Prevalence of Helicobacter Pylori and Its Associated Peptic Ulcer Infection Among Adult Residents of Aba, Southeastern, Nigeria

Int.J.Curr.Microbiol.App.Sci (2016) 5(6): 16-21

International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 5 Number 6 (2016) pp. 16-21 Journal homepage: http://www.ijcmas.com

Original Research Article http://dx.doi.org/10.20546/ijcmas.2016.506.002

Prevalence of Helicobacter pylori and its associated Peptic Ulcer Infection among Adult Residents of Aba, Southeastern, Nigeria

Ezeigbo, R. Obiageli1* and Ezeigbo C. Ivan2

1Department of Biology/Microbiology, Abia State Polytechnic, Aba, Nigeria 2Natural and Computational Sciences, Minerva Schools at KGI, San Francisco, California, USA *Corresponding author

ABSTRACT

Helicobacter pylori (H. pylori) formerly known as Campylobacter pylori is a spiral rod-shaped Gram -negative, microaerophilic bacterium found in the stomach of

infected person(s) causing duodenal ulcer, gastric ulcer and gastric cancer. Faecal K eywo rd s and blood samples were collected from adult residents of Aba, Southeastern Nigeria between the months of March and July, 2015 for analysis using Diaspot H. Helicobacter pylori test kit and Faecal occult blood test. Out of three hundred (300) sampled, pylori , consisting of 128(42.7%) males and 172 (57.3%) females, a total of 119(39.7%) peptic ulcer, were infected with Helicobacter pylori while 129(43.0%) had peptic ulcer. A Gram- negative slightly higher percentage with peptic ulcer suggests that some other causes may bacterium. have contributed to the peptic ulcer infection. However, the association of H. pylori

with peptic ulcer positivity was found to be statistically non-significant (p-value > Article Info 0.05). The highest prevalence for H. pylori infection and peptic ulcer occurred Accepted:

07 May 2016 within the age group 38-47 years with 56.2% and 49.3% respectively, while ages

Available Online: 18-27 years had the least prevalence for both infections. The sex-related prevalence 10 June 2016 of H. pylori showed that more males were infected than females and both infections

increased with age. However, prevalence of H. pylori infection and peptic ulcer are not significantly associated with sex and age of the patients (p-value > 0.05). This

study confirms Helicobacter pylori as a contributor and causative agent of peptic

ulcer and recommends maximum food hygiene practice and clean environment by food handlers.

Introduction

Helicobacter pylori (H. pylori) is a spiral- gastric malignancy (Shamsuddeen et al., shaped Gram-negative microaerophilic 2009). The prevalence of H. pylori is closely bacterium that grows in human gastric associated with socioeconomic conditions epithelial tissues and mucus of the stomach and accordingly, this infection is more (Brooks et al., 2004; Chey et al., 2007). H. common in developing countries than in pylori remains one of the most common developed countries (Everhart, 2000). About worldwide human infections and is 40% of persons over 60 years of age have associated with a number of important Helicobacter pylori (Gastroenterological chronic gastritis, peptic ulcer disease, and society of Australia, 2003 on Facts about 16

Int.J.Curr.Microbiol.App.Sci (2016) 5(6): 16-21

Helicobacter pylori). Most people are failure (Megraud, 2004). The occurrence of infected in childhood. Helicobacter pylori side-effects has reduced the compliance of causes more than 90% of duodenal ulcers patients with treatment regimens and led to and up to 80% of gastric ulcers. the development of bacterial resistance (de Approximately two-thirds of the world’s Bortoli et al., 2007). This has led to the population is infected with H. pylori. In the development of alternative treatment options United State, H. pylori is more prevalent in H. pylori. Increasing antimicrobial among older adults, African American, resistance and falling eradication rates are Hispanics and lower socioeconomic groups. the result of the widespread use of Although, the prevalence of H. pylori antibiotics (Egan et al., 2007). The infection in developed countries seems to be prevalence of antimicrobial resistance in H. decreasing, it is still high in developing pylori shows regional variation both within world with as much as 90% (Konturek, and between countries. However, alternative 2008). In developing countries, 70-90% of antibiotics based on local resistance rates the population carries H. pylori; almost all may improve eradication rates (Egan et al., of these acquired the infection before the 2007). This survey is aimed at determining age of 10 years (Taylor and Parsonnet, the prevalence of H. pylori and its associated 1995). In developed countries, the peptic ulcer infection in Aba, Southeastern prevalence of infection is lower, ranging Nigeria. from 25-50%. The data from developed countries also suggests that most infections Materials and Methods are acquired in childhood (Taylor and Parsonnet, 1995). These remarkable Study Area organisms survive the extreme acidity of the stomach because of its ability to split urease Aba is a major settlement and commercial to release nitrogen which increases the pH center in the southeastern part of Nigeria. of gastric acid and for protein synthesis; thus The geographical co-ordinates for Aba are creating an alkaline microenvironment by 5º 07 N latitude and 7o 22 E longitude and hydrolyzing urea to ammonia. Other 205m (673ft) above sea level. Aba consists intestinal parasites like hookworms Ascaris of two Local Government Areas: Aba North lumbricoides, roundworms and non-steroid and Aba South LGAs. The city is thickly anti-inflammatory drugs (NSAIDS) such as populated with small towns and villages. Aspirin and Ibuprofen also contribute to the The people are predominantly traders, development of ulcer (Parkin et al., 1999). artisans, farmers and public/civil servants. Symptoms include abdominal discomfort, Because of climatic nature of the studied weight loss, bloating, burping, area (Aba being in the rainforest zone), nausea/vomiting and release of bloody or compounded with the socioeconomic nature dark coloured stool, bloody vomit or coffee of the people, infections associated with vomits and bleeding. personal and environmental hygiene are common. The treatment of H. pylori remains a challenging clinical problem despite Research Ethics extensive research over the last 25 years (Egan et al., 2007). Bacterial resistance and Ethical review and clearance of the research poor patient compliance are believed to be protocol were obtained from the Ethical the primary factors in H. pylori treatment Review Committee of the Department of

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Biology/Microbiology, Abia State the presence or absence of one or two Polytechnic, Aba. Permission was sought coloured lines: one is the control region (C) from each of the Local Government while the other is the test region (T). The Chairmen. All subjects who gave their appearance of one coloured line on the consent and are willingness to participate in control region indicates a negative result this study signed the consent form and while the appearance of two coloured lines presented their identification data (name, both on the test region and control region age, sex, occupation etc). indicates positive result to H. pylori infection. Sample Collection Faecal occult blood test was performed in Blood and stool samples were randomly the laboratory by thoroughly emulsifying 2g collected from 300 adult individuals of each stool sample in 5mL of normal between the ages of 18 years and above. saline in a test tube (faecal occult blood test About 2mL of venous blood was collected tube), using sterile rod, and each placed in a from each subject into an EDTA bottle test tube rack. The emulsified stool samples (labeled with code numbers, age and sex) were allowed to sediment, after which, a using 5mL syringe. Stool samples were also faecal occult test strip was dropped into the collected with the use of catching device mixture and allowed to absorb it. Two red (hat-shaped plastic lid). The catching device lines at the middle of the strip indicate a prevents contamination of the stool samples positive result, while negative result is an by water, urine or dirt. The stool samples indication of one red line. were put in sterile screw-capped bottles and labeled with identification numbers. The Statistical Analysis collected samples were taken to the Microbiology Laboratory of Abia State Statistical analysis was done using statistical Polytechnic, Aba for analysis. package for social sciences (SPSS) version 20.0. Statistical significance tests included Analysis of the Samples the use of p-value to assess the role of chance and χ2 (Chisquare) test to account The presence of H. pylori was determined for the association between different by Blood Antibody Test and Stool Antigen variables. In this study, p-value < 0.05 was Test. used to disapprove the null hypothesis.

Blood Antibody test was carried out using Results and Discussion H. pylori Test device (Diaspot H. pylori), an invitro chromatographic immunoassay for Table 1 represents the sex-related the qualitative detection of H. pylori prevalence of H. pylori and peptic ulcer. Out antibodies. Each of the 2mL of blood of 300 adult individuals examined, samples collected was centrifuged for 20 consisting of 128(42.7%) males and minutes. The blood formed two layers (the 172(57.3%) females, 119(39.7%) were serum and the red blood cells). The Diaspot infected with H. pylori compared to129 H. pylori test kits were placed on a clean (43.0%) with peptic ulcer. The prevalence of table. A rubber dropper was used to transfer H. pylori infection and peptic ulcer are not 3 drops of serum into each well of the test significantly associated with sex (P = 0.242, kit and timed for 20 minutes to observe for t = -2.500).

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Table.1 Sex-related Prevalence of H. pylori infection and Peptic ulcer

Sex Number Number Positive Number Positive for Examined (%) for H. pylori (%) peptic ulcer (%) Male 128 (42.7) 51(39.8) 54(42.2) Female 172(57.3) 68(39.5) 75(43.6) Total 300 119(39.7) 129(43.0)

Table.2 Age-related Prevalence of H. pylori infection and Peptic ulcer

Age (years) Number Number positive Number Examined for H. pylori (%) Positive for (%) peptic ulcer 18-27 135 (45.0) 45 (33.3) 50 (37.0) 28-37 92 (30.7) 33 (35.9) 43 (46.7) 38-47 73 (24.3) 41 (56.2) 36 (49.3) Total 300 119 (39.7) 129 (43.0)

H. pylori and peptic ulcer infections are Southeastern Nigeria. The result showed that statistically not significant (P= 0.529, t = - the H. pylori infection is endemic in the 0.756). studied area. On the relationship between H. pylori and peptic ulcer, result showed non- The age-related prevalence of H. pylori and significant difference in their prevalence. peptic ulcer is shown in Table 2. The highest This therefore confirmed the link between prevalence for both H. pylori and peptic H. pylori and the pathogenesis of peptic ulcer occurred within the age group 38-47 ulcer disease (Paptheodoridis et al., 2006; years with 56.2% and 49.3% respectively, Chey et al., 2006). Although, H. pylori is while ages 18-27 years had the least for both known to cause peptic ulcer, others like non- the bacterial infection and peptic ulcer. Age- steroidal anti-inflammatory drugs have also distribution of H. pylori and peptic ulcer been implicated by other authors (Peterson, infection is not statistically significant 1991; Parkin et al., 1999). On sex-related (P=0.568, t= 0.386). prevalence of H. pylori and peptic ulcer, the result revealed that males and females are H. pylori are spiral-shaped bacteria that can approximately infected although more males cause peptic ulcer disease by damaging the were infected than females. The statistical mucous coating that protects the lining of analysis showed there is no significant the stomach and duodenum. This study difference in prevalence between the males investigated the prevalence of H. pylori and the females and this agrees with the infection and peptic ulcer in Aba, findings of other authors (Tarkhashvili et al.,

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2009; Shokrzadeh et al., 2012; Adlekha et 3(4): 559-563. al., 2013). On age –related prevalence, the Brooks, G.F., Butel, J.S., Morse, S.A. 2004. results also revealed that both H. pylori Jawetz, Melnick, and Adelberg’s infection and peptic ulcer increased with Medical Microbiology, 23rd edition, age; however this is not significantly Mc Graw Hill International Edition, different. This result agrees with the New York. Pp 275- 6. findings of Tarkhashvili et al (2009) and Chey, W.D., Wong, B.C.Y., Practice Adlekha et al (2013) but contrasts with the Parameters Committee of the results of Shokrzadeth et al (2012) and American College of Kaore et al (2012) were H. pylori positivity Gastroenterology Guideline on the increased with age of 20-40 years. There is a management of Helicobacter pylori need therefore to create awareness on H. infection. J. Gastroenterol., 102: pylori infection and its associated peptic 1808-1825. ulcer infection in Aba. De Bortoli, N., Leonardi, G., Ciancia, E., Merio, .A, Bellini, M., Costa, F., In conclusion, this study evaluated the Mumolo, M.G., Ricchiuti, A., prevalence of Helicobacter pylori (H. Cristiani, F., Santi, .S, Rossi, M., pylori), a Gram-negative bacterium that Marchi, S. 2007. Helicobacter pylori causes peptic ulcer. The close association eradication: a randomized prospective between the two infections suggests that H. study of triple therapy versus triple pylori could be a major cause of peptic therapy plus lactoferron and ulcer; although other causes such as non- probiotics. Am. J. Gastroenterol., steroidal anti-inflammatory drugs and 102(5): 951-956. Aspirin (taken to prevent heart attack or Egan, B.J., Katicic, M., O’Connor, H.J., stroke) have also been implicated. Personal O’Morain, C.A. 2000. Treatment of hygiene and early detection and treatment of Helicobacter pylori. Helicobacter, H. pylori will go a long way in eradicating 12(suppl. 1):13-37. the infection and its associated peptic ulcer Everhart, J.E. 2000. Recent development in infection. the epidemiology of Helicobacter pylori. Gastroenterol. Clin. N. Am., Acknowledgement 29: 559-578. Kaore, N.M,. Nagdeo, N.V., Thombare, The authors wish to acknowledge the V.R. 2012. Comparative evaluation of approval of the Aba North and South local the diagnostic tests for Helicobacter government authorities in the collection of pylori and dietary influence for its samples. acquisition in dyspeptic patients: A rural hospital based study in central References India. JCDR, 6: 636-641. Konturek, J.W. 2008. Helicobacter pylori Adlekha, S., Chadha, T., Krishnan, P., and its pathogenicity role in peptic Sumangala, B. 2013. Prevalence of ulcer, gastritis and gastric cancer. J. Helicobacter pylori infection among Physio-pharmacol., 54(suppl. 3): 23- patients undergoing upper 41. gastrointestinal endoscopy in a Megraud, F. 2004. Helicobacter pylori medical college hospital in Kerala, antibiotics resistance: prevalence, India. Annals of Med. Health Sci. Res., important and advances in testing.

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How to cite this article:

Ezeigbo, R. Obiagelim and Ezeigbo C. Ivan. 2016. Prevalence of Helicobacter Pylori and its Associated Peptic Ulcer Infection among Adult Residents of Aba, Southeastern, Nigeria. Int.J.Curr.Microbiol.App.Sci. 5(6): 16-21. doi: http://dx.doi.org/10.20546/ijcmas.2016.506.002