Abstract
Helicobacter pylori (formerly Campylobacter pylori) was identified in 1982 by researchers from Australia as a pathogenic factor in peptic ulcer disease. Due to the few studies on H. pylori infection conducted in the population of persons with intellectual disability it was decided to conduct a clinical study in Israel. The purpose of the study was to determine the occurrence of H. pylori infection in persons who presented with severe dyspeptic symptoms and to monitor clinically the effect of treatment. The Division for Mental Retardation in Israel provides service to 6,022 persons in 53 residential care centers and 1 in central Israel was selected for this pilot study. The study has been performed since 1999 and each patient who came to the medical clinic of the institution with severe dyspeptic symptoms was examined clinically and a blood specimen drawn for IgG antibodies to H. pylori (ELISA, Pharmatop Millenia). In case of positive serology, triple drug treatment (amoxycillin, metronidazole, and pantoprazole or omepra-zole) was initiated for 1 week. Since 1999 a total of 43 persons (total population in care was 224) had severe dyspeptic symptoms and 42 persons (98%, 26 males, 16 females, mean age 45 years, mean institutionalization 20 years) had Helicobacter infection. All patients were treated for 1 week, but six patients received an extra month of omeprazole due to persistent symptoms. At follow-up, clinically all patients had improvement and only seven still had minor complaints (83% treatment success). Persons with developmental disability, intellectual disability, or mental retardation in residential care presenting with severe dyspeptic symptoms had a high incidence of H. pylori infection. Therefore, we recommend serology or urea breath investigations in this population presenting with dyspeptic symptoms and triple drug treatment for 1 week in case of positive findings.
Highlights
Peptic ulcer disease, defined as a chronic inflammation of the stomach and duodenum, has been thought of as a disorder associated with stress and dietary factors, which resulted in bed rest treatment and special diets
The purpose of the present study was to determine the occurrence of H. pylori infection in persons with intellectual disability (ID) in residential care who presented with severe dyspeptic symptoms, and to monitor clinically the effect of treatment if H. pylori was found
The study was initiated in January 1999 and it was decided to investigate every person for H. pylori who presented to the medical clinic of the center with severe dyspeptic symptoms
Summary
Peptic ulcer disease, defined as a chronic inflammation of the stomach and duodenum, has been thought of as a disorder associated with stress and dietary factors, which resulted in bed rest treatment and special diets. In 1971, Sir James Black identified a subtype of the histamine receptor (H2-receptor) that appeared to be the principal mediator of gastric acid secretion and antagonists of this receptor were introduced[1]. Marshall[2] from Royal Perth Hospital in Australia discovered a spiral, Gram-negative flagellate and microaerophilic bacteria in the narrow interface between the gastric epithelial cell surface and the overlying mucus gel in biopsies from patients with active chronic gastritis, duodenal ulcer or gastric ulcer. This bacteria was named Campylobacter pylori, but in 1989 renamed Helicobacter pylori[3]
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