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A Single Center Retrospective Review ofH. pyloriCases Diagnosed via Esophagogastroduodenoscopy and Biopsy


Khan, Zubair MD; Darr, Umar MD; Abdel-Aziz, Yousef MD; Abdelfattah, Thaer MD; Tiwari, Abhinav MD; Alim, Hussam MD; Nawras, Ali MD, FACP, FACG, FASGE

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American Journal of Gastroenterology: October 2017 - Volume 112 - Issue - p S678-S679
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Introduction: Helicobacter Pylori (H. Pylori) affects 50% of the world's population and is a major cause of chronic gastritis. Histology via endoscopy is a most sensitive and specific diagnostic test. Testing for eradication is required after diagnosis. The aim of this retrospective review is to study the clinical indications, endoscopic findings, histologic features, post therapy testing and follow up of subset of H. Pylori cases diagnosed via Esophagogastroduodenoscopy (EGD) and biopsy.

Methods: This is a retrospective study of patients diagnosed to have H. Pylori infection via EGD and biopsy from January 2011 to June 2016. After IRB approval, hospital records were searched via ICD 9 code for H. Pylori Gastritis. We found a total of 50 cases who underwent EGD and biopsy for various indications and tested positive for H. Pylori.

Results: The Mean age was 51 ± 18 Years, with Male to Female ratio of 1:2 (17 vs 33). Half of the cases were at or below age 50 (n=24). The mean BMI was 26.5 ± 5.5. Majority of the patients (44%, n=22) underwent EGD for symptoms of persistent dyspepsia and epigastric pain despite treatment with PPIs, followed by 26 % patients (n=13) who underwent EGD for Hematemesis, Melena and Anemia without epigastric pain. Most predominant finding on endoscopy was moderate gastritis 30% (n=15), followed by no gastritis 24% (n=12). Gastric ulcers were found in 14% patients (n=7). Significant additional endoscopic findings were duodenitis and duodenal ulcers (30%, n=15). Most of the patients 54% (n=27) were found to have Moderate active chronic gastritis on histology (Sydney system). More than half of the patients 54% (n=27) on follow up were having either incomplete resolution of symptoms or developed epigastric pain and dyspepsia despite completing H. Pylori eradication treatment. Only 9 patients in total and 4 out of 27 patients with persistent symptoms were tested for H. Pylori eradication. One fourth of the patients (n=13) were having co-morbid diagnosis of Anxiety and depression.

Clinical, Endoscopic and Histologic Findings.
Follow up and testing for eradication.

Conclusion: Our study suggests that H. Pylori incidence is more in females and it is less incident in obese i.e. BMI > 30. Epigastric pain and dyspepsia not responding to PPI were the predominant symptoms of H. Pylori infection. Moderate gastritis was the predominant finding on endoscopy and histologic grading. Post therapy H. Pylori testing needs more focus and emphasis with more than half of the patients having persistent symptoms post treatment.

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