Original articleComparison of Helicobacter pylori Prevalence in Symptomatic Patients in Northeastern Mexico with the Rest of the Country: Its Association with Gastrointestinal Disease
Introduction
Helicobacter pylori is considered the main etiologic agent of the most common form of chronic gastritis in an adult population and has been related to peptic ulcer disease (PUD), gastric cancer, and mucosa-associated lymphoid tissue (MALT) lymphoma 1, 2, 3. Some virulence factors present in bacterium have been studied, among them CagA protein, produced by approximately 60% of strains. In some populations, CagA production has been related to increased amounts of interleukin 8 and increased risk for duodenal ulceration and gastric cancer development 4, 5, 6, 7, 8, 9, 10.
H. pylori infection has been documented worldwide with prevalence ranging from 10 to 90% depending on age, geographic location, and socioeconomic condition (11). In developed countries, a low prevalence of H. pylori has been reported and at present, prevalence in children is near 10% (11). Otherwise, in many developing countries H. pylori infection begins in early childhood; up to 50% of children are infected before reaching 10 years of age and 80–90% of individuals become infected in adulthood 9, 10, 11, 12.
In Mexico, a nationwide community-based seroepidemiologic survey showed overall prevalence of 66% and specific prevalence of 64.1% for northeastern Mexico, according to development status (12). Variations in prevalence have been reported among particular regions with a prevalence of 86.1% reported in southeastern Mexico (10) and 47.1% in children from northwestern Mexico (9).
Most epidemiologic studies have been conducted in asymptomatic patients and employed serologic assays to detect H. pylori, in which interpretation is problematic because noninfected patients could be identified as infected due to low specificity of serologic tests (1). Precise information concerning prevalence of H. pylori in symptomatic patients is needed. The aim of this study was to assess H. pylori prevalence in symptomatic patients and its association with disease presented in the northeast region of Mexico.
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Study population
Data were obtained from 261 patients (107 men and 154 women). The study included consecutive unselected patients seen at the Hospital Universitario Dr. José Eleuterio González in Monterrey, Nuevo León, Mexico between February 2000 and November 2000. All patients had indication for diagnostic endoscopy due to abdominal and/or gastric symptoms. No patient had received antibiotics or proton pump inhibitory drugs during the 4 weeks prior to endoscopy. Informed consent was obtained from all
H. pylori infection prevalence in study population
Overall prevalence of H. pylori infection in symptomatic population was 67.8%. As previously reported, prevalence increased with age as follows: for patients from 20 to 29 years, H. pylori prevalence was 53.3%: from 30 to 59 years prevalence was >80%, and for patients >60 years H. pylori prevalence was highest, at 90% (Figure 1). These results indicate that >80% of patients are infected with H. pylori during the decade from 30 to 39 years of age, and there is minimal increase in infection
Discussion
Results presented in this paper indicate that H. pylori seroprevalence is consistently high (67.8%) compared with additional data from developing countries 10, 11, 12. Interestingly, prevalence in this study of symptomatic patients undergoing endoscopy was very similar to a previous overall seroepidemiologic report of the Mexican asymptomatic population (66%) and to the prevalence reported in northeastern Mexico (64.1%) (12). In general, population-based epidemiologic studies rely on
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