A SEROLOGIC SURVEY OF HELICOBACTER-PYLORI INFECTION IN 3281 ITALIAN PATIENTS ENDOSCOPED FOR UPPER GASTROINTESTINAL SYMPTOMS

Aim: To assess the seroprevalence of Helicobacter pylori infection in a large series of patients with upper gastrointestinal symptoms referr ed for their first upper gastrointestinal endoscopy, and to evaluate a ny association with disease. Methods: A large survey of 3281 dyspeptic patients undergoing their first endoscopic examination was undertaken , involving 93 centres in Italy. A blood sample was taken from each pa rticipant, for measuring IgG antibodies against H. pylori using a comm ercially available kit, and two biopsies of the antral gastric mucosa were obtained for evaluating a Giemsa-stained specimen. Results: Endos copic macroscopic diagnoses included normal mucosa (25.3%), gastroduod enitis (51.6%), gastric and duodenal ulcers (3.7 and 14.9%, respective ly) and other conditions, including gastric cancer (0.8%). Overall, th e seroprevalence result was 71.3% with a strong positive association w ith increasing age and male sex and a negative one with educational le vel. According to endoscopic diagnoses, the association with H. pylori seropositivity was highest for duodenal and gastric ulcer (multivaria te odds ratio: 6.1 and 2.2) and lowest for carcinoma. The comparison b etween the results of serology and the single Giemsa-stained specimen showed good reliability of H. pylori IgG, particularly in a subgroup ( n = 2056) for which the interpretation was performed by a single dedic ated pathologist: sensitivity and specificity were 92 and 78%, respect ively. Conclusion: Commercial IgG serology is a reliable tool for the assessment of H. pylori infection in large-scale multicentre surveys. A very high seroprevalence among dyspeptic patients was confirmed, par ticularly in the presence of peptic disease. Factors associated with t he infection were very similar to those usually reported in the genera l population but male patients showed a significantly higher prevalenc e.