Page 34 - World Journal of Laparoscopic Surgery

Role of Helicobacter pylori in Chronic Abdominal Pain and Endoscopy-suggested Gastritis
Patients with abdominal pain due to gall stone, renal stone, chronic according to occupation revealed that the laborer was commonly
pancreatitis, hiatus hernia, esophagitis, and esophageal candidiasis found positive to the RUT (n = 17) (Table 2).
were excluded. In 11 and 19 patients of positive urease test, the duration of
Detailed patient history and data obtained from the routine abdominal pain was 3–6 months and 6–12 months, respectively
clinical and physical examination were recorded in pro forma. Upper (Table 3).
gastrointestinal endoscopy was performed using local anesthesia Retrosternal burning (n = 30), nocturnal association (n = 17),
in the left lateral position with flexed knees and hips and hands and periodicity (n = 18) were the commonly observed symptoms in
between the legs. A plastic mouth gag was placed and held firmly patients. Whereas, loss of appetite and weight loss were observed
by the assistant. The endoscope was passed into the oropharynx in five and four patients, respectively.
crossing the cricopharynx into the esophagus, asking the patient to
swallow until the passage from the cricopharyngeal sphincter. The dIscussIon
esophagus, stomach, first and the second part of the duodenum
were viewed and screened for pathology. If the patient was The most common cause of gastritis is an infection of H. pylori.
detected with gastritis (mucosa inflamed and edematous associated It is a microaerobic bacterium found in the gastric mucosa. The
with congestion), then biopsy was performed at various sites in the prevalence of this bacterium is affected by various factors such as
antrum of the stomach. If the patient with duodenum pain for more geographic distribution, age, race, and socioeconomic status. Its
than 6 months and was normal to radiological examinations, then diagnosis is categorized based on endoscopic and nonendoscopic
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biopsy was performed on normal mucosa. tests. The serological test for antibody shows exposure to bacteria;
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The specimen obtained from the biopsy was subjected to a however, it is insufficient in the assessment of active infection. RUT
RUT. Commercially prepared liquid urea broth medium was used provides evidence regarding infection by identifying the presence
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for the test. Immediately after collection, the sample was incubated of nonmammalian enzyme, i.e., urease, in, or on the gastric mucosa.
using 1.5–2 mL of urea broth at 37°C for 36 hours. Change in the The study aimed to assess the role of H. pylori infection among
color of the liquid urea broth from pale yellow to deep pink was patients with chronic abdominal pain and endoscopy suggested
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considered a positive test. Depending upon endoscopy findings, chronic gastritis and also to evaluate the association of endoscopic
severity, and urease test, appropriate treatment was given. Patients findings and RUT.
were advised for follow-up a week after. Upper gastrointestinal endoscopy is usually performed to
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assess the symptoms of upper abdominal pain. However, the
Statistical Analysis endoscopic diagnosis of H. pylori gastritis based on the gross
Data were analyzed using R Studio V 1.2.5001 software. Categorical appearance of the gastric mucosa is not recommended. Either
and continuous variables were expressed in frequency and pathological evaluation of biopsy of gastric mucosa or detection
mean ± SD, respectively. A Chi-square test was used to find the of urease in the mucosa by RUT produces accurate diagnosis
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association between variables. p <0.05 was considered statistically of H. pylori infection. H. pylori genes code for bacterial urease,
significant. which is essential for its metabolism and colonization of the
gastric mucosa. The presence of this enzyme in the sample is
visualized by hydrolyzing urea in a test medium to form ammonia
results and carbon dioxide. The color change from pale yellow to
The average age of the patients was 42.64 ± 14.30 years. Most pink is considered as positive RUT. 8,12 In this study, endoscopy
of the patients of the study were male (74%). The endoscopic investigation suggested gastritis in 76% of the patients. Among
investigation suggested gastritis in 76% (n = 38) of patients among these patients, 62% were positive to RUT. In the study of Mahesh
which n = 31 patients were positive to the RUT. In patients of normal et al., endoscopy gastritis was found in 81.54% of patients and
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endoscopic findings (24%, n = 12), the RUT was positive in n = 5 RUT was positive in 83.54% of the patients. Similarly, the study
patients. A significant association was found between endoscopy Table 2: Distribution of RUT according to occupation
suggested gastritis and RUT (p = 0.013). Patients of 31–40 years of
age (n = 11) were most commonly affected with the H. pylori. The Occupation Number of patients (n) Positive RUT % (n)
detailed distribution of RUTs according to the patient’s age-group Laborer 21 89.95 (17)
is shown in Table 1. Housewife 11 63.64 (7)
RUT was predominantly positive in males (75%, n = 27) Business/service 10 70 (7)
compared to females (25%, n = 9). Distribution of the patients Student 8 62.50 (5)
RUT, rapid urease test
Table 1: Distribution of RUT according to age
Age (years) Number of patients (n) Positive RUT % (n) Table 3: Distribution of RUT according to the duration of abdominal pain
11–20 2 0 Duration of abdominal
21–30 9 6 (66.67) pain (months) Number of patients Positive RUT % (n)
31–40 15 11 (73.33) <3 4 25 (1)
41–50 9 7 (77.78) 3–6 16 68.75 (11)
51–60 8 7 (87.50) 6–12 24 79.17 (19)
>60 7 5 (71.43) >12 6 83.33 (5)
RUT, rapid urease test RUT, rapid urease test

32 World Journal of Laparoscopic Surgery, Volume 15 Issue 1 (January–April 2022)