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.