Evaluation of clinical, endoscopic and histopathologic findings associated with helicobacter pylori

H.pylori is a gram negative, unipolar, spiral, microaerophilic bacteria. Humans are the only source of H.pylori and it can subsist in antrum, corpus and cardia of the stomach. Although the prevalence of H.pylori is decreasing in developed countries, high prevalence's persist in developing countries. It has been previously demonstrated that gastric colonization of H.pylori is etiologically associated with chronic gastritis, peptic ulcer, atrophic gastritis, stomach adenocancer and lymphoma. In our study, we retrospectively evaluated the association of H.pylori infection with clinical, endoscopic and histopathological findings such as atrophy, intestinal metaplasia and dysplasia. Patients were also evaluated in terms of same parameters according to density of H.pylori which demonstrated histopathologically. 262 patients who underwent upper gastrointestinal endoscopy and biopsy due to dyspeptic symptoms such as epigastric pain, nausea and abdominal discomfort were included in this study. Pathology reports were also evaluated retrospectively. Upper gastrointestinal endoscopy indications, endoscopic findings and histopathological findings were compared between H.pylori negative and positive groups. H.pylori positive patients were further divided into mild, moderate and severe density according to the Sydney classification; they were compared within each other and with H.pylori negative patients. 69.5% percent of patients had histopathologically positive H.pylori infection. Age groups, age averages and gender percentages were similar between H.pylori positive and negative patients. Most common indications for endoscopic evaluation was dyspeptic complaints in both groups, there were no statistically significant differences (p=0,79). Other indications were similarly distributed as well. Most common endoscopic finding was gastritis and there were no statistically significant difference between groups (p=0,562). Esophagitis was less prominent in patients with H.pylori positive patients (p=0,02), other endoscopic findings were similar. Atrophy was found in 86 patients (47.25%) with H.pylori positive whereas only 15 patients (18.75%) with H.pylori negative had atrophy (p=0.001). Intestinal metaplasia and dysplasia were similar between groups (p=0,118 and p=0,462, respectively). In H.pylori positive patients, H.pylori density was mild in 59 cases (56%), moderate in 23 cases (22%) and severe in 23 cases (22%). Upper GI endoscopy indications were similar between groups. Erosive gastritis were less prominent in patients with mild density when compared with patients with moderate density (p=0,002). Atrophy, intestinal metaplasia and dysplasia were similar between groups. In conclusion, we demonstrate that upper GI endoscopy indications were similar in patients with H.pylori positive and negative cases. Esophagitis was found to be less prominent in patients with H.pylori positivity; however peptic ulcer was similar between groups. This finding is consistent with studies in the literature debating H.pylori infection may be protective against gastroesophageal reflux disease. Atrophy was found to be more frequent in patients with H.pylori positivity, this finding is consistent with the literature pointing out role of H.pylori infection in malignant processes. H.pylori density was found be unrelated to clinical, endoscopical and histopathological findings. Although H.pylori is accepted as an important etiological factor in dyspepsia, peptic ulcer and premalignant histopathological findings, it can be argued that H.pylori may not be the only pathological factor in development of these pathologies; geographic, ethnic, socioeconomic and environmental factors may also act as multifactorial determinants.