الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
This study was performed to evaluate the magnitude of H. pylori
problem in Egypt by assessing the prevalence in general population and in
dyspeptic persons, it’s relation to upper G.I.T. symptoms and diseases, and
assessing the effect of eradication ofH. pylori on healing of the upper G.I.T.
diseases.
This study was classified into three parts. The first and the second part
of the study were conducted in Egypt and the third part was conducted in the
USA. The first part included 510 persons from the general population
allover Egypt. The sample was selected by hybrid multistage stratified
cluster random method with family interview. A questionnaire and clinical
examination were done to every one. Everyone was examined to H. pylori
by Quick Vue Finger Prick ELISA test.
The over all prevalence of H. pylori in general population in Egypt
was 72.2% with the highest prevalence 75% in Nile Delta region and 74.5%
in Upper Egypt and the lowest prevalence in Sea shore areas (61.1%) and
Great Cairo 68.~% without statistically significant difference among them.
The prevalence of H. pylori is 65.9% in completely asymptomatic
population and 82.1% in symptomatic persons (have one or more upper
G.I.T. symptom) with a significant difference between them.
There is a highly significant relation between prevalence ofH. pylori
and age. The prevalence in children in the first decade was 42.2% rising to
85% at the age of 50-59 years.
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This study failed to find a significant relation between prevalence of
H. pylori and sanitation and level of education although there were trend of
association with higher crowding index.
Persons with heartburn were found to be 2.5 times more likely and
persons with fullness after meal twice likely to have H. pylori than normal
persons.. There was no relation between H. pylori prevalence and sex or
history of schistosomiasis.
The second part of the study included 411 Egyptian dyspeptic patients
who were refereed to the endoscopy unit. Upper G.I.T. endoscopy was done
for all of them and multiple biopsies were taken for detection ofH. pylori by
histopathological examination, hp fast rapid urease test and culture. Quick
vue finger prick ELISA test was done to all patients. Urea breath test was
done to some patients after treatment to ensure eradication of the organism.
H. pylori was diagnosed in 83% of patients by ELISA method, in
90.5% by histopathology, in 85% by hp fast rapid urease test and in 73.8%
by culture method.
The highest prevalence of H., pylori was found in patients with peptic
ulcer 98.7% and the lowest prevalence was found in patients with N.U.D
87.24% and C.L.D. 86.08%. The prevalence ofH. pylori in duodenal ulcer
patients is the highest prevalence 98.69% while in gastric ulcer it was 90%.
A highly significant relation was found between the number of the
organisms and the activity of gastritis. On the endoscopic level there was
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also a highly significant relation between number of organisms and
endoscopic finding where duodenal ulcer was associated with the high dense
colonization of the organism. Intestinal metaplasia and dysplasia were
associated also with the high-density colonization of the organism. These
findings suggest the role ofthe load of the organism in the pathogenesis of
gastroduodenal disease, and suggest a role for H. pylori in cancer stomach.
Patients with H. pylori were classified into 6 groups for treatment.
Group 1 (44 patients) two weeks treatment with nitazoxanide SOOrng b.i.d.,
G2 (77 patients) one-week treatment with nitazoxanide 500 mg t.d.s, G3
(109 patients) two weeks treatment with nitazoxamide 1000 mg b.i.d., G4
(53 patients) one-week treatment with nitazoxanide 1000 mg b.i.d. The fourgroups
above received omeprazole 20 mg b.i.d. for 4 weeks. G5 (2.’)
patients) roxithromycin treatment 300 mg/d for two weeks plus
metronidazole 500 mg tds for two weeks plus lansoprazole 30 mg b.i.d for 4
weeks”G6 (16) roxithromycin 300 mg bid for two weeks, rest for two weeks
then another course plus lansoprazole 30 mg bid for 4 weeks.
The eradication of the orgamsm was 70.45% in GI, 64% in G2,
78.57% in G3, 75.92% in G4, 86-36 in G5 and 80% in G6. The healing of
the lesions was found to be highly significant correlated with the eradication
ofH. pylori.
The eradication rate was not affected by the type of the gastroduodenal
lesions. The side effects were found in 8.83% of patients with no significant
difference between different groups of therapy.
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The third part of the study included 127 dyspeptic patients from USA.
We found that the prevalence of H. pylori is significantly lower (22%) than
the prevalence in our Egyptian population. However, we found the same
other findings that we found in our Egyptian patients. There was no
association with sex or age. The highest prevalence was found in patients
with duodenal ulcer disease (75%). There was an association between the
presence of H, pylori and the severity of gastritis.