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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 6  |  Issue : 2  |  Page : 278-283

Detection, clinical features, and laboratory markers of H.pylori infection in individuals attended kosti teaching hospital, Sudan


1 Department of Surgery, Faculty of Medicine and Health Sciences, University of El Imam El Mahdi, Kosti, Sudan
2 Department of Microbiology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti, Sudan

Date of Submission18-Mar-2022
Date of Acceptance13-May-2022
Date of Web Publication17-Jun-2022

Correspondence Address:
Omer Mohammed Ali Ibrahim
Department of Microbiology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti
Sudan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bbrj.bbrj_71_22

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  Abstract 


Background: Helicobacter pylori infections are associated with significant morbidity. The study intended to screen H. pylori among symptomatic patients and assess the performance of anti-H. pylori immunoglobulin G (IgG) test compared to stool Ag test as well as to investigate some clinical and hematology findings in H. pylori-seropositive persons. Methods: One hundred individuals with the clinical suspicion of infection by H. pylori and 100 control subjects matched for gender (χ2 = 0.026, P = 0.873) and age groups (χ2 = 5.303, P = 0.151) were recruited. Clinical assessment, endoscopy, anti-H. pylori IgG test, and stool for cagA Ag were performed to investigate H. pylori infection. White blood cells, red blood cells (RBCs), hemoglobin (Hb), and mean corpuscular hemoglobin (MCH) were also analyzed. Results: Vomiting and hematemesis were reported in 44% and 8% of the study group, respectively. Whereas, nausea, epigastric pain, and weight loss were observed in all (100%). Notably, gastritis and duodenal ulcer were detected in 100% and 80% of cases, respectively. Based on Immunochromatographic test (ICT), 75% and 78% of the study group were positive for anti-H. pylori Ab and cagA Ag of H. pylori, respectively. The odd of reported a positive result for H. pylori was less likely in females than males as determined by anti-H. pylori (odds ratio [OR]: 0.529, 95% confidence interval [CI]: 0.142–1.970, P: 0.343) and stool cagA Ag test (OR: 0.364, 95% CI: 0.087–1.532, P: 0.168). Compared to the cagA Ag test, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of anti-H. pylori test were 77.2%, 85.3%, 78.7%, 84.1%, and 81.9%, respectively. Interestingly, RBCs count, MCH, and Hb were significantly higher in the control compared to study cases, P < 0.05. Conclusions: Our results highlight the epidemiology of into H. pylori, assess the performance of anti H. pylori test compared to cagA Ag test, and demonstrate the direct link between some hematologic indices and H. pylori. Further studies are necessary to verify these findings.

Keywords: Antibiotics, CagA Ag, Duodenal ulcer, Gastritis, Helicobacter pylori


How to cite this article:
Azoz ME, Almugadam BS, Ibrahim OM, Ahmed YM, Tayeb AA, Eshagg NH, Hassan RA. Detection, clinical features, and laboratory markers of H.pylori infection in individuals attended kosti teaching hospital, Sudan. Biomed Biotechnol Res J 2022;6:278-83

How to cite this URL:
Azoz ME, Almugadam BS, Ibrahim OM, Ahmed YM, Tayeb AA, Eshagg NH, Hassan RA. Detection, clinical features, and laboratory markers of H.pylori infection in individuals attended kosti teaching hospital, Sudan. Biomed Biotechnol Res J [serial online] 2022 [cited 2022 Dec 9];6:278-83. Available from: https://www.bmbtrj.org/text.asp?2022/6/2/278/347725




  Introduction Top


Helicobacter pylori (H. pylori) is a microaerophilic bacteria.[1] Worldwide, it is a common cause of gastritis, gastric ulcer, and duodenal ulcer. H. pylori infection can be acquired through person-to-person, fecal–oral, and oral–oral routes.[1],[2],[3] In the past decades, it has attracted much attention and is linked to the pathophysiology of many disorders including dermatological, cardiovascular, and metabolic diseases.[2] Several virulence factors were related to the pathogenesis of H. pylori. In particular, urease, catalase, superoxide dismutase, and cytotoxin-associated antigen A (cagA) play a major role in the progression of infection.[2],[4] Formerly, H. pylori has been identified as a Group I carcinogen attributable to 89% of all gastric cancers (GCs).[5] Similarly, it is a known risk factor for mucosal-associated tissue lymphoma.[6] GC is the most common malignancy and represents 9% of all cancer-related mortality.[7],[8] Worldwide, it has been estimated that 4.4 billion individuals were infected with H. pylori.[1],[2],[5] In developing countries, about 85%–95% of the population carries H. pylori, whereas, in developed countries, the prevalence ranges from 30% to 50%.[9] The rate of H. pylori infection can be affected by socioeconomic status, age, and personal hygiene.[3],[5],[9] Taking into account the significant morbidity and mortality associated with H. pylori, there is a need for early and urgent assessment of patients. The diagnosis of H. pylori can be performed by using the non-invasive methods such as urea breath and stool antigen tests. Invasive methods (culture, rapid urease test, polymerase chain reaction, and histology) are difficult to perform since they involve endoscopy to obtain the sample. The H. pylori stool antigen test (monoclonal test) is reliable for screening H. pylori infection.[9] Overall, identifying the epidemiology of H. pylori and the sensitivity of its isolated strains for antibiotics are critical in the control and management of H. pylori-related illnesses and complications. The study intended to screen H. pylori among symptomatic patients and assess the performance of anti-H. pylori immunoglobulin G (IgG) test as well as clinical features and levels of white blood cells (WBCs), red blood cells (RBCs), hemoglobin (Hb), and mean corpuscular hemoglobin (MCH) in H. pylori-seropositive individuals.


  Methods Top


This was an observational hospital-based study conducted from May 2018 to September 2018. The study was performed in Kosti Teaching Hospital, which is one of the major hospitals in Kosti city, Sudan.

Ethical issue

The study was approved by the Ethics Review Committee of Kosti Teaching Hospital.

Patients consent

All samples and information were collected from patients after their acceptance to be part of the study and signed written informed consent.

Sampling

It is a convenience sample type.

Study participants, sample size, and data

Throughout the study duration, every outpatient attended to the targeted hospital with the clinical suspicion of infection by H. pylori was included in this study. Alcoholic users and patients with a history of radiotherapy, chemotherapy, or antimicrobial use before less than one week were excluded from the study. A total of 100 cases and 100 controls were enrolled. Persons with no history of H.pylori infection and negative test for H.pylori cagA Ag in stool as determined by immunochromatographic test (ICT) were enrolled as control. The study data were collected using interviewing questionnaire, which includes personal information, medical information, and outcomes of laboratory investigations.

Sample collection and laboratory investigations

About 4–5 ml of venous blood was collected from everyone and immediately divided into two containers (Plain and ethylenediaminetetraacetic acid [EDTA] containers). Serum samples were obtained by centrifugation of blood without anticoagulant (Plain container samples) at 3000 rpm for 5 min.

All serum samples were immediately tested for the qualitative detection of anti-H. pylori using ICT (ACON® Laboratories, Inc. Sang Diego, USA). Whereas, EDTA samples were used for complete blood count analysis using Sysmex KX-21N semiautomated hematology analyzer. In addition, stool sample was also collected from each person in sterile container and examined for the qualitative detection of cagA Ag of H. pylori using ICT (ACON® Laboratories, Inc. Sang Diego, USA).

Statistical analysis and presentation of results

The study data were entered into a Microsoft Excel sheet and rechecked to ensure successful entering. Statistical analysis was performed by Statistical Package for the Social Sciences software, version 21, and the results were presented in form of tables and figures. Fisher's exact test and person Chi squared test (for categorical data) as well as the two independent samples and Mann-Whitney U tests (for numerical data) were used to test the variation between the study groups. To evaluate the degree of association between variables, binary logistic regression was performed. Categorical data were presented as numbers and percentages and numerical data as means. P < 0.05 was specified for the statistically significant variation. To evaluate the findings of the diagnostic test, all of the specificity, sensitivity, negative predictive value (NPV), positive predictive value (PPV), and accuracy were estimated as following:











TP: True positive, TN: True negative, FP: False positive, FN: False negative, PPV: Positive predictive value, NPV: Negative predictive value.


  Results Top


Characteristics of participants

Two hundred individuals were enrolled in this study (100 cases and 100 controls). The mean age of the cases and control groups were 35.2 and 32.8 years (Z = −1.000, P = 0.317), respectively. Between groups, there was no significant variation in the distribution of participants among gender (χ2 = 0.026, P = 0.873) or age groups (χ2 = 5.303, P = 0.151). In both case and control groups, the vast majority of the study participants were females and had age range from 15–30 years [Table 1].
Table 1: Characteristics of the study participants

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Clinical and medical examination findings

All the study cases (100%) complained of nausea, epigastric pain, and weight loss. Only 44% and 8% of the study cases (100) were suffered from vomiting and hematemesis, respectively [Figure 1]a. Based on the endoscopy findings, 100% of the study cases had gastritis, whereas 80% suffered from duodenal ulcers. Moreover, esophagitis and cancer of the esophagus were observed in 20% and 15% of participants, respectively [Figure 1]b.
Figure 1: Clinical features and endoscopy report in Helicobacter pylori patients. (a) Clinical features. (b) Endoscopy report. Data presented as percentage. Statistical analysis was performed using Fisher's exact test. χ2: Chi-square

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Rate of Helicobacter pylori and accuracy of anti H. pylori test

Based on ICT, 75% and 78% of the study cases were positive for anti-H. pylori Ab and cag Ag of H. pylori, respectively. In contrast, no one of the control group was showed positive results for these tests. Notably,the seropositivity rate of anti-H. pylori Ab and cag Ag of H. pylori was not significantly different among gender or age groups [Table 2]. The odd of reported a positive result for H. pylori was less likely in females compared to males as assessed based on both blood Ab (odds ratio [OR]: 0.529, 95% confidence interval [CI]: 0.142–1.970, P: 0.343) and stool Ag tests (OR: 0.364, 95% CI: 0.087–1.532, P: 0.168) [Table 3]. Compared to the cagA Ag test, the sensitivity, specificity, PPV, NPV, and accuracy of the blood Ab test were 77.2%, 85.3%, 78.7%, 84.1%, and 81.9%, respectively [Table 4].
Table 2: Rate of H.pylori infection in study cases

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Table 3: Relationship of Helicobacter pylori infection with gender and age

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Table 4: Accuracy of the anti-H.pylori test compared to Stool Ag test

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Hematological alterations

In this study, RBCs count [Figure 2]a, MCH [Figure 2]b, and Hb [Figure 2]c were significantly higher in the control compared to study cases. In contrast, WBCs were nonsignificantly different between the groups [Figure 2]d. Interestingly, erythropenia was detected in 62% of cases compared to 46% in the control group, P = 0.023. Similarly, a low Hb level was observed in 64% of patients compared to 41% in the control group, P < 0.05. The rate of low MCH was 19% in patients and 11% in the control group, P = 0.113 [Figure 2]e.
Figure 2: Effect of Helicobacter pylori infection on the hematological parameters. Data of figures 2a-d presented as mean ± standard deviation and Figure 2e as percentage. For numerical data, two independent samples t-test was used to assess the difference between groups. (a) RBCs, (b) MCH, (c) Hb, (d) WBCs, and (e) rate of high and low value, ns: P > 0.05, **: P < 0.01, ***: P < 0.001. RBCs: Red blood cells, MCH: Mean cell hemoglobin concentration, Hb: Hemoglobin, WBCs: White blood cells

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  Discussion Top


Clinical and endoscopy

H. pylori is one of the most common human pathogens affecting around 50% of the world population. Clinically, H. pylori infections range from asymptomatic to life-threatening conditions such as cancer.[2] In the present study, all H. pylori-seropositive individuals were suffered from nausea, epigastric pain, and weight loss. In contrast, 44% and 8% of them were complained from vomiting and hematemesis, respectively. Kouitcheu Mabeku et al.'s study detected the upper abdominal and epigastric pain in all H. pylori-positive patients, whereas nausea/vomiting only in 34.1% of H. pylori-positive cases.[10] In another study performed at Kassala (East of Sudan), the most frequent symptoms associated with H. pylori infection were nausea (25.5%), gastric pain (24.5%), heartburn (20.2%), and vomiting (12.8%).[11] Interestingly, we found that 100% and 80% of the study cases had gastritis and duodenal ulcer, respectively. Unlike our study, Wang et al.'s study reported chronic gastritis, gastric ulcer, and duodenal ulcer in 11%, 3.6%, and 2.2% of the subjects in Jidong community (China), respectively.[12]

Seropositivity for Helicobacter pylori

Compared to several prior studies, the rate of seropositive results for H. pylori was more in the present study based on both anti-H. pylori Ab (75%) and cag Ag of H. pylori (78%). In 2018, the rate of positive tests for H. pylori in the healthy asymptomatic United Arab Emirates residents was 41%,[9] as well as 52.25% in Jidong Community (China) individuals.[12] In line with the current study, Aitila et al.'s study observed that 24.3% (stool Ag) or 31.5% (serum Ab test) of children attended to Holy Innocents Children's Hospital with gastroenteritis complaints were positive for H. pylori.[3] Formerly, Castaneda et al.'s study found that the prevalence of H. pylori was 60.8% in the GC subset and 67.9% in the chronic gastritis subset.[13] Unlike the current study, Ahmed et al.'s study found that 45.8% of participants were positive for H. pylori.[14] Moreover, a prior study reported that 21.8% of schoolchildren in Kassala were seropositive H. pylori IgG antibody.[11] Among Sudanese diagnosed with colon polyps and cancer, 23.2% were reported positive for H. pylori.[15] In a population-based cross-sectional study, 63.4% of adults in Southern Brazil were reported positive for H. pylori.[16] Formerly, Kouitcheu Mabeku et al.'s study showed that 64.39% of patients who attended the Gastroenterology Department of Laquintinie Hospital and District Hospital of Bonassama (Cameron) were positive for H. pylori.[10] All these findings provide ideas about variation in the rate of H. pylori based on the clinical situation of individuals and geographic location. Comparable with this study, the previously reported pooled prevalence for H. pylori infection in Africa, Australia, the United States, Western Europe, Western Asia, and Northern America was 70.1%, 24.6%, 35.6%, 34.3%, 66.6%, and 37.1%, respectively.[1] The discrepancy between studies could be attributed to differences in sample size, study population and area, and diagnostic procedures. In general, our study showed alarming rates of H. pylori, which underscores the need for surveillance programs to limit the burden of H. pylori infection and its complications.

Notably, there was insignificant dissimilarity in the positivity rate of anti-H.pylori or cagA Ag of H. pylori among gender or age groups. Similarly, the probability of a positive result for H. pylori infection was also less likely in females than males. Internationally, unlikeness findings were observed. Indeed, Khoder et al.'s study revealed that the frequency of H. pylori infection is significantly higher in females than males and in subjects aged 16–30 years old compared to others.[9] In contrast, Wang et al. (China)[12] and Kouitcheu Mabeku et al.[10] studies reported a nonsignificantly higher rate of H. pylori in males than in females. Unlike our study, Kouitcheu Mabeku et al.'s[10] study found that the frequency of H. pylori was nonsignificantly higher in age 35–44 years compared to higher age groups. In line with the current study findings, Abbas et al.'s study reported a significantly higher rate of H. pylori in the boys than girls.[11] Dissimilar to our study, Aitila et al.'s study showed a nonsignificantly higher rate of H. pylori in girls than in boys.[3] Altogether, these results underscore the relationship of age and gender with H. pylori. A possible explanation for variation in study results might be due to variation in study design, sample size, area, and population. Compared to the cagA Ag test, the sensitivity, specificity, PPV, and NPV of the blood antibody test were 77.2%, 85.3%, 78.7%, and 84.1%, respectively, which could reflect the effect of the diagnostic tests in the study findings.

Hematological alterations

It is interesting to note that RBCs count, MCH, and Hb were significantly higher in the control compared to study cases. In contrast, WBCs were nonsignificantly different between the study groups. Previously, a strong relationship between H. pylori and some hematology parameters has been reported in many studies. In line with our findings, Ahmed et al.'s study observed a decrease of Hb level in 14.1% of males and 31.7% of females in North Darfur.[14] In another study, Hb, RBCs, and MCH were significantly declined in H. pylori-infected patients compared to the control with 13.9%, 7%, and 14.4% reduction in Hb, RBCs, and MCH concentration in H. pylori-positive persons, respectively.[17] The results of the current study are also consistent with those of Elamin et al.'s study.[18] Accordingly, the outcomes of the current study supported previous research and verified that the estimation of such parameters could help in the early detection and management of such patients.


  Conclusions Top


The diagnostic tests affect the rate of H. pylori. There are alarming rates of H. pylori, which underscores the need for surveillance programs. Seropositive individuals for H. pylori exhibit a marked decline in RBCs, Hb, and MCH. Other studies are essential to verify the current findings.

Limitation of the study

The weakness of our study is due to several reasons, which include the lack of highly sensitive diagnostic methods.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hooi JK, Lai WY, Ng WK, Suen MM, Underwood FE, Tanyingoh D, et al. Global prevalence of Helicobacter pylori infection: Systematic review and meta-analysis. Gastroenterology 2017;153:420-9.  Back to cited text no. 1
    
2.
de Brito BB, da Silva FA, Soares AS, Pereira VA, Santos ML, Sampaio MM, et al. Pathogenesis and clinical management of Helicobacter pylori gastric infection. World J Gastroenterol 2019;25:5578-89.  Back to cited text no. 2
    
3.
Aitila P, Mutyaba M, Okeny S, Ndawula Kasule M, Kasule R, Ssedyabane F, et al. Prevalence and risk factors of Helicobacter pylori infection among children aged 1 to 15 years at Holy Innocents children's hospital, Mbarara, South Western Uganda. J Trop Med 2019;2019:9303072.  Back to cited text no. 3
    
4.
Chmiela M, Kupcinskas J. Review: Pathogenesis of Helicobacter pylori infection. Helicobacter 2019;24 Suppl 1:e12638.  Back to cited text no. 4
    
5.
Savoldi A, Carrara E, Graham DY, Conti M, Tacconelli E. Prevalence of antibiotic resistance in Helicobacter pylori: A systematic review and meta-analysis in World Health Organization Regions. Gastroenterology 2018;155:1372-82.e17.  Back to cited text no. 5
    
6.
Gravina AG, Zagari RM, De Musis C, Romano L, Loguercio C, Romano M. Helicobacter pylori and extragastric diseases: A review. World J Gastroenterol 2018;24:3204-21.  Back to cited text no. 6
    
7.
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin 2015;65:87-108.  Back to cited text no. 7
    
8.
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359-86.  Back to cited text no. 8
    
9.
Khoder G, Muhammad JS, Mahmoud I, Soliman SS, Burucoa C. Prevalence of Helicobacter pylori and its associated factors among healthy asymptomatic residents in the United Arab Emirates. Pathogens 2019;8:44.  Back to cited text no. 9
    
10.
Kouitcheu Mabeku LB, Noundjeu Ngamga ML, Leundji H. Potential risk factors and prevalence of Helicobacter pylori infection among adult patients with dyspepsia symptoms in Cameroon. BMC Infect Dis 2018;18:278.  Back to cited text no. 10
    
11.
Abbas M, Sharif FA, Osman SM, Osman AM, El Sanousi SM, Magzoub M, et al. Prevalence and associated symptoms of Helicobacter pylori infection among schoolchildren in Kassala State, East of Sudan. Interdiscip Perspect Infect Dis 2018;2018:4325752.  Back to cited text no. 11
    
12.
Wang W, Jiang W, Zhu S, Sun X, Li P, Liu K, et al. Assessment of prevalence and risk factors of Helicobacter pylori infection in an oilfield Community in Hebei, China. BMC Gastroenterol 2019;19:186.  Back to cited text no. 12
    
13.
Castaneda CA, Castillo M, Chavez I, Barreda F, Suarez N, Nieves J, et al. Prevalence of Helicobacter pylori infection, its virulent genotypes, and epstein-barr virus in Peruvian patients with chronic gastritis and gastric cancer. J Glob Oncol 2019;5:1-9.  Back to cited text no. 13
    
14.
Ahmed MA, Atayeb MA, Abdelrahman NK, Abdelrahman NA, Osman EI. Prevalence of Helicobacter pylori infection among adults in Elfashir, North Darfur, western Sudan. Int J Biomed Adv Res 2020;11:e5342.  Back to cited text no. 14
    
15.
Mohamed AK, Elhassan NM, Awhag ZA, Ali FS, Ali ET, Mhmoud NA, et al. Prevalence of Helicobacter pylori among Sudanese patients diagnosed with colon polyps and colon cancer using immunohistochemistry technique. BMC Res Notes 2020;13:322.  Back to cited text no. 15
    
16.
Santos IS, Boccio J, Santos AS, Valle NC, Halal CS, Bachilli MC, et al. Prevalence of Helicobacter pylori infection and associated factors among adults in Southern Brazil: A population-based cross-sectional study. BMC Public Health 2005;5:118.  Back to cited text no. 16
    
17.
Haile K, Timerga A. Evaluation of hematological parameters of Helicobacter pylori-infected adult patients at Southern Ethiopia: A comparative cross-sectional study. J Blood Med 2021;12:77-84.  Back to cited text no. 17
    
18.
Elamin EA, Suliman MA, Azoz ME, Ali EW, Olerile LD, Jiao Y, et al. Effect of Helicobacter pylori infection on haematological parameters in Kosti, Sudan. Iran Red Crescent Med J 2018;20(2):e58276.  Back to cited text no. 18
    


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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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