Endoscopic Test for Helicobacter pylori Infection in Patients without Alarm Symptoms: A Study in a Minority Population

Abstract

Purpose: In addition to detecting common lesions in the upper gastrointestinal (UGI) tract, upper endoscopy is commonly used for diagnosis of H. pylori. In this study we would like to evaluate the yield of endoscopic test in detecting H. pylori infection, premalignant or malignant UGI lesions in patients with dyspepsia who did not have alarm symptoms or use NSAIDs chronically in our minority population. Methods: All men and women between 18-55 years of age with chronic abdominal pain who underwent EGD at the GI division of Bronx Lebanon Hospital Center (BLHC) between July 1, 2008 - December 31, 2009 were included in this retrospective study. Exclusion criteria were the presence of alarm symptoms and chronic NSAIDs use. Results: There were 205 patients who fulfilled the inclusion and exclusion criteria with median age of 43 years old. Of these patients, 59% were women, 66% hispanics, 24% African Americans and 9% other race. Most of the patients (92%) had upper abdominal pain. The endoscopic findings of these patients were esophagitis (12%), hiatus hernia (14%), erythema of gastric mucosa (49%), gastric ulcers (14%), erosion of gastric mucosa (23%), gastric polyp (5.9%), erythema of duodenal mucosa (4%) and erosion of duodenal mucosa (1%). Tissue biopsy from gastric mucosa revealed 22% (45/205) of positive urea based test and 17% (35/205) of positive H. pylori bacteria on histologic assessment. The yield of tissue biopsy for H. pylori was significantly higher among patients with gastric ulcers compared to those without gastric ulcers (12/30 in patients with gastric ulcers versus 35/175 in patients without gastric ulcers, p=0.02). Other findings from the tissue biopsy were esophageal inflammatory changes (7%), esophageal intestinal metaplasia (0.5%), gastric inflammatory changes (40%), hyperplastic gastric mucosa (1%), gastric foveolar hyperplasia (2%) and duodenal inflammatory changes (5%). None of the patients was diagnosed for upper gastrointestinal malignancy. Conclusion: Among patients with dyspepsia who did not have alarm symptoms or use NSAIDs chronically, endoscopic test revealed 22% of H. pylori infection. None of the patients were found to have premalignant or malignant lesions. Similar to previous studies in other communities, study in our minority population may indicate that the use of nonendoscopic test is an appropriate initial approach for detection of H. pylori infection in patients with dyspepsia who do not have have alarm symptoms or use NSAIDs chronically.