Dyspepsia and Helicobacter pylori infection: Analysis of 200 Kuwaiti patients referred for endoscopy

Background: Dyspepsia is a very common symptom, and is the reason for most referrals for esophagogastroduodenoscopy (EGD). Peptic ulcer disease (PUD), gastroesophageal reflux and gastric cancer account for a minority of such patients. However, the majority have no significant endoscopic abnormalitie s (non-ulcer dyspepsia). Recently, infection with Helicobacter pylori (HP) has been implicated in the pathogenesis of PUD and gastric cancer, Since HP can be diagnosed by noninvasive techniques, it has been suggested that end oscopy should be restricted to HP-positive patients who do not respond to e mpirical therapy with antimicrobials. The aim of this study was to establis h the prevalence of I-IF among Kuwaiti dyspeptic patients referred for endo scopy and to determine whether demographic and clinical screening, or the p resence of HP, can help distinguish groups of patients with significant gas troduodenal pathology from those with non-ulcer dyspepsia. Patients and Methods: Two hundred randomly selected Kuwaiti patients referr ed for endoscopy were evaluated prospectively. A detailed personal intervie w was conducted to establish the demographic and clinical profile of each p atient and a diagnostic EGD was performed after the interview. Finally, ant ral mucosal biopsies were taken to determine the presence of I-IF. The pre- coded data were analyzed. Results: The main endoscopic findings were normal (32%), non-erosive antral gastritis (26%), duodenitis (17.5%), duodenal ulcer (11.5%), deformed bulb (4%), esophagitis (7%), and erosive gastritis (2%). The demographic and cl inical characteristics of patients did not correlate with endoscopic findin gs. The overall prevalence of HP infection was 88.5%. There were no statist ically significant differences in the prevalence of HP among patients with various endoscopic findings. Conclusion: HP infection is common in Kuwaiti dyspeptic patients referred f or endoscopy, irrespective of their demographic and clinical features or th e underlying cause of dyspepsia. Noninvasive methods to detect HP are not v alid alternatives to endoscopy in the work-up of dyspeptic patients.