Prevalence, diagnosis and antibiotic resistance pattern of H. pylori in the patients with heterogeneous gastroduodenal disorders

Abstract

Background: Isolation of Helicobacter pylori (H. pylori) from gastric biopsies by Warren and Marshall has transformed our perception of gastro duodenal disorders. In India with miscellaneous environmental, dietary and lifestyle factors, it's common to acquire H. pylori infections. So screening becomes imperative for its early diagnosis and treatment. We intend to correlate the infection with diverse risk factors and also to appraise all microbiological diagnostic modalities with its local antibiogram. Methods and materials: Nine hundred and seventeen (n = 917) consecutive, symptomatic patients (562 males and 355 females) attending the endoscopy unit at a tertiary care center, Gujarat, India, were included. Four fragments of antral biopsies in a sterile Brain-heart infusion broth were processed for Rapid Urease Test (RUT), Gram's staining, Histopathology and Culture. Serum samples were tested for IgG antibody by ELISA. Susceptibility test was done by Kirby-Bauer disk diffusion method. Results: We found low Prevalence rate of H. pylori infection (15.2% 140/917). Symptoms of persistent gnawing abdominal pain (73%) was significantly associated with H. pylori infection (p < 0.01). Infection was mainly found in the patients with gastritis (44.2%), followed by reflux esophagitis (39%) and peptic ulcer disease (9.2%).The prevalence was higher in males (65%) probably due to their addictive habits to smoking/alcohol/tobacco. Amongst all the diagnostic techniques, serology was found 98.8% sensitive followed by Gram staining (96.8%) and histopathology (83%). Culture was 100% specific followed by RUT (99%). The combination of RUT with Gram's staining showed highest agreement of 95%. 83.8% of strains were resistant to metronidazole with a rising resistance to amoxicillin (72%) and clarithromycin (58%). Conclusion: Male gender, older age, chewing tobacco, Gastritis were individual risk factor associated to H. pylori infection. Combination of Gram staining and RUT was the Gold standard diagnostic test. Study recommends the need of sensitivity profile regionally and periodically before the general use of an eradication schedule.