Determination of clearance of Helicobacter pylori through bacterial density, Nairobi, Kenya

Abstract

Background: Eradication of Helicobacter pylori (H. pylori) is a challenge to physicians and gastroenterologists worldwide and has led to change of drug regimens and their durations to ensure cure. H. pylori density has been considered as a factor which may influence eradication failure.

Objective: To establish whether bacterial density found during diagnosis is a determinant of clearance of H. pylori after treatment.

Design: A retrospective study was carried out to establish clearance of H. pylori through stool antigen testing on those patients who were positive for H. pylori on rapid urease test, and had bacterial density reported on histology.

Setting: Centre for Clinical Research (CCR), Kenya Medical Research Institute (KEMRI).

Methods: Biopsy samples taken on endoscopy were used for rapid urease testing and histology. Giemsa stain was used on histology to identify H. pylori. At the end of triple therapy treatment, stool antigen testing was done using the enzyme linked immunosorbent assay (ELISA) method to detect the presence or absence of H. pylori.

Results: 150 patients were positive for H. pylori on rapid urease testing. 42/150 (28%) patients had results for histology after completion of the study. Those who reported no H. pylori on histology were 24.4%, slight H. pylori 41.5%, moderate H. pylori 14.6%, numerous H. pylori 19.5%. This was compared to clearance of H. pylori on stool antigen testing after treatment. Those with no H. pylori on histology had a 70% cure rate after treatment; mild H. pylori - a 47% cure rate; moderate H. pylori on - 100% cure rate and those with numerous H. pylori - a 50% cure rate. There was no statistical significance noted in all categories (P>0.05). There was no relation of patients positive for H. pylori with bacterial density noted on histology and clearance of H. pylori at the end of treatment.

Conclusion: H. pylori bacterial density cannot be used as an indication for clearance of H. pylori after treatment. One may need a larger sample or other diagnostic test to determine bacterial density and clearance of H. pylori.