Upper gastrointestinal eddoscopic findings and helicobacter pylori status in diabetic outpatients with dyspesia at Kenyatta National Hospital

Abstract

Objectives The aim of the study was to determine the prevalence of Helicobacter pylori and the associated upper gastrointestinal findings in diabetic outpatients with dyspepsia. Methods This was a cross-sectional study in which diabetes mellitus outpatients aged 18 years and above were screened for dyspepsia. Demographic information (age, sex, residential area and employment status), and clinical information (type and duration of diabetes, weight, height, blood pressure, mode of glycemic control) was obtained from those who had dyspepsia and consented to an upper GIT endoscopy. HbAlc was determined and upper GIT endoscopy was performed. H. pylori was detected by the urease test and Cold ZN-stain while HE-stain was used for histological evaluation of the gastric biopsy specimens. Results Of the 257 diabetics screened, 137 (53.3%) had dyspepsia. 71 of the dyspeptic diabetics underwent an upper GIT endoscopy, out of whom, 55 (77.5%) had H. pylori infection. The prevalence of H pylori increased with HbAlc level but there was no statistically significant association with poor glycemic control (HbAlc >7.0%). Of the 71 patients, 48 (67.6%) had gastritis, 17 (25.7%) had duodenitis, 8 (11.3%) had oesophageal candidiasis, 7 (9.9%) had bile reflux and 6 (8.5%) had reflux oesophagitis. Six (8.4%) had ulcers (5 duonenal, 1 gastric) and 1 (1.4%) had gastric cancer. Endoscopically normal mucosa was found in 14 (19%) patients. The prevalence of H pylori was 82.3% (32/38) and 82.4% (14/17) in patients with antral gastritis and duodenitis respectively. All ulcers and the cancer lesion (adenocarcinoma) were associated with H.pylori. Histological gastritis was found in 57 (81.8%) and was significantly associated with H. pylori. Conclusion Dyspeptic diabetics have upper GIT endoscopic findings and H. pylori prevalence which are comparable to those of non-diabetic dyspeptic historical controls.