Demographic, Clinical and Endoscopic Characteristics of Active and Antibiotic-resistant H. pylori-associated Gastritis in Egyptian Adults OC32-OC37
Dr. Fady Maher Wadea,
Assistant Professor, Department of Internal Medicine, Zagazig University, Zagazig-75575, Egypt.
Introduction: In Egypt the prevalence of H. pylori infection is high up to 90% in adults. Sequels of infection range from asymptomatic colonisation of the gastric mucosa to acute gastritis, chronic gastritis, atrophic gastritis, intestinal metaplasia, dysplasia and cancer. Antimicrobial resistance increases with time and decline in eradication rate reported globally.
Aim: To determine demographic, clinical and endoscopic presentation of H. pylori infected Egyptian adults and characteristics of patients resistant to eradication therapy used in Egypt.
Materials and Methods: This was a retrospective observational study which included 202 patients who had chronic active H. pylori gastritis and were referred to Internal Medicine Department Endoscopy Unit, Zagazig University Hospital; a tertiary referral centre from June to December 2017. Retrospective analysis of demographic features such as age and sex, clinical presentation, endoscopic features such as distribution of gastritis, nodularity, ulcers, erosions, polyps, Gastroesophageal Reflux Disease (GERD) and duodenitis as well as histological reports were used. Data were computerised and statistically analysed using SPSS program version 24.0.
Results: Middle-aged females had more infection and referral for endoscopic evaluation. Persistent epigastric pain is the common presentation. Pan gastritis and diffuse erythematous mottling are the common endoscopic criteria while mucosal nodularity was present in 21.8% especially in females. Mild activity is the more pronounced histological finding. Associated features were the presence of apparent submucosal vasculature (39.6%), erosions (22.8%), ulcers (22.8%), hyperplastic polyps (5.9%), incompetent cardia (89.1%), GERD mainly of Type A (40.6%) and mild duodenitis (52.5%). Resistance to first line therapy was seen in 45.5% of patients. Epigastric pain, the presence of apparent submucosal vasculature and GERD were independently associated with resistant infection (p<0.001, 0.001, 0.001, respectively). False negative stool antigen was present in 22.8%.
Conclusion: Females are more affected and presented with persistent epigastric pain and pangastritis type of mild activity. Availability of other antibiotics as the first line eradication therapy is needed. Patients with epigastric pain, apparent submucosal vasculature and GERD have resistant infection and other eradication regimens should be used however larger studies are needed to confirm the same. Improving diagnostic tests to avoid unnecessary endoscopic referral is needed.