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.

The Role of National Specialist Societies in Influencing Transformational Change in Low-Middle Income Countries - Reflections on the Model of Implementation for a National Endoscopy Training Programme in Bangladesh

The British Society of Gastroenterology (BSG) and the Bangladesh Gastroenterology Society (BGS) have collaborated on an endoscopy training programme, which has grown up over the past decade from a small scheme borne out of the ideas of consultant gastroenterologists in Swansea, South Wales (United Kingdom) to improve gastroenterology services in Bangladesh to become a formalised training programme with broad reach. In this article, we document the socioeconomic and historical problems that beset Bangladesh, the current training needs of doctors and how the BSG-BGS collaboration has made inroads into changing outcomes both for gastroenterologists in Bangladesh, but also for the populations they serve.

Prevalence, risk factors and metabolic profile of the non-obese and obese non-alcoholic fatty liver disease in a rural community of South Asia

Introduction

Since there is a paucity of data on the epidemiology of the non-alcoholic fatty liver disease (NAFLD), particularly in rural areas in Asia, we undertook such a study among the population of a rural community in Bangladesh with the aims to (1) determine the prevalence of non-obese and obese NAFLD, (2) compare the sociodemographic clinical and metabolic characteristics between non-obese and obese NAFLD subjects, and (3) determine the risk factors of NAFLD and no-nobese NAFLD.

Methods

In this door-to-door survey, clinical examination, anthropometric measurements, biochemical tests and ultrasonography were performed on the adult population (≥18 years) of three villages in Bangladesh.

Results

Of 1682, 1353 (80.44%) responded. After the exclusion of 48 subjects for alcohol consumption, HBsAg or anti-hepatitis C virus positivity, 1305 ((mean age 41.28±15.10 years, female 908 (69.6%)) were included in the final analysis. On ultrasonography, among the study population, 57 (4.4%) non-obese, 185 (14.2%) obese and, overall, 242 (18.5 %, (male 23.40%, female 16.4%, p=0. 003)) participants had NAFLD. NAFLD was detected in 57/804 (7.1%) of non-obese and 185/501 (36.93%) obese participants. Among the lean subjects, 24/592 (4.1%) had NAFLD. Among NAFLD subjects, 57 (23.55%) were non-obese, and 53 (22%) had raised alanine aminotransferase. On multivariate analysis, age >40 years, male gender, metabolic syndrome (MS), diabetes mellitus (DM), abdominal obesity, hypertension, dyslipidaemia and obesity were found as the risk factors for NAFLD. There were no differences in sociodemographic characteristics, DM, MS, abdominal obesity, hypertension and dyslipidaemia between non-obese and obese NAFLD (all p>0.05).

Conclusion

In this community study in Bangladesh, NAFLD was present in 18.5% participants, one-quarter of whom were non-obese. Apart from body mass index, the metabolic profile was comparable between obese and non-obese NAFLD. Public health measures are needed to control and prevent NAFLD and MS and their adverse health consequences.

Prevalence, risk factors, and healthcare-seeking among subjects with esophageal symptoms: A community-based study in a rural Bangladeshi population

BACKGROUND AND AIM

As there is a scarcity of data on overall prevalence, risk factors, and health-care utilization of esophageal symptoms using the Rome criteria in the rural population in Asia, we undertook a study with the aims to evaluate: (i) the prevalence of heartburn, chest pain, globus, and dysphagia of presumed esophageal origin; (ii) the prevalence of functional esophageal disorders by Rome III criteria; (iii) the risk factors for esophageal symptoms; and (iv) the health-care utilization.

METHODS

This door-to-door survey was conducted in three villages (Charcharia, Churain of Dhaka district, and Kharrah of Munshiganj district of Bangladesh) among the adult population (≥18 years) using the translated and validated Enhanced Asian Rome III questionnaire.

RESULTS

Of 3559 individuals, 3351 (94.15%) responded (mean age 40.41 ± 16.04 years, female, 1924 [57.4%]). Heartburn was the most common symptom, 863 (25.8%), followed by chest pain, 367 (11%); globus, 285 (8.5%); and dysphagia, 146 (4.4%). At least one symptom was present in 1108 (33.1%) respondents. Based on Rome III criteria, 428 (12.8%), 41 (1.2%), 49 (1.5%), 26 (0.8%), and 524 (15.6%) had heartburn, chest pain, globus, dysphagia, and at least one functional esophageal disorder, respectively. Female gender, lower family income, presence of functional dyspepsia-irritable bowel syndrome (FD-IBS) overlap, FD only, and psychological distress were found to be risk factors for esophageal symptoms on multivariate analysis. Among the subjects with any esophageal disorders, 156 (14.1%) consulted any health-care provider, and 517 (46.6%) took antisecretory medications.

CONCLUSION

Esophageal symptoms are common in the rural community of Bangladesh and are associated with substantial health resource utilization.

Translation and Validation of Enhanced Asian Rome III Questionnaires in Bengali Language for Diagnosis of Functional Gastrointestinal Disorders

BACKGROUND/AIMS

Functional gastrointestinal disorders (FGIDs), diagnosed by symptom-based criteria due to lack of biomarkers, need translatedvalidated questionnaires in different languages. As Bengali, the mother tongue of Bangladesh and eastern India, is the seventh most spoken language in the world, we translated and validated the Enhanced Asian Rome III questionnaire (EAR3Q) in this language.

METHODS

The EAR3Q was translated in Bengali as per guideline from the Rome Foundation. The translated questionnaire was validated prospectively on Bengali-speaking healthy subjects (HS, n = 30), and patients with functional dyspepsia (FD, n = 35), irritable bowel syndrome (IBS, n = 40) and functional constipation (FC, n = 12) diagnosed by clinicians using the Rome III criteria. The subjects were asked to fill-in the questionnaire again after 2 weeks, to check for its reproducibility.

RESULTS

During translation, the original and the backward translated English versions of the questionnaire demonstrated high concordance. Sensitivity of the Bengali questionnaire to diagnose patients with FD, IBS, FC, and HS was 100%, 100%, 75%, and 100%, respectively, considering diagnosis by the clinicians as the gold standard. On test-retest reliability analysis, Kappa values for FD, IBS, FC, and HS were 1.0, 1.0, 0.83, and 1.0, respectively. The Bengali questionnaire detected considerable overlap of FD symptoms among patients with IBS, IBS among patients with FD, and FD among patients with FC, which were not detected by the clinicians.

CONCLUSIONS

We successfully translated and validated the EAR3Q in Bengali. We believe that this translated questionnaire will be useful for clinical evaluation and research on FGIDs in the Bengali-speaking population.

Long-term re-infection rate after Helicobacter pylori eradication in Bangladeshi adults

BACKGROUND AND AIM

Bangladesh is a developing country with a very high prevalence of Helicobacter pylori infection, which has been ascribed to overcrowding and poor sanitary conditions. It has generally been accepted that the re-infection rate is higher in countries with a high prevalence of H. pylori infection. Short-term follow-up studies support this assumption but no long-term studies are available to confirm or refute this assertion. The present study was aimed to define the long-term H. pylori re-infection rate (6 years after successful eradication) in duodenal ulcer patients.

METHODS

In a previous study, 90 patients were successfully eradicated for H. pylori and followed-up for 24 months. 17/90 were found to be re-infected (18% re-infection rate per year in the first 12 months) [Gastroenterology 2001;792-798]. The remaining 73 patients were targeted for long-term follow-up. 26/73 were lost to follow-up; 6 symptomatic patients were tested H. pylori positive in the period between 24 and 60 months post-eradication. The remaining 41 patients were evaluated 72 months after successful eradication. The evaluation included clinical history taking, a (13)C-urea breath test (UBT), and endoscopy.

RESULTS

Of the 41 H. pylori-eradicated patients analyzed after 72 months, 16 were H. pylori-positive. If the 6 patients, who were tested positive between 24 and 60 months, are added, the total re-infection cases amount to 22 subjects in the period between 24 and 72 months. Therefore, an overall annual re-infection rate 6 years after eradication of 5.02% can be calculated. Six of the 23 symptomatic patients had duodenal ulcer relapse, 5/6 were H. pylori re-infected and one was H. pylori-negative at 72 months post-treatment.

CONCLUSION

The long-term annual H. pylori re-infection rate in Bangladeshi adults is markedly higher than in Western countries but lower than anticipated. In this study, duodenal ulcer relapse is clearly related to H. pylori re-infection.