Prevalence of Helicobacter pylori Infection in Haitians with Symptoms of Dyspepsia and Heartburn

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Purpose: Haitian patients seen at mobile medical clinics frequently complain of dyspepsia and/or heartburn. Treatment in these resource poor locations is empiric and varies depending on assumed etiology. Empiric treatment of symptomatic patients infected with H. pylori using acid antisecretory medications alone is unlikely to resolve symptoms. Empiric treatment of patients without H. pylori using triple drug therapy will waste limited resources while placing patients at risk for unnecessary side effects. The purpose of this study was to determine the prevalence of H. pylori infection in symptomatic Haitians so as to direct therapy based on data versus assumption. Methods: One hundred consecutive patients with symptoms of dyspepsia and/or heartburn presenting at a medical clinic in the rural Luly Community located in Arcahaie, Haiti, were the study population. An intake form was completed utilizing a local Haitian Interpreter. In addition to the specific symptoms of dyspepsia and heartburn, data recorded included: patient demographics, tobacco use, coffee use, alcohol use, and epigastric tenderness on examination. The presence of active H. pylori infection was determined by fecal H. pylori antigen testing. Stool for testing was obtained during digital rectal examination of each symptomatic patient. Patients were then treated based on results of fecal antigen testing. Results: Of the 100 patients tested there were 21 males/79 females. Average age was 37 years (range 16 to 87). Of note only 3 patients (3%) were positive for H. pylori. There was 1 male and 2 females. Ages were 19, 25, and 40 (male). All 3 drank coffee, none used tobacco, and 2 consumed alcohol. One of the three positive patients had epigastric tenderness. Conclusion: Testing for H. pylori using the fecal antigen test is feasible and easily performed in a rural Haitian medical clinic setting. Because of the low prevalence (3%) of H. pylori in rural Haitians presenting with symptoms of dyspepsia/heartburn, we recommend against empiric treatment targeting H. pylori. The potential role of Haitian diet including meal content, timing and frequency as a cause for these symptoms will be the subject of future investigation.