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Prevalence of H.pylori infection in patients with peptic ulcers in an inner city minority population
A724 AGA ABSTRACTS
GASTROENTEROLOGY Vol. 118, No.4
3937
3939
PREVALENCE OF H.PYLORI INFECTION IN PATIENTS WITH PEPTIC ULCERS IN AN INNER CITY MINORITY POPULATION. Behzad Kalaghchi, Momodu A. Jack, Getachew Mekasha, Duane T. Smoot, D C Gen Hosp, Washington, DC; Howard Univ, Washington, DC.
CHANGING PREVALENCE OF H. PYLORI INFECTION IN EN· DOSCOPICALLY DEMONSTRATED DUODENAL ULCER(DU). Raymond G. Lahaie, Marie-Andree Lahaie, Michel Boivin, Michel Gagnon, Michel Lemoyne, Bic Nguyen, Victor Plourde, Pierre Poitras, Anand V. Sahai, CHUM St-Luc, Montreal, PQ, Canada. Background: Prevalence of H. pylori infection in DU was initially shown to be above 90% and was 95% in our unit in when last studied in 1993. Recent observations suggest a much lower prevalence rate of H. pylori infection in DU. Aim: Determine the current prevalence of H. pylori infection in endoscopically proven DU and determine the cause(s) of H. pylori negative duodenal ulcers. Methods: Retrospective study of all active DU's seen in our endoscopy unit between 01/1996 and 12/1998. H. pylori infection was determined by two antral biopsies read b~ same GI pathologist or in cases without biopsy by locally validated C 4'urea breath test' or serology (commecial). Charts reviewed for NSAID, ASA, PPI, antibiotic and bismuth use or for other potential cause of DU. Results: 140 patients with active DU. Average age 58.6 years. H. pylori status available in 125/140 (89%): antral biopsies 116/125 (92%). H. pylori infection was present in 78/125 (62%) DU's whereas 47/125 DU's were H. pylori negative. Average age in H. pylori positive DU patients was 56.6 (CI 52-61) and 61.7 (CI 57-67) in H. pylori negative DU patients. Of the 47 H. pylori negative DU's 18 (38%) were taking NSAIDS or ASA, 7 had another plausible cause of DU (Cronh's disease, gastrinoma, CMV, ICU) and in 7 there was a discordance between the presence of chronic active gastritis and the absence of H. pylori on antral biopsies suggesting that they may have been infected. This leaves 15 of 125 DU's (12%) for which no common etiology was found. H. pylori infection was found in 18.7% of 556 normal endoscopies where antral biopsies were taken. Conclusions: The prevalence of H. pylori infection in endoscopically demontrated DU (62%) was much lower in the last three years than it was in our unit when last studied in 1993 (95%). If the discordant histology cases are taken to be Hp positive, the prevalence would still be only 68%. Use of NSAIDS or ASA was the most frequent cause of H. pylori negative DU's. Since only 2/3 DU's are infected with H. pylori, proof of infection should be obtained before initiating treatment with antibiotics in DU patients. 1. Desroches et al J Nuc. Med. 1997;38:1141.
Background: Among patients with peptic ulcer disease, historically the prevalence of H. pylori (HP) has been reported to be 90% or greater. However, recent studies have suggested that the prevalence of HP in ulcer patients is closer to 60%. The aim of this study was to determine the prevalence of HP in peptic ulcer patients in an inner-city minority population. Methods: Medical records of all patients who underwent EGD at D.C. General Hospital between July 1997 and June 1999 were retrospectively reviewed. All patients who had Gastric ulcer (GU) andlor Duodenal ulcer (DU) on EGD were studied. An ulcer was defined as a lesion with loss of mucosal integrity which was >0.5 em in greatest diameter with apparent depth. Patients who had prior gastric surgery with an anastomotic ulcer or an ulcer without endoscopic biopsy were excluded. Patients with repeat ulcers were only included once. Patient demographic characteristics, history of NSAID ingestion, alcohol consumption, and presence of associated diseases were collected. HP was considered present if either CLO test or histopathology was positive for HP. HP was considered negative if histopathology was negative for HP or both CLO test and histology were negative for HP. Histopathology was sent when CLO test was negative. Results: Among 948 patients who had an EGD during the study period, 156 patients were found to have au andlor DU. Fifty-one ulcer patients were excluded for reasons mentioned above. There were 105 ulcer patients who were included in the study, all were African Americans. au was found in 48 patients, DU in 46 patients, and both GU&DU in 11 patients. Mean age of HP-pos ulcer patients was 53.9 (range of 22-84 years). Mean age of HP-neg ulcer patients was 50.1 (range of 17-87) . Females represented 36% of HP-pos and 48% of HP-neg ulcer patients. HP was present 67.6% of ulcer patients, and a history of NSAID usage was found in 35% of ulcer patients. HP was present in 66.7%, 69.6% and 63.6% of GUs, DUs and GU +DU, respectively. Antral histology and CLOtest were in agreement in 96% of cases. There was no significant difference in the reason for endoscopy between patients who took NSAIDs and HP-pos patients. Conclusion: In this minority inner city population H. pylori is by far the most common cause of peptic ulcer disease. However, the prevalence of H. pylori in this population is much less than that reported in initial studies. It is important that H. pylori be diagnosed by appropriate use of diagnostic tests before giving antibiotic treatment to persons with peptic ulcer disease.
3938 SEROPREVALENCE OF HEUCOBACTER PYLORI AND TT VI· RUS IN JAPANESE CHILDREN. Seiichi Kato, Hiroaki Okamoto, Yoshikazu Nishino, Ichiro Tsuji, Kyoko Ozawa, Yasuo Oyake, Yutaka Nakazato, Takuji Fujisawa, Kazuie Iinuma, Tohoku Univ Sch of Medicine, Sendai, Japan; Jichi Med Sch, Tochigi, Japan; Hachinohe Red Cross Hosp, Hachinohe, Japan; Social Insurance Ohmiya Gen Hosp, Ohmiya, Japan; Kurume Univ Sch of Medicine, Kurume, Japan. Background: Helicobacterpylori and TT virus (TTY), recently discovered pathogens which are prevalent in normal population, are thought to be transmitted by a non-parenteral route. On the hypothesis that these two microorganisms have a common route of transmission, we investigated seroprevalence of H. pylori and TTY in Japanese children. Methods: In this cross-sectional study, a total of 449 children (0-15 years) in five areas who had neither blood transfusion, hepatitis, nor peptic ulcer disease were studied. TTV DNA was semi-quantitatively determined by polymerase chain reaction with semi-nested primers (the N22 region). Detection of H. pylori infection was based on serum anti-IgG and -lgA antibodies using enzyme immunoassay (HM-CAP and PP-CAP, Enteric Products, Inc., U.SA). Results: In age groups of <1,1-5,6-10, and 11-15 years, overall prevalence of TTV was 11.7%, 22.6%, 21.2%, and 24.0%, and that of H. pylori was 1.8%, 8.5%, 15.5%, and 20.4%, respectively. There was a regional difference in TTV, but it was small in H. pylori. Titers of TTY DNA were higher in children aged under 5 years than in older children (p
3940 HEUCOBACTER PYLORI SEROPOSITIVITY AND ESOPHAGEAL SQUAMOUS CANCER RISK IN LINXIAN, CHINA. Paul 1. Limburg, Sanford M. Dawsey, Youlin Qiao, Guoqing Wang, Guillermo I. Perez-Perez, Martin 1. Blaser, Steven D. Mark, Zhiwei Dong, Philip R. Taylor, National Cancer Institute, Bethesda, MD; Chinese Acad of Med Sci, Beijing, P. R. China; Vanderbilt Univ Sch of Medicine, Nashville, TN. Background: Esophageal squamous cancer (ESC) incidence and mortality rates are markedly elevated in Linxian, China. Despite extensive epidemiologic investigation, the major risk factors for this disease remain largely unknown. Our group has previously observed that serum antibodies to Helicobacter pylori are positively associated with gastric (cardia and non-cardia) cancer risk in this population. In the present nested case-cohort study, we examined the association between H. pylori seropositivity and ESC risk. Methods: Serum specimens were collected in 1985 as part of the baseline evaluation for a large (n=29,584) nutrition intervention trial. Data records complete through 1991 (end of the intervention period) were used to select a random sample of 67 prospectively identified ESC cases and 107 cancer-free controls. Antibodies to H. pylori were detected using optical density ratio (ODR) measurements from two regionally validated ELISAs for IgG and CagA. Assay results were assessed according to IgG alone (seropositive=ODR ~ 1.0), CagA alone (seropositive=ODR ~ 0.35) and IgG + CagA in combination (seropositive=one or both ~ to its ODR cut-point). Odds ratios for ESC were estimated using multivariable logistic regression analyses. Results: H. pylori seropositivity did not differ significantly between ESC cases and controls by IgG alone (p=0.36), CagA alone (p=0.24), or IgG + CagA iii combination (p=0.26). Antibodies to CagA were associated with increased ESC risk, but the adjusted odds ratio was not significantly different from unity (see Table). Conclusion: Based on these serology data, H. pylori infection does not appear to be a major risk factor for ESC in Linxian, China. However, further exploration of the possible strain-specific association between CagA + H. pylori and ESC risk may be warranted.
Assay IgG CagA IgG + CagA
Controls (n=107) %Pos. OR'
61 71 75
1.0 1.0 1.0
ESC Cases (n=67) %Pos.
OR'
95%Cr'
54 79 82
0.71 1.77 1.69
0.37·136 0.81-3.90 075-3.82
'Odds Ratio (adjusted forage, gender, and family history ofesophageal cancer); "95% Confidence Interval
GASTROENTEROLOGY Vol. 118, No.4
3937
3939
PREVALENCE OF H.PYLORI INFECTION IN PATIENTS WITH PEPTIC ULCERS IN AN INNER CITY MINORITY POPULATION. Behzad Kalaghchi, Momodu A. Jack, Getachew Mekasha, Duane T. Smoot, D C Gen Hosp, Washington, DC; Howard Univ, Washington, DC.
CHANGING PREVALENCE OF H. PYLORI INFECTION IN EN· DOSCOPICALLY DEMONSTRATED DUODENAL ULCER(DU). Raymond G. Lahaie, Marie-Andree Lahaie, Michel Boivin, Michel Gagnon, Michel Lemoyne, Bic Nguyen, Victor Plourde, Pierre Poitras, Anand V. Sahai, CHUM St-Luc, Montreal, PQ, Canada. Background: Prevalence of H. pylori infection in DU was initially shown to be above 90% and was 95% in our unit in when last studied in 1993. Recent observations suggest a much lower prevalence rate of H. pylori infection in DU. Aim: Determine the current prevalence of H. pylori infection in endoscopically proven DU and determine the cause(s) of H. pylori negative duodenal ulcers. Methods: Retrospective study of all active DU's seen in our endoscopy unit between 01/1996 and 12/1998. H. pylori infection was determined by two antral biopsies read b~ same GI pathologist or in cases without biopsy by locally validated C 4'urea breath test' or serology (commecial). Charts reviewed for NSAID, ASA, PPI, antibiotic and bismuth use or for other potential cause of DU. Results: 140 patients with active DU. Average age 58.6 years. H. pylori status available in 125/140 (89%): antral biopsies 116/125 (92%). H. pylori infection was present in 78/125 (62%) DU's whereas 47/125 DU's were H. pylori negative. Average age in H. pylori positive DU patients was 56.6 (CI 52-61) and 61.7 (CI 57-67) in H. pylori negative DU patients. Of the 47 H. pylori negative DU's 18 (38%) were taking NSAIDS or ASA, 7 had another plausible cause of DU (Cronh's disease, gastrinoma, CMV, ICU) and in 7 there was a discordance between the presence of chronic active gastritis and the absence of H. pylori on antral biopsies suggesting that they may have been infected. This leaves 15 of 125 DU's (12%) for which no common etiology was found. H. pylori infection was found in 18.7% of 556 normal endoscopies where antral biopsies were taken. Conclusions: The prevalence of H. pylori infection in endoscopically demontrated DU (62%) was much lower in the last three years than it was in our unit when last studied in 1993 (95%). If the discordant histology cases are taken to be Hp positive, the prevalence would still be only 68%. Use of NSAIDS or ASA was the most frequent cause of H. pylori negative DU's. Since only 2/3 DU's are infected with H. pylori, proof of infection should be obtained before initiating treatment with antibiotics in DU patients. 1. Desroches et al J Nuc. Med. 1997;38:1141.
Background: Among patients with peptic ulcer disease, historically the prevalence of H. pylori (HP) has been reported to be 90% or greater. However, recent studies have suggested that the prevalence of HP in ulcer patients is closer to 60%. The aim of this study was to determine the prevalence of HP in peptic ulcer patients in an inner-city minority population. Methods: Medical records of all patients who underwent EGD at D.C. General Hospital between July 1997 and June 1999 were retrospectively reviewed. All patients who had Gastric ulcer (GU) andlor Duodenal ulcer (DU) on EGD were studied. An ulcer was defined as a lesion with loss of mucosal integrity which was >0.5 em in greatest diameter with apparent depth. Patients who had prior gastric surgery with an anastomotic ulcer or an ulcer without endoscopic biopsy were excluded. Patients with repeat ulcers were only included once. Patient demographic characteristics, history of NSAID ingestion, alcohol consumption, and presence of associated diseases were collected. HP was considered present if either CLO test or histopathology was positive for HP. HP was considered negative if histopathology was negative for HP or both CLO test and histology were negative for HP. Histopathology was sent when CLO test was negative. Results: Among 948 patients who had an EGD during the study period, 156 patients were found to have au andlor DU. Fifty-one ulcer patients were excluded for reasons mentioned above. There were 105 ulcer patients who were included in the study, all were African Americans. au was found in 48 patients, DU in 46 patients, and both GU&DU in 11 patients. Mean age of HP-pos ulcer patients was 53.9 (range of 22-84 years). Mean age of HP-neg ulcer patients was 50.1 (range of 17-87) . Females represented 36% of HP-pos and 48% of HP-neg ulcer patients. HP was present 67.6% of ulcer patients, and a history of NSAID usage was found in 35% of ulcer patients. HP was present in 66.7%, 69.6% and 63.6% of GUs, DUs and GU +DU, respectively. Antral histology and CLOtest were in agreement in 96% of cases. There was no significant difference in the reason for endoscopy between patients who took NSAIDs and HP-pos patients. Conclusion: In this minority inner city population H. pylori is by far the most common cause of peptic ulcer disease. However, the prevalence of H. pylori in this population is much less than that reported in initial studies. It is important that H. pylori be diagnosed by appropriate use of diagnostic tests before giving antibiotic treatment to persons with peptic ulcer disease.
3938 SEROPREVALENCE OF HEUCOBACTER PYLORI AND TT VI· RUS IN JAPANESE CHILDREN. Seiichi Kato, Hiroaki Okamoto, Yoshikazu Nishino, Ichiro Tsuji, Kyoko Ozawa, Yasuo Oyake, Yutaka Nakazato, Takuji Fujisawa, Kazuie Iinuma, Tohoku Univ Sch of Medicine, Sendai, Japan; Jichi Med Sch, Tochigi, Japan; Hachinohe Red Cross Hosp, Hachinohe, Japan; Social Insurance Ohmiya Gen Hosp, Ohmiya, Japan; Kurume Univ Sch of Medicine, Kurume, Japan. Background: Helicobacterpylori and TT virus (TTY), recently discovered pathogens which are prevalent in normal population, are thought to be transmitted by a non-parenteral route. On the hypothesis that these two microorganisms have a common route of transmission, we investigated seroprevalence of H. pylori and TTY in Japanese children. Methods: In this cross-sectional study, a total of 449 children (0-15 years) in five areas who had neither blood transfusion, hepatitis, nor peptic ulcer disease were studied. TTV DNA was semi-quantitatively determined by polymerase chain reaction with semi-nested primers (the N22 region). Detection of H. pylori infection was based on serum anti-IgG and -lgA antibodies using enzyme immunoassay (HM-CAP and PP-CAP, Enteric Products, Inc., U.SA). Results: In age groups of <1,1-5,6-10, and 11-15 years, overall prevalence of TTV was 11.7%, 22.6%, 21.2%, and 24.0%, and that of H. pylori was 1.8%, 8.5%, 15.5%, and 20.4%, respectively. There was a regional difference in TTV, but it was small in H. pylori. Titers of TTY DNA were higher in children aged under 5 years than in older children (p
3940 HEUCOBACTER PYLORI SEROPOSITIVITY AND ESOPHAGEAL SQUAMOUS CANCER RISK IN LINXIAN, CHINA. Paul 1. Limburg, Sanford M. Dawsey, Youlin Qiao, Guoqing Wang, Guillermo I. Perez-Perez, Martin 1. Blaser, Steven D. Mark, Zhiwei Dong, Philip R. Taylor, National Cancer Institute, Bethesda, MD; Chinese Acad of Med Sci, Beijing, P. R. China; Vanderbilt Univ Sch of Medicine, Nashville, TN. Background: Esophageal squamous cancer (ESC) incidence and mortality rates are markedly elevated in Linxian, China. Despite extensive epidemiologic investigation, the major risk factors for this disease remain largely unknown. Our group has previously observed that serum antibodies to Helicobacter pylori are positively associated with gastric (cardia and non-cardia) cancer risk in this population. In the present nested case-cohort study, we examined the association between H. pylori seropositivity and ESC risk. Methods: Serum specimens were collected in 1985 as part of the baseline evaluation for a large (n=29,584) nutrition intervention trial. Data records complete through 1991 (end of the intervention period) were used to select a random sample of 67 prospectively identified ESC cases and 107 cancer-free controls. Antibodies to H. pylori were detected using optical density ratio (ODR) measurements from two regionally validated ELISAs for IgG and CagA. Assay results were assessed according to IgG alone (seropositive=ODR ~ 1.0), CagA alone (seropositive=ODR ~ 0.35) and IgG + CagA in combination (seropositive=one or both ~ to its ODR cut-point). Odds ratios for ESC were estimated using multivariable logistic regression analyses. Results: H. pylori seropositivity did not differ significantly between ESC cases and controls by IgG alone (p=0.36), CagA alone (p=0.24), or IgG + CagA iii combination (p=0.26). Antibodies to CagA were associated with increased ESC risk, but the adjusted odds ratio was not significantly different from unity (see Table). Conclusion: Based on these serology data, H. pylori infection does not appear to be a major risk factor for ESC in Linxian, China. However, further exploration of the possible strain-specific association between CagA + H. pylori and ESC risk may be warranted.
Assay IgG CagA IgG + CagA
Controls (n=107) %Pos. OR'
61 71 75
1.0 1.0 1.0
ESC Cases (n=67) %Pos.
OR'
95%Cr'
54 79 82
0.71 1.77 1.69
0.37·136 0.81-3.90 075-3.82
'Odds Ratio (adjusted forage, gender, and family history ofesophageal cancer); "95% Confidence Interval