This document summarizes a study on the prevalence of Helicobacter pylori infection in patients with peptic ulcer disease in Manipur, India. The study found a prevalence of H. pylori infection of 20% among 60 peptic ulcer patients, which is significantly lower than other studies in India. Positive H. pylori status was significantly associated with non-vegetarian diet and not taking anti-ulcer drugs in the past week. The study concludes that a rapid antibody test kit is a suitable, cheap, and reliable screening technique for H. pylori infection in peptic ulcer patients.

1. Prevalence of Helicobacter pylori
infection in Peptic Ulcer Diseases
in Manipur - a hospital based study
Dr Manoj Mishra (PGT), Dr Ksh Gomti (Prof)
Department of Physiology,
Regional Institute of Medical Sciences,
Imphal, Manipur.

2. Introduction :
H
pylori
 a gram – negative spiral bacteria
 causes chronic gastritis, peptic ulcer disease,
gastric mucosa-associated lymphoid tissue
(MALT) lymphoma, and gastric cancer
an estimated 50% of world’s population is
colonized
prevalence is decreasing in the Western world
but remains widespread in the developing
world
Infection with H. pylori can be diagnosed with
cheap, simple, reliable, technique in the
community level and hence can often be
successfully treated timely

3. Aims and Objects :
 To
determine the prevalence of H. pylori
infection in PUD patients attending RIMS
hospital
 To assess the association between H. pylori
infection and variables like age, sex,
occupation, diet, drugs and symptoms

4. Materials and Methods:
 Cross
sectional study
 A hospital based study, RIMS, Imphal,
Manipur
 Duration: Oct’ 2011- Nov’ 2012
 Study population : PUD patients with
 dyspeptic symptoms,
 blotting,
 epigastric pain,
 GERD,
 indication for endoscopy & referral to
surgical gastroenterology for MAS.

5. 

Exclusion criteria:
Pts with any organic diseases
H/o alcoholism
Use of steroids / NSAID
H/o H2 blockers
Proton pump inhibitors
Antibiotics intake 1week prior to study
Age < 18 years

60 cases of PUD taken up in the study.







6. Study tools:
(SD – BIOLINE) H. pylori test kit is used
(Sensitivity : 95.9%. Specificity : 89.6%.)
 It’s a rapid test for detection of antibody
IgG specific to H. pylori in human serum,
plasma and whole blood.
 Manufacturer :
 SD STANDARD DIAGNOSTICS PVT LTD
Haryana, India.
 20 µl of whole blood is added to sample well,
3 drops of assay diluents added and test
results interpreted at 10 minutes


7. Limitation of the test :
A negative result does not preclude the
possibility of infection with H. pylori.
2. As with all diagnostic tests, a definitive
clinical diagnosis should not be based on the
result of a single test but should only be
made by the physician after all clinical and
laboratory findings have been evaluated.
1.

8. 30
25
25
percentage
20
15
23.3
20
15
15
10
5
1.7
0
18 - 27 28 - 37 38 - 47 48 - 57 58 - 67 68 - 77 78 - 87
Age in interval
Figure 1: Age prevalence of patients with Peptic Ulcer
mean age : 41.61 14.97

9. Table 1. Distribution of patients
according to gender:
Sex
No. of patients Percentage (%)
Male
37
61.7
Female
23
38.3
Total
60
100

10. Table2. Distribution of patients
according to religion :
Hindu
No. of patients Percentage
(%)
39
65
Christian
14
23.3
Muslim
7
11.7
Total
60
100
Religion

11. Table3. Distribution of Patients
according to Occupation :
Occupation
Laborers
No. of patients
8
Percentage (%)
13.3
Farmers
Social workers
Housewives
Students
Government
servants
Businessmen
Teachers
Total
5
7
10
2
9
8.3
11.6
16.6
3.3
15
14
23.3
5
60
8.3
100

12. Table4. Distribution of Patients
according to Symptoms :
Symptoms
Abdominal pain
Nausea
Vomiting
Nausea,
vomiting, loss of
appetite
Haematemesis
Malaena
Fullness of
abdomen
Total
No. of patients
33
Percentage (%)
55
4
2
11
6.7
3.3
18.3
5
3
8.3
5
2
3.3
60
100

13. Table 5. Past treatment drug history
Past treatment
Taken antibiotics,
PPI or H2 blocker
> 1 wk back
Not taken
antibiotics, PPI
or H2 blocker > 1
wk back
Total
No. of patients
Percentage (%)
42
70
18
30
60
100

14. Table 6. Results of Helicobacter pylori
antibody test :
H. Pylori
antibody (SD
BIOLINE)
Positive
No. of patients Percentage
(%)
12
20
Negative
48
80
Total
60
100

15. H. Pylori positive status :
H. pylori
* significant
7 Symptoms
31 (51.6)
36 (60)
0.13
7 (11.6)
17 (28.3)
24 (40)
Male
8 (13.3)
29 (48.3)
37 (61.6)
4 (6.6)
19 (31.6)
23 (38.3)
Hindus
9 (15)
30 (50)
39 (65)
3 (5)
18 (30)
21 (35)
Sedentary
10 (16.6)
18 (30)
28 (46.6)
2 (3.3)
30 (50)
32 (53.3)
Veg
3 (5)
16 (26.6)
19 (31.6)
9 (15)
38 (63.3)
41 (68.3)
taken >1w 4 (6.6)
38 (63.3)
42 (70)
Not
taken>1w
6 Drug
5 (8.3)
Non - veg
5 Diet
<47
Hard
work
4 Occupat’n
P value
Others
3 Religion
Total (%)
Female
2 Sex
- n (%)
>47
1 Age
+ n (%)
8 (13.3)
10 (16.6)
18 (30)
Abdomina 7 (11.6)
l pain
26 (43.3)
33 (55)
0.48
0.51
0.007*
0.52
0.003 *
0.79

16. Discussion :
 60
cases of PUD have been screened.
 12 cases have been detected positive for H. pylori.
 (Mean age SD) is 41.61 14.97
 The prevalence of H. pylori is significantly low (20%)
as compared to study by V. Kate et al (87%) in
Chennai and by GH. Jeelani et al (76%) in highly
endemic Kashmir.
 However, eradication of H. pylori is still strongly
suggested for the positive cases. Awareness program
to be carried out to the public at all levels.
 Weel.J.F.L, et al reported that different virulent and
non virulent strains of H. pylori exist and that only
virulent strains of H. pylori are ulcerogenic.

17. Conclusion :
 The
prevalence of H. pylori - 20%
 The positivity may be due to sedentary life,
abstaining anti ulcer drugs, dietary habits,
socio-economic status and environment.
 The advantageous aspect is the simplicity of
the rapid antibody test kit technique, using
whole blood which is cheap, reliable and
accurate with spot diagnosis at bedside as the
screening test of choice.

18. References :
 GH. Jeelani
Romshoo, et al. Prevalence of
Helicobacter pylori infection in peptic ulcer patients
of highly endemic Kashmir valley – a preliminary
study.
 V. Kate, et al. Prevalence of Helicobacter pylori
infection in disorders of the upper gastrointestinal
tract in south India.
 Johannes G, et al. Pathogenesis of Helicobacter
pylori Infection.
 Jones R, et al. An evaluation of near patient testing
for H. pylori in general practice.

19. Thank you.
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20. On … 21.12. 2012 !
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