 0.05. RESULTS The extract of F. thonningii showed a significant (p < 0.001) reduction in total acidity at all the tested doses (100, 200, and 400 mg/kg). All the tested doses of the hydro-methanol extract significantly reduced the gastric volume as compared to the vehicle (NC) (p < 0.01). The gastric pH was significantly (p < 0.05) increased by 200 and 400 mg/kg. Similarly, 200 mg/kg and 400 mg/kg significantly (p < 0.05) lowered gastric ulceration as compared to the NC. The hydro-methanol extract and aqueous fractions of F. thonningii at 200 mg/kg showed significant (p < 0.05) reduction in the ulcer index on a repeated dose of the hydro-methanol and solvent fractions. Ulcer healing effect on indomethacin-induced ulcer was not significant (p > 0.05) for all tested doses of the hydro-methanol extract. CONCLUSION The study demonstrated that the stem bark of F. thonningii has a potential antiulcer activity that might be due to antisecretory or cytoprotective effects.
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Affiliation(s)
- Habtalem Adane
- Pharmaceutical Fund and Supply Agency, Bahir Dar, Ethiopia
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Seyfe Asrade Atnafie
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemene Demelash Kifle
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Digambar Ambikar
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Archampong TN, Asmah RH, Richards CJ, Martin VJ, Bayliss CD, Botão E, David L, Beleza S, Carrilho C. Gastro-duodenal disease in Africa: Literature review and clinical data from Accra, Ghana. World J Gastroenterol 2019; 25:3344-3358. [PMID: 31341360 PMCID: PMC6639557 DOI: 10.3748/wjg.v25.i26.3344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/14/2019] [Accepted: 05/31/2019] [Indexed: 02/06/2023] Open
Abstract
Gastroduodenal disease (GDD) was initially thought to be uncommon in Africa. Amongst others, lack of access to optimal health infrastructure and suspicion of conventional medicine resulted in the reported prevalence of GDD being significantly lower than that in other areas of the world. Following the increasing availability of flexible upper gastro-intestinal endoscopy, it has now become apparent that GDD, especially peptic ulcer disease (PUD), is prevalent across the continent of Africa. Recognised risk factors for gastric cancer (GCA) include Helicobater pylori (H. pylori), diet, Epstein-Barr virus infection and industrial chemical exposure, while those for PUD are H. pylori, non-steroidal anti-inflammatory drug (NSAID)-use, smoking and alcohol consumption. Of these, H. pylori is generally accepted to be causally related to the development of atrophic gastritis (AG), intestinal metaplasia (IM), PUD and distal GCA. Here, we perform a systematic review of the patterns of GDD across Africa obtained with endoscopy, and complement the analysis with new data obtained on pre-malignant gastric his-topathological lesions in Accra, Ghana which was compared with previous data from Maputo, Mozambique. As there is a general lack of structured cohort studies in Africa, we also considered endoscopy-based hospital or tertiary centre studies of symptomatic individuals. In Africa, there is considerable heterogeneity in the prevalence of PUD with no clear geographical patterns. Furthermore, there are differences in PUD within-country despite universally endemic H. pylori infection. PUD is not uncommon in Africa. Most of the African tertiary-centre studies had higher prevalence of PUD when compared with similar studies in western countries. An additional intriguing observation is a recent, ongoing decline in PUD in some African countries where H. pylori infection is still high. One possible reason for the high, sustained prevalence of PUD may be the significant use of NSAIDs in local or over-the-counter preparations. The prevalence of AG and IM, were similar or modestly higher over rates in western countries but lower than those seen in Asia. . In our new data, sampling of 136 patients in Accra detected evidence of pre-malignant lesions (AG and/or IM) in 20 individuals (14.7%). Likewise, the prevalence of pre-malignant lesions, in a sample of 109 patients from Maputo, were 8.3% AG and 8.3% IM. While H. pylori is endemic in Africa, the observed prevalence for GCA is rather low. However, cancer data is drawn from country cancer registries that are not comprehensive due to considerable variation in the availability of efficient local cancer reporting systems, diagnostic health facilities and expertise. Validation of cases and their source as well as specificity of outcome definitions are not explicit in most studies further contributing to uncertainty about the precise incidence rates of GCA on the continent. We conclude that evidence is still lacking to support (or not) the African enigma theory due to inconsistencies in the data that indicate a particularly low incidence of GDD in African countries.
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Affiliation(s)
- Timothy N Archampong
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, University of Ghana, Accra Box 4236, Ghana
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Richard H Asmah
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra Box 4236, Ghana
| | - Cathy J Richards
- Department of Histopathology, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom
| | - Vicki J Martin
- Department of Histopathology, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom
| | - Christopher D Bayliss
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Edília Botão
- Department of Pathology, Maputo Central Hospital, Maputo POBox 1164, Mozambique
| | - Leonor David
- Department of Pathology, Medical Faculty of the University of Porto, Porto 4200-465, Portugal
- Institute of Molecular Pathology and Immunology at the University of Porto (Ipatimup), Porto 4200-465, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto 4200-465, Portugal
| | - Sandra Beleza
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo POBox 257, Mozambique
- Department of Pathology, Maputo Central Hospital, Maputo POBox 1164, Mozambique
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Smith S, Fowora M, Pellicano R. Infections with Helicobacter pylori and challenges encountered in Africa. World J Gastroenterol 2019; 25:3183-3195. [PMID: 31333310 PMCID: PMC6626727 DOI: 10.3748/wjg.v25.i25.3183] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/02/2019] [Accepted: 06/01/2019] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) is the causative agent of gastritis, peptic ulcer disease, mucosa associated lymphoid tissue lymphoma and gastric cancer (GC). While this bacterium infects 50% of the world’s population, in Africa its prevalence reach as high as 80% as the infection is acquired during childhood. Risk factors for H. pylori acquisition have been reported to be mainly due to overcrowding, to have infected siblings or parent and to unsafe water sources. Despite this high H. pylori prevalence there still does not exist an African guideline, equivalent to the Maastricht V/Florence Consensus Report of the European Helicobacter and Microbiota Study Group for the management of this infection. In this continent, although there is a paucity of epidemiologic data, a contrast between the high prevalence of H. pylori infection and the low incidence of GC has been reported. This phenomenon is the so-called “African Enigma” and it has been hypothesized that it could be explained by environmental, dietary and genetic factors. A heterogeneity of data both on diagnosis and on therapy have been published. In this context, it is evident that in several African countries the increasing rate of bacterial resistance, mainly to metronidazole and clarithromycin, requires continental guidelines to recommend the appropriate management of H. pylori. The aim of this manuscript is to review current literature on H. pylori infection in Africa, in terms of prevalence, risk factors, impact on human health, treatment and challenges encountered so as to proffer possible solutions to reduce H. pylori transmission in this continent.
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Affiliation(s)
- Stella Smith
- Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Lagos PMB 2013, Nigeria
| | - Muinah Fowora
- Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Lagos PMB 2013, Nigeria
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Addula M, Wilson VED, Reddymasu S, Agrawal DK. Immunopathological and molecular basis of functional dyspepsia and current therapeutic approaches. Expert Rev Clin Immunol 2018; 14:831-840. [PMID: 30235962 PMCID: PMC6287908 DOI: 10.1080/1744666x.2018.1524756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Functional dyspepsia (FD) is widespread with 20% prevalence worldwide and a significant economic burden due to health care cost and constraints on daily activities of patients. Despite extensive investigation, the underlying causes of dyspepsia in a majority of patients remain unknown. Common complaints include abdominal discomfort, pain, burning, nausea, early satiety, and bloating. Motor dysfunction of the gut was long considered a major cause, but recent investigations suggest immune-based pathophysiological and molecular events in the duodenum are more probable contributing factors. Areas Covered: Inflammatory mediators and immune cells including duodenal eosinophils, intraepithelial lymphocytes, and T-cells have been implicated in the underlying cause of disease process, as have genetic factors. In this article, we critically reviewed findings, identified gaps in knowledge and suggested future directions for further investigation to identify targets and develop better therapeutic approaches. Expert commentary: Impaired gastric accommodation, slow gastric emptying, and increased visceral sensitivity have long been thought of as main causal factors of FD. However, more recent identification of eosinophilic degranulation and recruitment of T cells that induce mild duodenal inflammation are giving rise to new insights into immune-mediated pathophysiology. These insights offer promising avenues to explore for immune-mediated therapy in the future.
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Affiliation(s)
- Mounika Addula
- Departments of Clinical & Translational Science, Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Victoria E. D. Wilson
- Departments of Clinical & Translational Science, Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Savio Reddymasu
- Departments of Clinical & Internal Medicine, Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Devendra K. Agrawal
- Departments of Clinical & Translational Science, Creighton University School of Medicine, Omaha, NE 68178, USA
- Departments of Clinical & Internal Medicine, Creighton University School of Medicine, Omaha, NE 68178, USA
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Akeel M, Elmakki E, Shehata A, Elhafey A, Aboshouk T, Ageely H, Mahfouz MS. Prevalence and factors associated with H. pylori infection in Saudi patients with dyspepsia. Electron Physician 2018; 10:7279-7286. [PMID: 30258561 PMCID: PMC6140988 DOI: 10.19082/7279] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 06/02/2018] [Indexed: 12/13/2022] Open
Abstract
Background Helicobacter pylori (H. pylori) is a major cause of peptic ulcer disease (PUD) and chronic active gastritis that may progress to gastric cancer. Globally, it has been estimated that 50% or more of the world’s population is infected by H. pylori, making it the most widespread infection across the globe. Objectives To determine the prevalence of H. pylori infection and to identify factors associated with H. pylori infection in Saudi patients presenting with dyspepsia. Methods In this prospective cross-sectional study, a total of 404 gastric biopsies were endoscopically obtained from 404 patients with dyspepsia from September 2014 to April 2016 (Jazan Province, Saudi Arabia). The specimens were analyzed using the real-time polymerase chain reaction (PCR). The data was examined using descriptive statistics as well as determining the prevalence, and employing Chi square and Fisher exact test. A p-value of ≤0.05 was considered statistically significant in examining the research hypotheses. Results The overall prevalence of H. pylori in Jazan Province was 46.5% (95% CI: 41.7–51.4) and the prevalence was lower among those > 55 years old. Prevalence was higher among urban (50.0%; 95% CI: 43.1–56.8) versus rural (42.1%; 95% CI: 35.1–49.3), but with no significant difference. Prevalence did not show significant difference among different Body Mass Index (BMI) categories, ranging from 40.2% to 47.7%. The prevalence of H. pylori in females was 47.1% (95% CI: 40.4–53.9) versus 45.6% (95% CI: 38.7–52.6) in males. Histopathology findings were associated with H. pylori infection with prevalence of 58.1% among patients with chronic active gastritis, compared to 24.1% and 34.8% among mild and chronic gastritis, respectively. Conclusion Our results indicate that there is a high prevalence of H. pylori among Saudi patients with dyspepsia. Prevalence of H. pylori was high in ages below 55 years. Chronic active gastritis was significantly associated with H. pylori infection. In depth studies are needed to determine associated factors with of H pylori infection in the region
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Affiliation(s)
- Mohammed Akeel
- Department of Anatomy, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Erwa Elmakki
- Department of Internal Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Atef Shehata
- Department of Microbiology and Immunology, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.,Department of Microbiology and Immunology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ahmed Elhafey
- Department of Pathology, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.,Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Thanaa Aboshouk
- Department of Clinical Biochemistry, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Hussein Ageely
- Department of Internal Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Mohammed Salih Mahfouz
- Associate Professor, Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
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12
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Agarwal PK, Badkur M, Agarwal R, Patel S. Prevalence of Helicobacter pylori infection in upper gastrointestinal tract disorders (dyspepsia) patients visiting outpatient department of a hospital of North India. J Family Med Prim Care 2018; 7:577-580. [PMID: 30112312 PMCID: PMC6069636 DOI: 10.4103/jfmpc.jfmpc_213_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: Helicobacter pylori infection is a major health ailment in developing countries. The infection is related with high morbidity and mortality ranging from chronic gastritis to gastric malignancies. The prevalence of H. pylori infection greatly varies from country to country and region to region. The aim is to study the prevalence of H. pylori infection in upper gastrointestinal (GI) tract disorders (dyspepsia) patients. Methods: The study was carried out in an outpatient department, India. Patients presenting with dyspeptic symptoms were subjected to serological investigation and upper GI endoscopy, histopathological examination, and rapid urease test of specimen. Diagnosis of H. pylori infection was made if one or both diagnostic test results were positive. Results: H. pylori infection was diagnosed in 85% of patients. There was no significant difference in sex- and age-related distribution (<50 years’ age group and >50 years’ age group) of H. pylori infection. However, association of H. pylori infection was positive in 83.3% (45) of patients with endoscopic abnormalities (54). Conclusion: The prevalence of H. pylori infection is high in the study population. Early detection and prompt treatment are essential for prevention of serious complications.
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Affiliation(s)
| | - Mayank Badkur
- Department of General Surgery, AIIMS, Bhopal, Madhya Pradesh, India
| | - Richa Agarwal
- Department of General Surgery, AIIMS, Bhopal, Madhya Pradesh, India
| | - Seema Patel
- Department of Community Medicine, GMC, Bhopal, Madhya Pradesh, India
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13
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Dhakal OP, Dhakal M. Prevalence of Helicobacter pylori infection & pattern of gastrointestinal involvement in patients undergoing upper gastrointestinal endoscopy in Sikkim. Indian J Med Res 2018; 147:517-520. [PMID: 30082578 PMCID: PMC6094510 DOI: 10.4103/ijmr.ijmr_1482_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- O P Dhakal
- Department of Medicine, Sikkim Manipal Institute of Medical Sciences, Gangtok 737 102, Sikkim, India
| | - Mona Dhakal
- Department of Medicine, Sikkim Manipal Institute of Medical Sciences, Gangtok 737 102, Sikkim, India
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14
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Jaka H, Rhee JA, Östlundh L, Smart L, Peck R, Mueller A, Kasang C, Mshana SE. The magnitude of antibiotic resistance to Helicobacter pylori in Africa and identified mutations which confer resistance to antibiotics: systematic review and meta-analysis. BMC Infect Dis 2018; 18:193. [PMID: 29699490 PMCID: PMC5921563 DOI: 10.1186/s12879-018-3099-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/17/2018] [Indexed: 12/19/2022] Open
Abstract
Background Worldwide Helicobacter pylori (H.pylori) treatment is of great challenge due to increased antibiotic resistance. The burden of H. pylori antibiotic resistance in Africa is high with unclear information regarding the real magnitude. This systematic review and meta-analysis was conducted to investigate the magnitude of H.pylori antibiotic resistance in Africa to gain insight of the extent of the problem among H.pylori naïve treatment patients. Method The search was performed in the academic databases, Embase, PubMed, Web of Science and Africa Wide Information. ProQuest Dissertation and Theses, Scopus, Ethos, Africa Index Medicus (WHO), BioMed Central Proceedings, BASE, British Library, Open grey, Library of Congress and the New York Academy of Grey Literature Report were additionally searched for grey literature. Published articles from Africa on H.pylori antibiotic resistance between 1986 and June 2017 were systematically reviewed to estimate the H. pylori extent of resistance to macrolides, quinolones, amoxicillin, tetracycline and metronidazole. Results In 26 articles a total of 2085 isolates were tested for metronidazole, 1530 for amoxicillin, 1277 for tetracycline, 1752 for clarithromycin and 823 for quinolones.The overall pooled proportion of H.pylori resistance to quinolones, clarithromycin, tetracycline, metronidazole and amoxicillin were: (17.4%, 95%CI 12.8 - 21.9), (29.2%, 95%CI:26.7-31.8), (48.7%, 95%CI: 44.5-52.9), (75.8%, 95% CI: 74.1-.77.4) and (72.6%, 95% CI: 68.6-76.6), respectively. The commonest mutation detected were A2143G (49/97) for clarithromycin, RdxA (41/56) for metronidazole and D87I (16/40) for quinolones. Conclusion Prevalence of metronidazole, clarithromycin, and amoxicillin resistance is high in developing world including Africa. This could impair the first line triple therapy of the H.pylori infection. There is a need of conducting surveillance of H.pylori susceptibility pattern in Africa for dual and triple resistance which can be used for the empirical treatment. Electronic supplementary material The online version of this article (10.1186/s12879-018-3099-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hyasinta Jaka
- Gastroenterology and Hepatology Unit, Weill Bugando School of Medicine, Catholic University of Heath and Allied Sciences and Bugando Hospital Mwanza, P.O. BOX 1464, Mwanza, Tanzania.
| | | | - Linda Östlundh
- National Medical Library, United Arab Emirates University, Abu Dhabi, United Arab Emirates
| | - Luke Smart
- Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
| | - Robert Peck
- Gastroenterology and Hepatology Unit, Weill Bugando School of Medicine, Catholic University of Heath and Allied Sciences and Bugando Hospital Mwanza, P.O. BOX 1464, Mwanza, Tanzania.,Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Stephen E Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Heath and Allied Sciences Mwanza, Mwanza, Tanzania
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15
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Emara MH, Salama RI, Salem AA. Demographic, Endoscopic and Histopathologic Features Among Stool H. pylori Positive and Stool H. pylori Negative Patients With Dyspepsia. Gastroenterology Res 2017; 10:305-310. [PMID: 29118872 PMCID: PMC5667697 DOI: 10.14740/gr886w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/31/2017] [Indexed: 12/12/2022] Open
Abstract
Background Dyspepsia is a common presentation for many patients in gastroenterology clinics. Helicobacter pylori (H. pylori) infection is endemic in many countries around the world and its relation to dyspepsia has long been questioned. This study aimed at comparing demographic, endoscopic and histologic features among dyspeptic patients with and without stool H. pylori antigen positivity. Methods One hundred and fifty-one consecutive patients with dyspepsia were divided into group I (n = 80) and group II (n = 71) according to positive or negative H. pylori stool antigen testing, respectively. All patients were subjected to history taking, clinical examination, laboratory investigations, abdominal ultrasonography, H. pylori stool antigen detection, and upper gastrointestinal tract endoscopy with four gastric mucosal biopsies for histopathologic examination. Results Stool H. pylori antigen negative group included more smokers and consumed much more fast and spicy food than the positive group. The most common endoscopic findings of both groups were gastritis, reflux esophagitis, gastric erosions, peptic ulcer, mucosal nodularity and hiatus hernia and were encountered in 100%, 74.2%, 23.2%, 15.2%, 13.9%, and 13.2% respectively with non-significant difference between both groups except for gastric erosions that were significantly higher in stool H. pylori negative group (P < 0.001). Histologic evidence of gastritis was reported in 100% and 92.9% of patients in group I and group II, respectively. Chronic active gastritis with neutrophil infiltration was significantly higher in group I (P < 0.001). H. pylori bacilli were histologically detected in 83.7% and 47.9% of patients in group I and group II, respectively (P < 0.001). Conclusion All patients with dyspepsia in this study had endoscopic evidence of gastritis. Most of these patients had histologic evidence of gastric mucosal inflammation. Consequently, it may be advisable to perform endoscopy on these patients and obtain gastric mucosal biopsies.
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Affiliation(s)
- Mohamed Hassan Emara
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Rasha Ibrahim Salama
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amira Amin Salem
- Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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16
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Adu-Aryee NA, Aabakken L, Dedey F, Nsaful J, Kudzi W. Comparison of endoscopic based diagnosis with Helicobacter urease test for Helicobacter pylori infection. BMC Res Notes 2016; 9:421. [PMID: 27576901 PMCID: PMC5004304 DOI: 10.1186/s13104-016-2237-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 08/23/2016] [Indexed: 01/27/2023] Open
Abstract
Background Helicobacter pylori is an important risk factor for gastritis, peptic ulcers and gastric cancer. The prevalence in developed countries is lower than 40 % but higher than 80 % in some developing countries. It is 75 % in Ghana. The Helicobacter urease test (HUT) is performed at endoscopy and gives an accurate diagnosis. The HUT is not routinely done at our facility and presumption of H. pylori is made based on endoscopic findings and H. pylori eradication prescribed, as the incidence in the general population is presumed high. Is this endoscopic diagnosis sufficient for diagnosing and treating H. pylori? We aimed to assess the feasibility of an endoscopic based H. pylori diagnosis and its accuracy using a HUT as the gold standard in consecutive patients. Methods Seventy-six consecutive adult patients with dyspepsia were assessed by upper gastrointestinal endoscopy. A clinical diagnosis of H. pylori or not was made. Biopsy samples were collected for HUT. H. pylori was diagnosed if HUT was positive. The results were then compared. Results Median age of patients was 45.0 years. H. pylori prevalence detected by HUT was 51.3 % (95 % CI 40.0–63.0). Sensitivity of endoscopic diagnosis of H. pylori was 71.8 % (95 % CI 55.1–85.0) and specificity was 37.8 % (95 % CI 22.5–55.2). There was no association between clinical findings (73.7 %) and HUT (26.3 %) (OR = 0.80; [95 % CI 0.24–2.64], p = 0.682). There was also no association between endoscopic diagnosis (71.8 %) and HUT (28.2 %), (OR = 1.55; 95 % CI 0.59–4.06, p = 0.373). Conclusion Helicobacter pylori infection was not as high as that published in earlier reports. The endoscopic diagnosis alone is not sufficient to make a diagnosis of H. pylori.
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Affiliation(s)
- N A Adu-Aryee
- Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, P.O. Box GP 4236, Accra, Ghana
| | - L Aabakken
- Division of Gastroenterology, University of Oslo, Oslo, Norway
| | - F Dedey
- Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, P.O. Box GP 4236, Accra, Ghana
| | - J Nsaful
- Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, P.O. Box GP 4236, Accra, Ghana
| | - W Kudzi
- Centre for Tropical Clinical Pharmacology and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, P.O. Box GP 4236, Accra, Ghana.
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17
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Workineh M, Andargie D. A 5-year trend of Helicobacter pylori seroprevalence among dyspeptic patients at Bahir Dar Felege Hiwot Referral Hospital, Northwest Ethiopia. Res Rep Trop Med 2016; 7:17-22. [PMID: 30050336 PMCID: PMC6028059 DOI: 10.2147/rrtm.s105361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Helicobacter pylori infection is a major public health problem affecting half of the world's population. The prevalence of H. pylori varies in different societies and geographical locations. Thus, timely information on H. pylori epidemiology is critical to combat this infection. This study aimed to determine the seroprevalence and trend of H. pylori infection over a period of 5 years among dyspeptic patients at Bahir Dar Felege Hiwot Referral Hospital, Northwest Ethiopia. Methods A retrospective analysis of consecutive dyspeptic patients' records covering the period between January 2009 and December 2013 was conducted. The hospital laboratory generated the data by a serological method of detecting the antibodies for H. pylori from serum by a one-step rapid test device. Chi-square analysis was used to identify significant predictors. A P-value of <0.05 was considered as statistically significant. Results Among all the study subjects, 2,733 (41.6%) were found to be seropositive. The seroprevalence was significantly higher in males (43.2%) than in females (39.9%) (χ2=9; P=0.002). In terms of age groups of the patients, high rates of H. pylori were found among the participants older than 60 years (57%) (χ2=36.6; P≤0.00001). The trend analysis of H. pylori prevalence revealed a fluctuating prevalence; it was 44.5% in the year 2009 and decreased to 34% and 40% in the years 2010 and 2011, respectively. However, there was an increment to 52.5% in the year 2012, and then it decreased to 30.2% in the year 2013. Conclusion This study showed high seroprevalence of H. pylori among the dyspeptic patients in Bahir Dar Felege Hiwot Referral Hospital. The trend of the seroprevalence varied from year to year in the 5 consecutive years. Considering this, designing appropriate prevention and control strategies is mandatory.
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Affiliation(s)
- Meseret Workineh
- Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar
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18
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Nkurunziza A, Dusabejambo V, Everhart K, Bensen S, Walker T. Validation of the Kinyarwanda-version Short-Form Leeds Dyspepsia Questionnaire and Short-Form Nepean Dyspepsia Index to assess dyspepsia prevalence and quality-of-life impact in Rwanda. BMJ Open 2016; 6:e011018. [PMID: 27266772 PMCID: PMC4908900 DOI: 10.1136/bmjopen-2015-011018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES We aimed to develop and validate Kinyarwanda versions of Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) and Short-Form Nepean Dyspepsia Index (SF-NDI) to measure the frequency and severity of dyspepsia and associated quality-of-life impact in Rwanda. SETTING A single, tertiary care centre in Rwanda. PARTICIPANTS 200 consecutive Kinyarwanda-speaking patients referred to endoscopy (100 patients) or medical outpatients (100 patients). INTERVENTIONS Kinyarwanda versions of the SF-LDQ and SF-NDI were developed from English versions by translation, with back translation, crosschecking and pilot testing. Study participants completed these questionnaires at enrolment (time 1), and then completed the surveys again with blinded phone interviewers 3 days later (time 2). 20 randomly selected participants, diagnosed with a peptic ulcer on index endoscopy, completed a third survey by phone at day 30 (time 3), after therapy. PRIMARY OUTCOME MEASURES Internal consistency at time 1 (by Cronbach's α) and test-retest reliability between time 1 and time 2 (Spearman's correlation coefficient) for translated SF-LDQ and SF-NDI; validity versus clinical diagnosis (by receiver operating characteristic (ROC) curve) and responsiveness to treatment for SF-LDQ (by change in mean score). All outcomes were measured as per protocol. RESULTS Cronbach's α of the translated SF-LDQ was 0.93, showing high internal consistency. Spearman's correlation coefficient comparing time 1 and time 2 was 0.978 (p<0.001), demonstrating high reliability. Cronbach's α for the translated SF-NDI was 0.92. A cut-off score of 16 on the SF-LDQ showed a sensitivity of 97% and a specificity of 71% for the diagnosis of dyspepsia, correctly classifying 89% of patients. In the responsiveness analysis, the mean SF-LDQ score was reduced from 20.1 prior to treatment to 13.9 after 30 days of treatment (p=0.003). CONCLUSIONS The Kinyarwanda versions of the SF-LDQ and SF-NDI were valid, reliable and responsive to treatment.
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Affiliation(s)
- Arcade Nkurunziza
- College of Medicine and Health Sciences, University of Rwanda,Huye, Rwanda
| | - Vincent Dusabejambo
- College of Medicine and Health Sciences, University of Rwanda,Huye, Rwanda
- Kigali University Teaching Hospital, Kigali, Rwanda
| | - Kelly Everhart
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Steve Bensen
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Tim Walker
- College of Medicine and Health Sciences, University of Rwanda,Huye, Rwanda
- Butare University Teaching Hospital, Huye, Rwanda
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