Upper gastrointestinal tract abnormalities in patients referred for gastroscopy and the prevalence of Helicobacter pylori infection among them: a hospital based study in Sri Lanka

Abstract

Upper gastrointestinal endoscopy is a common procedure in routine clinical practice. This study examines the types of upper gastrointestinal abnormalities, their correlation with histological changes and the- prevalence of Helicobacter pylori (H pylori) infection among a group 251 Sri Lankan patients referred for upper gastrointestinal endoscopy. Nine gastric mucosal biopsies were obtained from each patient for three diagnostic tests i.e. histology, rapid urease test and culture and 5 ml of peripheral venous blood was obtained for the detection of anti-H.pylori IgA and IgG. Three case control studies were performed by comparing patients with peptic ulcer disease, gastro-oesophageal reflux disease and gastritis with age and sex matched, hospital based control groups to asses the risk and protective factors for each disease entity. The quality of life of patient group was compared with a control group using the validated Sinhala translation of WHO Quality of Life BREF (WHO QOL BREF) questionnaire. Approximately 86% of patients had histological evidence of chronic gastritis. There was a poor correlation between endoscopic and histological gastritis with more than 60% of patients with histological gastritis failing detection endoscopically. The prevalence of H.pylori determined by histology was 49.4%. When compared with histology which was taken as the gold standard (either Hematoxyline & Eosin or modified Giemsa positive) for the detection of H.pylori, all other diagnostic tests had low sensitivity and specificity. In the three case control studies, the middle socioeconomic group had lesser tendency to develop upper gastrointestinal diseases. While smoking had no effect, alcohol consumption, frequent use of certain groups of drugs and bad food habits significantly increased the risk of upper gastrointestinal diseases. Patients with upper gastrointestinal symptoms showed significantly low scores in physical and psychological domains of WHO QOL BREF. A majority of patients referred for upper gastrointestinal, endoscopy had a clinically relevant abnormality. There was relatively a low prevalence of H.pylori infection. Histology using H & E or modified Giemsa stain appeared to be the most reliable technique to detect H.pylori. Bad food practices, commonly Used drugs arid alcohol consumption were significant risk factors for upper gastrointestinal diseases arid the symptoms significantly affect the quality of