| Abstract|| |
Background: Pathologies of Helicobacter pylori infection show distinct regional patterns and are unclassified for Northern Ghana. Materials and Methods: Demographic and clinical data of 1580 patients who underwent upper gastrointestinal endoscopy (Tamale Teaching Hospital) were assessed. Results: The prevalence of H. pylori infection was 73.4%. Patients 31-50 years-old and >50 years-old had significantly more positive H. pylori tests than the ≤30 year-olds (odds ratios [ORs] [95% confidence interval [CIs]: 8.6 [6.637-11.22] and 6.1 [4.609-8.203]; both, P< 0.0001). Presenting symptoms were epigastric pain (67.3%), abdominal pain (21.5%), hematemesis (7.6%), and dysphagia (2.0%). H. pylori was diagnosed in 72.5% of patients with duodenal ulcers and 77.0% with gastric ulcer (n = 444). Gastric ulcer was significantly associated with H. pylori (OR [95% CI]: 1.3 [1.01-1.69], P= 0.042), and gastritis showed a positive but not statistically significant association. Conclusions: In Northern Ghana, H. pylori infection is associated with gastritis, gastric ulcer, and duodenal ulcer and is most common in middle-aged adults (31-50 years old).
Keywords: Endoscopy, gastrointestinal pathology, Helicobacter pylori infection, Northern Ghana
|How to cite this article:|
Tabiri S, Alhassan A, Anyomih TT. Helicobacter pylori association with upper gastrointestinal pathologies in Northern Ghana. Ann Trop Med Public Health 2018;11:48-51
|How to cite this URL:|
Tabiri S, Alhassan A, Anyomih TT. Helicobacter pylori association with upper gastrointestinal pathologies in Northern Ghana. Ann Trop Med Public Health [serial online] 2018 [cited 2020 Feb 29];11:48-51. Available from: http://www.atmph.org/text.asp?2018/11/2/48/272543
| Introduction|| |
The prevalence of Helicobacter pylori is highly variable, depending on factors such as geography, ethnicity, age, and socioeconomics. Middle-aged adults are most frequently affected and the highest incidence rates are in developing countries (>80% vs. 20%-50% in industrialized countries).H. pylori infection causes chronic gastritis and peptic ulcers and is involved in the development of gastric carcinoma. It has been a challenge, thus far, in Northern Ghana to demonstrate an association between upper gastrointestinal (GI) endoscopy diagnosis and causes of dyspepsia, due to lack of equipment and personnel for such studies.
The high prevalence of H. pylori infection in developing countries makes it a public health issue requiring strategic intervention. However, generating and implementing a successful intervention strategy is dependent on a basis of empirical data. Tabiri et al. previously performed a study in the northern region of Ghana and reported evidence of a relationship between H. pylori and endoscopic findings. The current study's objective was to demonstrate the association between H. pylori infection and upper GI pathologies among patients in Northern Ghana.
| Materials and Methods|| |
Study design and features
This was a cross-sectional, retrospective study of data obtained from medical records of patients who underwent upper (U) GI endoscopy at the Minimal Access Therapy and Operative Endoscopy Unit of the Department of Surgery at the Tamale Teaching Hospital (TTH) between October 2010 and October 2014. The TTH is the third largest teaching hospital in Ghana and serves the northern region of the country but also receives patients from neighboring Burkina Faso and Togo (the northern region). All UGI endoscopy procedures were performed by general surgeons with training and experience using the EVIS 140 series videoendoscopy system (Olympus Corp., Shinjuku, Tokyo, Japan).
Patient data for age, sex, indications for referral for UGI endoscopy, clinical diagnosis, endoscopy findings, histopathology reports, and urease test results were retrieved from the hospital's records. Ethical clearance was obtained from the Internal Review Board of the TTH for all records reviewed in the study period.
Data were analyzed using SPSS statistical software, version 16.0 (SPSS Inc., Chicago, IL, USA). Fisher's exact test was used to determine the association between urease test results and histopathology findings. P < 0.05 was considered statistically significant.
| Results|| |
A total of 1580 patients underwent UGI endoscopy at TTH during the 4-year study period. The patients included 799 (50.6%) males and 781 (49.4%) females. The mean age of the total population was 41.1 ± 16.2 years (range: 6-89 years), with males slightly older than females [40.2 ± 16.2 years vs. 39.3 ± 16.5 years; [Figure 1]. The largest age group represented was 31-50 years old (41.7%), followed by ≤30 years (33.5%).
Helicobacter pylori infection rates
Among the total study population, 73.4% showed positivity on H. pylori infection (urease) test. The age-specific prevalence rates are presented in [Table 1]. The proportion of positive H. pylori test results was significantly higher in the 31-50 years old and >50 years old age groups than that in the ≤30 years old group (odds ratio [OR] [95% confidence interval [CI]: 8.6 [6.637-11.22] and 6.1 [4.609-8.203]; both, P < 0.0001). The proportion of male patients with positive H. pylori test results was not, however, significantly different from that of the females (OR [95% CI]: 0.9 [0.745-1.166]; P < 1.00).
The most common presenting symptom was epigastric pain, followed by abdominal pain, hematemesis, and dysphagia [Table 2]. The remaining symptoms were grouped as “other” and included heartburn, belching, and hiccups. The patients who presented with epigastric pain had the largest proportion of positive test for H. pylori, followed by those who presented with abdominal pain and hematemesis [Table 2].
The most common endoscopic finding was gastritis, followed by gastric ulcer and gastric cancer [Figure 2]; less frequent was gastric and duodenal ulcers, duodenal ulcers, and gastric cancers.
Patients with duodenal ulcers and those with gastric ulcers had the highest rates of positivity for H. pylori infection [Table 3]. While the presence of duodenal ulcer was not significantly associated with H. pylori infection (OR [95% CI]: 0.95 [0.64-1.39]) that of gastric ulcer was (OR [95% CI]: 1.3 [1.01-1.69]). There was also a positive association between gastritis and H. pylori infection even though it was not statistically significant (OR [95% CI]: 1.2 [0.98-1.54]). Nearly one-half of the gastric cancer patients tested positive for H. pylori infection.
|Table 3: Relationship between upper gastrointestinal lesions and Helicobacter pylori infection|
Click here to view
Some patients had multiple endoscopy findings, including gastric and duodenal ulcers (OR [95% CI]: 0.60 [0.33-1.11]) and gastric cancers and duodenal ulcers (OR [95% CI]: 0.17 [0.016-1.98]); however, multiple pathologies did not showed a statistically significant association.
| Discussion|| |
This North Ghanaian patient population contained a high level of H. pylori infected-individuals, similar to reports from other parts of Africa,, and to one from the southern part of Ghana. This is in contrast to two other studies of Ghanaians, which found lower rates., The current study found the highest prevalence of H. pylori infection in adults over 30 years of age, which is similar to the previous studies but also differ from one which demonstrated decreasing incidence of H. pylori with advancing age. Our study population showed no significant association between sex and H. pylori infection. This finding is consistent with a previous report from Uganda but, again, differs from other studies that found a strong association with sex., However, we did find a significant association between H. pylori infection and peptic ulcer disease, as suggested by two other studies.,
H. pylori infection plays an important role in the development of gastritis which is consistent with the observations in our study population. Yet while previous studies have demonstrated the significant association of gastric cancers and H. pylori infection,, we found no significant association with the various subtypes of gastric adenocarcinoma. In contrast to our findings, Kuipers et al. reported that in Kenya, the incidence of gastric cancer is moderately associated with the prevalence of H. pylori infection.
Our study did not demonstrate any statistically significant association between H. pylori infection and presence of duodenal ulcer, unlike findings reported from a previous study. This apparent discrepancy in findings may be attributable to the small proportions of patients with duodenal ulcer in the current study.
Collectively, the findings from this study show the distinctive profile of H. pylori infection and upper GI pathologies in Northern Ghana and form a basis on which strategic intervention strategies may be developed for this particular region.
| Conclusions|| |
Among Patients in Northern Ghana, H. pylori infection is associated with upper GI pathologies and is most common in middle-aged adults (31-50 years old).
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Suerbaum S, Michetti P. Helicobacter pylori
infection. N Engl J Med 2002;347:1175-86.
McColl KE. Helicobacter pylori
and acid secretion: Where are we now? Eur J Gastroenterol Hepatol 1997;9:333-5.
Tabiri S, Akanbong P, Atiku A. Upper gastrointestinal endoscopic findings in patients presenting to Tamale Teaching Hospital, Ghana. Unified J 2015;1:006-11.
Asrat D, Nilsson I, Mengistu Y, Ashenafi S, Ayenew K, Al-Soud WA, et al.
Prevalence of Helicobacter pylori
infection among adult dyspeptic patients in Ethiopia. Ann Trop Med Parasitol 2004;98:181-9.
Ndip RN, Malange AE, Akoachere JF, MacKay WG, Titanji VP, Weaver LT, et al. Helicobacter pylori
antigens in the faeces of asymptomatic children in the Buea and Limbe health districts of Cameroon: A pilot study. Trop Med Int Health 2004;9:1036-40.
Ndip RN, Malange Takang AE, Ojongokpoko JE, Luma HN, Malongue A, Akoachere JF, et al. Helicobacter pylori
isolates recovered from gastric biopsies of patients with gastro-duodenal pathologies in Cameroon: Current status of antibiogram. Trop Med Int Health 2008;13:848-54.
Aduful H, Naaeder S, Darko R, Baako B, Clegg-Lamptey J, Nkrumah K, et al.
Upper gastrointestinal endoscopy at the Korle Bu Teaching Hospital, Accra, Ghana. Ghana Med J 2007;41:12-6.
Darko R, Yawson AE, Osei V, Owusu-Ansah J, Aluze-Ele S. Changing patterns of the prevalence of Helicobacter pylori
among patients at a corporate hospital in Ghana. Ghana Med J 2015;49:147-53.
Afihene MKY, Denyer M, Amuasi JJ, Boakye I, Nkrumah K. Prevalence of Helicobacter pylori
and endoscopic findings among dyspeptics in Kumasi, Ghana. Open Sci J Clin Med. 2014;2:63-8.
Kanbay M, Gür G, Yücel M, Yilmaz U, Muderrisoglu H. Helicobacter pylori
seroprevalence in patients with coronary artery disease. Dig Dis Sci 2005;50:2071-4.
Chen S, Ying L, Kong M, Zhang Y, Li Y. The prevalence of Helicobacter pylori
infection decreases with older age in atrophic gastritis. Gastroenterol Res Pract 2013;2013:494783.
Tsongo L, Nakavuma J, Mugasa C, Kamalha E. Helicobacter pylori
among patients with symptoms of gastroduodenal ulcer disease in rural Uganda. Infect Ecol Epidemiol 2015;5:26785.
Seyda T, Derya C, Füsun A, Meliha K. The relationship of Helicobacter pylori
positivity with age, sex, and ABO/Rhesus blood groups in patients with gastrointestinal complaints in Turkey. Helicobacter 2007;12:244-50.
Naja F, Kreiger N, Sullivan T. Helicobacter pylori
infection in Ontario: Prevalence and risk factors. Can J Gastroenterol 2007;21:501-6.
Nomura A, Stemmermann GN, Chyou PH, Perez-Perez GI, Blaser MJ. Helicobacter pylori
infection and the risk for duodenal and gastric ulceration. Ann Intern Med 1994;120:977-81.
Kuipers EJ, Thijs JC, Festen HP. The prevalence of Helicobacter pylori
in peptic ulcer disease. Aliment Pharmacol Ther 1995;9 Suppl 2:59-69.
Kuipers EJ, Lundell L, Klinkenberg-Knol EC, Havu N, Festen HP, Liedman B, et al.
Atrophic gastritis and Helicobacter pylori
infection in patients with reflux esophagitis treated with omeprazole or fundoplication. N Engl J Med 1996;334:1018-22.
Blaser MJ, Chyou PH, Nomura A. Age at establishment of Helicobacter pylori
infection and gastric carcinoma, gastric ulcer, and duodenal ulcer risk. Cancer Res 1995;55:562-5.
Parsonnet J, Friedman GD, Vandersteen DP, Chang Y, Vogelman JH, Orentreich N, et al. Helicobacter pylori
infection and the risk of gastric carcinoma. N Engl J Med 1991;325:1127-31.
Kuipers EJ, Nelis GF, Klinkenberg-Knol EC, Snel P, Goldfain D, Kolkman JJ, et al.
Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial. Gut 2004;53:12-20.
Kate V, Ananthakrishnan N, Tovey FI. Is Helicobacter pylori
infection the primary cause of duodenal ulceration or a secondary factor? A Review of the evidence. Gastroenterol Res Pract 2013;2013:425840.
Prof. Stephen Tabiri
Department of Surgery, University for Development Studies, School of Medicine and Health Sciences, Tamale Teaching Hospital, Tamale
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]