INCIDENCE OF HELICOBACTER PYLORI IN PATIENTS WITH GASTRITIS

PRESENTATION BY:-Sarvodayai SinhaIII/III MBBS

GRANT MEDICAL COLLEGE

GUIDED BY:-

Dr. Girish D. Bakhshi

ASSOCIATE PROFESSOR

DEPARTMENT OF SURGERY,

GRANT MEDICAL COLLEGE

Is Gastritis becoming a common problem?

Ref: National Institute of Diabetes and Digestive and Kidney Diseases

COUNTRY PREVALENCE

U.S.A 1% (approx. 1 in 100)

INDIA 0.11% (?)

HISTORY

Failed attempts for a complete

cure to gastritis and peptic ulcer

exceptions to the old dictum by Schwartz of

“no acid, no ulcer”

DISCOVERY OF HELICOBACTER

PYLORI

HISTORY

J. Robin Warren and Barry Marshall(1982)

discovered the association of Helicobacter pylori with gastritis and peptic ulcers.

Ref: Marshall & Barry, “Helicobacter Pioneers”

AIMS

& OBJECTIVES

Incidence of H.pylori in patients

with gastritis

Role of Anti H.pylori

regimen in gastritis

Anti H.pylori regimen versus Proton pump

inhibitor

MATERIALS & METHODS

Sample size = 50 patients.

Total duration = 3 months.

Approved by Institutional Ethics Committee (IEC).

INCLUSION CRITERIA

Heartburn

Water brash

Nausea/Vomiting

EXCLUSION CRITERIA

Patients < 18 years of age.

Pregnant women.

Patients on NSAIDs.

Patients on AKT.

EXCLUSION CRITERIA

Systemic illness like DM/IHD/HTN.

Complications of ulcer.

Previous acid lowering surgery/oesophagus surgery.

MATERIALS & METHODS

Endoscopy performed after the prior consent.

Extraction of gastric antral tissue.

CLO (Campylobacter Like Organisms) test performed.

MATERIALS & METHODS

Duration of observation : 48 hours.

Comparison with the histopathological report.

Patients administered with drugs.

STATISTICAL ANALYSIS PLAN

Chi square test with Yates’ correction.

OBSERVATIONS & RESULTS

21/50 patients positive for the H.pylori test; incidence = 42%

Colour of the PYLOTEST kit:

yellow pink H.pylori present

NEGATIVE

POSITIVE

0

10

20

30

40

50

60

70

80

90

H.pylori POSITIVE

% POSTITIVE

H.pylori NEGATIVE

% NEGATIVE

%age of TOTAL patients

ON THE BASIS OF QUESTIONNAIRE

10

1

20

0

7

1

5

0 0

25

0

8

00

5

10

15

20

25

30

OGD SCOPY FINDINGS

H.pylori POSITIVE PATIENTS

H.pylori NEGATIVE PATIENTS

SEX DISTRIBUTION

H.PYLORI NEGATIVEH.PYLORI POSITIVE

20

159

6

MALE FEMALE

APPROACH TO GASTRITIS PATIENTS

Gastritis patients

H.pylori –ve(29)

Advised Pantoprazole 40

(not under study)

H.pylori+ve(21)

9/21 administered with

Pantoprazole 40

11/21administered

with Anti-H.pylori regimen

Anti H.pylori regimen

Clarithromycin 500 mg

Pantoprazole 40 mg

Amoxicillin 750 mg

Twice daily (morning &

evening) for 14 days

0

2

4

6

8

10

12

PPI ANTI-HP REGIMENNOT CURED 8 2

CURED 2 9

CHI SQUARE TEST RESULT

Using the formula of Chi square test with Yates’ correction :-

where O = observed value

E = expected value

df = degree of freedom

Ref: Yates F (1934);"Contingency table involving small numbers and the χ2 test", Journal of the Royal Statistical Society

CHI SQUARE TEST RESULT

At p=0.05 (Fischer’s table) ;

On calculation;

Corresponding p value = 0.017 (<0.05)

CONCLUSION

Significant association of Helicobacter pylori with gastritis.

Consistency of CLO test (pylotest) being consistent with histopathologic studies.

Anti-H.pylori regimen being more promising than the proton-pump inhibitors alone.