Prevalence and factors associated with H. pylori infection in Saudi patients with dyspepsia
Keywords:
H. pylori, PCR, Prevalence, Jazan provinceAbstract
Background: Helicobacter pylori (H. pylori) is a major cause of peptic ulcer disease (PUD) and chronic active gastritis that may progress to gastric cancer. Globally, it has been estimated that 50% or more of the world's population is infected by H. pylori, making it the most widespread infection across the globe. Objectives: To determine the prevalence of H. pylori infection and to identify factors associated with H. pylori infection in Saudi patients presenting with dyspepsia. Methods: In this prospective cross-sectional study, a total of 404 gastric biopsies were endoscopically obtained from 404 patients with dyspepsia from September 2014 to April 2016 (Jazan Province, Saudi Arabia). The specimens were analyzed using the real-time polymerase chain reaction (PCR). The data was examined using descriptive statistics as well as determining the prevalence, and employing Chi square and Fisher exact test. A p-value of ≤0.05 was considered statistically significant in examining the research hypotheses. Results: The overall prevalence of H. pylori in Jazan Province was 46.5% (95% CI: 41.7-51.4) and the prevalence was lower among those > 55 years old. Prevalence was higher among urban (50.0%; 95% CI: 43.1-56.8) versus rural (42.1%; 95% CI: 35.1-49.3), but with no significant difference. Prevalence did not show significant difference among different Body Mass Index (BMI) categories, ranging from 40.2% to 47.7%. The prevalence of H. pylori in females was 47.1% (95% CI: 40.4-53.9) versus 45.6% (95% CI: 38.7-52.6) in males. Histopathology findings were associated with H. pylori infection with prevalence of 58.1% among patients with chronic active gastritis, compared to 24.1% and 34.8% among mild and chronic gastritis, respectively. Conclusion: Our results indicate that there is a high prevalence of H. pylori among Saudi patients with dyspepsia. Prevalence of H. pylori was high in ages below 55 years. Chronic active gastritis was significantly associated with H. pylori infection. In depth studies are needed to determine associated factors with of H pylori infection in the regionReferences
Warren JR, Marshall B. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. The
Lancet. 1983; 321(8336): 1273-5. doi: 10.1016/S0140-6736(83)92719-8.
Essawi T, Hammoudeh W, Sabri I, Sweidan W, Farraj MA. Determination of Helicobacter pylori virulence
genes in gastric biopsies by PCR. ISRN Gastroenterol. 2013; 2013.
Pounder RE, Ng D. The Prevalence of Helicobacter pylori infection in Different Countries. Aliment
Pharmacol Ther .1995; 9(Suppl 2): 33–39. PMID: 8547526.
Bytzer P, Dahlerup JF, Eriksen JR, Jarbøl DE, Rosenstock S, Wildt S. Diagnosis and treatment of
Helicobacter pylori infection. Dan Med Bull. 2011; 58(4): C4271. PMID: 21466771.
Al-Akwaa AM. Prevalence of Helicobacter pylori infection in a group of morbidly obese Saudi patients
undergoing bariatric surgery: A preliminary report. Saudi J Gastroenterol. 2010; 16: 264-7. doi:
4103/1319-3767.70610. PMID: 20871190, PMCID: PMC2995094.
Hasosah M, Satti M, Shehzad A, Alsahafi A, Sukkar G, Alzaben A, et al. Prevalence and Risk Factors of
Helicobacter pylori Infection in Saudi Children: A Three ‐ Year Prospective Controlled Study.
Helicobacter. 2015; 20(1): 56-63. doi: 10.1111/hel.12172. PMID: 25495104.
de Martel C, Ferlay J, Franceschi S, Vignat J, Bray F, Forman D, et al. Global burden of Cancer
attributable to H. pylori infection: a review and synthetic analysis. Lancet Oncol. 2013; 3(6): 607-15. doi:
1016/S1470-2045(12)70137-7. PMID: 22575588.
Dixon MF. Pathology of gasitritis and peptic ulceration. In: Mobley HLT, Mendz GI, Hazell: H. pylori:
Physiology and Genetics. Washington DC: ASM Press; 2001.
Wang HC, Cheng FC, Wu MS, Shu HY, Sun HS, Wang YC, et al. Genome sequences of three Helicobacter
pylori strains from patients with gastric mucosa-associated lymphoid tissue lymphoma. Genome
announcements. 2015; 30; 3(2): e00229-15.
Souod N, Sarshar M, Dabiri H, Momtaz H, Kargar M, Mohammadzadeh A, et al. The study of the oipA
and dupA genes in Helicobacter pylori strains and their relationship with different gastroduodenal diseases.
Gastroenterol Hepatol Bed Bench. 2015; 8(Suppl1): S47-53. PMID: 26171137, PMCID: PMC4495424.
Al-Moagel MA, Evans DG, Abdulghani ME, Adam E, Evans DJ Jr, Malaty HM, et al. Prevalence of
Helicobacter (formerly Campylobacter) pylori infection in Saudi Arabia, and comparison of those with and
without upper gastrointestinal symptoms. Am J Gastroenterol. 1990; 85(8): 944-948. PMID: 2375321.
Marie MA. Seroprevalence of Helicobacter pylori Infection in Large Series of Patients in an Urban Area of
Saudi Arabia. Korean J Gastroenterol. 2008; 52: 226-9. PMID: 19077524.
Iman N, Khan H, Iqbal S, Rehman S. Frequency of H. pylori in patients with upper G.I symptoms. J Med
Sci. 2008; 16(1): 1-3.
Ayoola AE, Ageely HM, Gadour MO, Pathak VP. Prevalence of Helicobacter pylori infection among
patients with dyspepsia in South- Western Saudi Arabia. Saudi Med J. 2004; 25(10): 1433-8. PMID:
Momenah A, Tayeb MH. Helicobacter pylori cagA and iceA genotypes staus and risk of peptic ulcer in
Saudi patients. Saudi Med J. 2007; 28(3): 382-5.
Alazmi WM, Siddique I, Alateeqi N, Al-Nakib B. Prevalence of Helicobacter pylori infection among
Kuwaiti patients with dyspepsia. BMC Gastroenterol. 2010; 10: 14. doi: 10.1186/1471-230X-10-14. PMID:
, PMCID: PMC2835643.
Tanih NF, Okeleye BI, Ndip LM, Clarke AM, Naidoo N, Mkwetshana N, et al. Helicobacter pylori
prevalence in dyspeptic patients in the Eastern Cape province: race and disease status. S Afr Med J. 2010;
(11): 734-7. doi: 10.7196/SAMJ.4041. PMID: 21081026.
Chong VH, Lim KC, Rajendran N. Prevalence of active Helicobacter pylori infection among dyspeptic
patients referred for endoscopy in Brunei Darussalam. Singapore MED J. 2008; 49: 42-6. PMID:
Shokrzadeh L, Baghaei K, Yamaoka Y, Shiota S, Mirsattari D, Porhoseingholi A, et al. Prevalence of
Helicobacter pylori infection in dyspeptic patients in Iran. Gastroenterology Insight. 2012; 4: e8. doi:
4081/gi.2012.e8.
Replogle ML, Glaser SL, Hiatt RA, Parsonnet J. Biologic sex as a risk factor for Helicobacter pylori
infection in healthy young adults. Am J Epidemiol. 1995; 142(8): 856-63. doi:
1093/oxfordjournals.aje.a117725. PMID: 7572962.
Ramis IB, Vianna JS, Silva Junior LV, Von Groll A, Silva PE. CagE as a biomarker of the pathogenicity of
Helicobacter pylori. Rev Soc Bras Med Trop. 2013; 46(2): 185-9. doi: 10.1590/0037-8682-0054-2012.
PMID: 23740068.
Aziz F, Chen X, Yang X, Yan Q. Prevalenceand Correlation with Clinical Diseases of Helicobacter pylori
cagA and vacA Genotype among Gastric Patients from Northeast China. Biomed Res Int. 2014; 2014:
doi: 10.1155/2014/142980. PMID: 24949419, PMCID: PMC4052682.
Ashtari S, Pourhoseingholi A, Molaei M, Taslimi H, Zali M. The prevalence of Helicobacter pylori is
decreasing in Iranian patients. Gastroenterol Hepatol Bed Bench. 2015; 8(Suppl1): S23–9. PMID:
, PMCID: PMC4495420.
Ahmed SM, Hussein A, Ali M, Ali E, Mekky WM, Abdel-Fattah HM, et al. The Prevalence of Cag-A and
Vac-A Genotypes among Helicobacter pylori Infected Egyptian Patients. The ASM. 114th General
Meeting of the American Society for Microbiology Boston: USA; 2014.
Pajavand H, Alvandi A, Mohajeri P, Bakhtyari S, Bashiri H, Kalali B, et al. High Frequency of vacA s1m2
Genotypes Among Helicobacter pylori Isolates From Patients With Gastroduodenal Disorders in
Kermanshah. Jundishapur J Microbiol. 2015; 8(11). doi: 10.5812/jjm.25425. PMID: 26862378, PMCID:
PMC4740511.
Essawi T, Hammoudeh W, Sabri I, Sweidan W, Farraj M. Determination of H. pylori virulence genes in
gastric biopsies by PCR. Gastroenterol. 2013.
Nguyen T, Ramsey D, Graham D, Shaib Y, Shiota S, Velez M, et al. The Prevalence of Helicobacter pylori
Remains High in African American and Hispanic Veterans. Helicobacter. 2015; 20(4): 305-11. doi:
1111/hel.12199. PMID: 25689684.
Kadi R, Halawani E, Abdelkader H. Prevalence of H. pylori strains harbouringcag A and iceA virulence
genes in Saudi patients with gastritis and peptic ulcer disease. Microbiology discovery. 2014.
Zamani M, Ebrahimtabar F, Zamani V, Miller WH, Alizadeh‐Navaei R, Shokri‐Shirvani J, et al.
Systematic review with meta ‐analysis: the worldwide prevalence of Helicobacter pylori infection.
Alimentary pharmacology & therapeutics. 2018; 47(7): 868-76. doi: 10.1111/apt.14561. PMID: 29430669.
Lender N, Talley NJ, Enck P, Haag S, Zipfel S, Morrison M, et al. Review article: Associations between
Helicobacter pylori and obesity--an ecological study. Aliment Pharmacol Ther. 2014; 40(1): 24-31. doi:
1111/apt.12790. PMID: 24832176.
Xu C, Yan M, Sun Y, Joo J, Wan X, Yu C, et al. Prevalence of Helicobacter pylori infection and its relation
with body mass index in a Chinese population Helicobacter. 2014; 19(6): 437-42. doi: 10.1111/hel.12153.
PMID: 25256639.
Kyriazanos ID1, Sfiniadakis I, Gizaris V, Hountis P, Hatziveis K, Dafnopoulou A, et al. The incidence of
Helicobacter pylori infection is not increased among obese young individuals in Greece. J Clin
Gastroenterol. 34: 541-6. doi: 10.1097/00004836-200205000-00012. PMID: 11960066.
Khalifa M, Khodair S, Almakdad A. Cigarette smoking status and H. pyloriinfection in non-ulcer dyspepsia
patients. Egyptian Journal of chest diseases and tuberculosis. 2014; 63(3): 695-99. doi:
1016/j.ejcdt.2014.03.007.
Ogihara A, Kikuchi S, Hasegawa A, Kurosawa M, Miki K, Kaneko E, Mizukoshi H. Relationship between
Helicobacter pylori infection and smoking and drinking habits. Journal of gastroenterology and hepatology.
; 15(3): 271-6. doi: 10.1046/j.1440-1746.2000.02077.x. PMID: 10764027.
Hassan M, Mohammed K, Zipporah N, Husdson L. Khat (Catha edulis) use is associated with the
development of gastritis among adults in Nairobi Kenya. East Afr Med J. 2014; 91(6).
Mahfouz MS, Rahim BE, Solan YM, Makeen AM, Alsanosy RM. Khat chewing habits in the population of
the Jazan Region, Saudi Arabia: prevalence and associated factors. PloS one. 2015; 10(8): e0134545.
Almakdad A, Aldohlae M, Thabet A, Alhaimi M, Bafaqih O, Alhadad A. Prevalence of H. pylori infection
in Yemeni patients. Yemeni Journal for Medical Sciences. 2013; 7.
Mohammed MO. Correlation of Endoscopic Findings with Various Helicobacter pylori Tests among
Dyspeptic Patients. Int J Clin Med. 2014; 9; 5(19): 1180-8.
Ayana S, Sawi B, Venance B, Kibiki G. Upper GI endoscopic findings and prevalence of H. pylori
infection among adult patients with dyspepsia in Northern Tanzania. Tanzan J Health Res. 2014; 16(1).
Al-Hamdani A, Fayady M, Majed B. H.pylori gastritis: Correlation between the endoscopic and
histological findings. IJGE. 2001; 2001: (1).
Puodal A, Regmi S, Poudal S, Joshi P. Correlation between endoscopic and histopathological findings in
gastric lesions. Journal of University college of Medical Sciences. 2013: 1(3).
Yakoob M, Hussainy A. Chronic gastritis and H.pylori: A histopathological study of gastric mucosal
biopsy. J Coll Physicians Surg Pak .2010; 20(11): 773-5. PMID: 21078257.
Olmez S, Aslan M, Erten R, Sayar S, Bayram I. The prevalence of gastric intestinal metaplasia and
distribution of helicobacter pylori infection, atrophy, dysplasia, and cancer in its subtypes. Gastroenterol
Res Pract. 2015; 2015: 434039. doi: 10.1155/2015/434039. PMID: 26635875, PMCID: PMC4655281.
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
