Holcombe, Chris; (1992) Helicobacter pylori: its role in the aetiology of non-ulcer dyspepsia in northern Nigeria. Doctoral thesis (M.D), UCL (University College London).

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Abstract

In a pilot study dyspepsia was found to account for 20/1,000 admissions at the University of Maiduguri Teaching Hospital, in Northern Nigeria, the majority of these patients had non-ulcer dyspepsia. In a prospective study of patients presenting with carefully defined non-ulcer dyspepsia 53 of 57 patients had gastritis and of these 46/53 (87%) were infected by the bacteria Helicobacter pylori (H.pvlori). As a result of this pilot study and a subsequent review of the literature it was hypothesised that H.pvlori is the cause of non-ulcer dyspepsia in northern Nigeria. The strong association of H.pylori with non-ulcer dyspepsia was confirmed in a prospective study of 138 patients, 126 (91%) of whom had gastritis and of these 120 (95%) were infected by H.pvlori. However this high prevalence of H.pvlori infection must be judged against the prevalence of infection in the general population. In a random serological survey 228/268 (85%) subjects over 5 years had IgG antibodies to H.pylori. This is not significantly different from that found in patients with nonulcer dyspepsia (87%). H.pvlori infection was also present in 80% of 40 asymptomatic volunteers. H.pvlori acting alone does not cause non-ulcer dyspepsia, but may play a role in combination with other factors. If this is the case, clearance of the organism should lead to improvement or resolution of symptoms. Therefore 130 patients were entered into a therapeutic trial of a combination antacid (Gelusil) one tablet four times a day versus an anti-H.pylori regime (DeNol 240 mg four times a day and amoxycillin, 500mg four times a day for the first 14 days). One hundred and nine patients were reassessed at the end of treatment. Symptoms completely resolved in 1 of 23 patients (4.4%) who had taken Gelusil and 28 of 86 (32%) of patients who had taken bismuth & amoxycillin, a statistically significant difference (p<0.01). However, resolution of symptoms was not related to H.pvlori clearance. These studies do not provide any evidence to support a role for H.pvlori in the cause of non-ulcer dyspepsia in northern Nigeria, thus disproving the hypothesis.

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