INTRODUCTION: Dyspepsia, meaning bad digestion, is a medical condition characterized by chronic or recurrent pain in the upper abdomen, upper abdominal fullness and feeling of fullness earlier than expected when eating. It can be accompanied by bloating, belching, nausea or heartburn. Dyspepsia is one of the most common symptoms bringing the patient to the physician according to Tally [1]. Dyspepsia is fourth ranking symptom presenting for diagnosis in primary care. Surveys in western societies have recorded prevalence between twenty one to forty ve percent [2, 3, and 4]. Dyspepsia symptoms have been classied as reux or ulcer or dysmotility. In patients with dyspepsia who are investigated, four major causes can be identied for their complaints- 1. Chronic peptic ulcer disease 2. Gastroesophageal reux disease (with or without esophagitis) 3. Malignancy 4. Functional (non ulcer) dyspepsia. Non ulcer dyspepsia is dened as chronic or recurrent pain or discomfort centred in the upper abdomen at least for three months where there is no c l in ical , b iochemical , ultrasonography or endoscopic evidence of known organic disease that is likely to explain these symptoms [5]. Various investigators have shown that evidence of non ulcer dyspepsia ranges from 7-38% among individuals with all types of dyspepsia. About 40% of all types of dyspepsia occur in patients younger than 25 and 3-7% of all cases occur in patients older than 60. Non ulcer dyspepsia has been associated with positive family history of dyspepsia and that of peptic ulcer disease [6]. Rome II diagnostic criteria for functional dyspepsia, based on consensus opinion of an international panel of clinical investigators, [7] are as follows: (1) One or more of (a) Post-prandial fullness (b) Early satitation. (c) Epigastric pain (d) Epigastric burning. (2) No evidence of structural disease (including at upper gastrointestinal endoscopy) that is likely to explain the symptoms. (3). No evidence that dyspepsia is exclusively relieved by defecation or associated with onset of a change in stool frequency or stool form (irritable bowel syndrome). Non-ulcer dyspepsia is sub-categorised into ulcer-like, dysmotility like and non-specic dyspepsia [8, 9]. Ulcer like dyspepsia: Three or more of the following are necessary, but upper abdominal pain must be a predominant complaint: 1. Pain that is well localised in the epigastrium. 2. Pain relieved by food, often (more than 25% of the time). 3. Pain relieved by antacids and/or H2 blockers, often.4.Pain occurring before meals or when hungry, often.5. Pain that at times wakes the PREVALENCE OF HELICOBACTER PYLORI IN NON-ULCER DYSPEPSIA PATIENTS Original Research Paper Rayees Ahmad Bhat Assistant Professor in Dept. of General Surgery. Al-Falah school of Medical Sciences and Research Centre (AFSMSRC), Faridabad, Haryana. General Surgery BACKGROUND: Helicobacter pylori had unquestionably been observed by a number of workers since Birchers rst description in 1874. Luck JM, Seth TN in 1924 documented urease activity in the human stomach. It was thought that this urease activity originated in gastric mucosal cells and was not associated with the presence of bacteria. AIMS AND OBJECTIVE: 1.To know the prevalence of Helicobacter pylori in non-ulcer dyspepsia patients and to know the prevalence of Helicobacter pylori in different clinical sub-groups of non-ulcer dyspepsia. METHODS AND MATERIALS: study was conducted in Post-graduate Department of Surgery in Govt. Medical College Jammu over a period of one year. Patients with non-ulcer dyspepsia, who attended the Department of Surgery either outpatient department or indoor, were subjected to this study. Diagnosis of patients was made from the history of patients and upper G.I. endoscopy. Overall seventy patients of non ulcer dyspepsia formed the material of the study. . Ultrasonography of abdomen was done to rule out any pathology responsible for dyspepsia. RESULT: th rd th The maximum numbers of non ulcer dyspepsia patients were seen in 4 decade of life followed by 3 and 5 decade of th rd thlife. 25.71% of cases were seen in 4 decade of life while 24.29% & 21.42% of cases were seen in 3 & 5 decade of life rdrespectively. The prevalence of H. pylori infection increases with age. Among 33 H. pylori positive patients, 7 patients are in 3 th thdecade while 9, 8 and 6 patients are in 4 , 5th & 6 decade respectively. Prevalence of H. pylori infection in each age group rd th th thincreases with each decade 41.18%, 50%, 53.33%, 60% cases in 3 , 4 , 5 & 6 decades respectively. CONCLUSION: Maximum percentage of non ulcer dyspepsia patients was in third decade. Prevalence of H pylori infection increased with age. Prevalence of H pylori in males and females was not signicantly different. Prevalence of H pylori in lower socio-economic class was signicantly different from middle and upper classes suggesting that poor hygiene and overcrowding are responsible for increased prevalence of H pylori in patients of lower socio economic status. ABSTRACT KEYWORDS : Dyspepsia, Helicobacter pylori, GERD, Peptic ulcer. Dr. Dug Tariq Hassan* Assistant Surgeon Directorate of Health services, Kashmir *Corresponding Author Dr. Liyaqat Nazir General Surgeon Health and Medical Education Dept. J & k. VOLUME-8, ISSUE-11, NOVEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Dr Shabir Ahmad Dar General Surgeon Health and Medical Education Dept. J & k. Dr. Mohammad Zakiuddin Professor, Dept. of Physiology. Madhubani Medical College, Madhubani. 4 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS patient from sleep. 6. Periodic pain with remissions and relapses. Dysmotility like dyspepsia: Pain is not a dominant symptom; upper abdomen discomfort should be present in all cases. This discomfort should be chronic and characterised by three or more of the following: 1. Early satiety 2. Postprandial fullness. 3. Nausea 4. Retching and/or vomiting that are recurrent. 5. Bloating in the upper abdomen not accompanied by visible distension. 6. Upper abdominal discomfort often aggravated by food. Unspecied dyspepsia (non-specic): Dyspeptic patients whose symptoms do not full the criteria for ulcer like and dysmotility like dyspepsia. Reux type dyspepsia: Dyspepsia with predominant feature heart burn. Many of these patients may actually have GERD. AIMS AND OBJECTIVE: Our study is undertaken with intent to know the prevalence of Helicobacter pylori in non ulcer dyspepsia patients through histopathological examination and rapid urease test of biopsy. 1. To know the prevalence of Helicobacter pylori in non-ulcer dyspepsia patients. 2. To know the prevalence of Helicobacter pylori in different clinical sub-groups of non- ulcer dyspepsia. MATERIAL AND METHODS: This study was conducted in Post-graduate Department of Surgery in Govt. Medical College Jammu over a period of one year. Patients with non-ulcer dyspepsia, who attended the Department of Surgery either outpatient department or indoor, were subjected to this study. Diagnosis of patients was made from the history of patients and upper G.I. endoscopy. Overall seventy patients of non ulcer dyspepsia formed the material of the study. A detailed history was taken and thorough clinical examination was done according to the Performa. Patients were subjected to routine investigations. Ultrasonography of abdomen was done to rule out any pathology responsible for dyspepsia. INCLUSION CRITERIA: Patients were subjected to upper G.I. endoscopy to rule out any organic cause for dyspepsia like erosions, ulcers, growth etc. Patients having normal gastric mucosa or having features of gastritis without erosions were included in the study. Endoscopic biopsy was taken from body and antrum of stomach and was studied for Helicobacter pylori by histopathological examination of specimen using haematoxylin and eosin and special stains such as Giemsa stain. Biopsy was also subjected to rapid urease test to check for urease activity of Helicobacter pylori. After taking the biopsy from gastric mucosa, specimen was immediately subjected to rapid urease test using rapid urease test kit. This kit contains urea in agar along with phenol red with an acidic HP . Biopsy was inoculated into the medium and kept at room temperature. The change in colour from yellow to pink was taken as positive. Mostly the colour change occurred within one hour in positive cases. OBSERVATION: In this study, following observations were made: Table – 1: Age distribution. Fig. : Showing Age distribution of patients. thMaximum numbers of patients of NUD were recorded in the 4 rd thdecade of life followed by 3 and 5 decade of life. There were th rd25.71% of cases in 4 decade, 24.29% in 3 decade and th21.42% in 5 decade. Table –2: Sex Distributions: Fig. 2: Showing sex distribution of patients 51.43% were males and 48.57% were females thus giving male to female ratio of 1.059. Table – 3: Distribution according to symptoms into clinical subgroups: The distribution of patients according to their symptoms into three clinical subgroups are as follows: Fig. 3-: Showing distribution of patients into clinical sub groups So patients in ulcer like subgroup are more compared to non specic subgroup & patients in non specic subgroup are more compared to those in motility disorder like subgroup. Table – 4: (NSAID Incidence) Incidence of drug intake (NSAIDS and proton pump inhibitors): VOLUME-8, ISSUE-11, NOVEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Age No. of Patients Percentage 0-10 0 0 11-20 3 4.29 21.30 17 24.29 31-40 18 25.71 41-50 15 21.42 51-60 10 14.29 >60 7 10 Total 70 100 Sex No. of Patients Percentage Males 36 51.43 Females 34 48.57 Total 70 100 Subgroup No. of patients Percentage Ulcer like 27 38.57 Motility disorder like 20 28.57 Mixed(Non – specic) 23 32.86 Total 70 100 NSAIDS Intake No. of Patients Percentage H/o NSAIDS intake 12 17.14 No. H/o NSAIDS intake 58 82.86 Total 70 100 X 5GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Fig. 4: Showing distribution according history of NSAIDS intake. Table – 5: PPI Intake Incidence. Fig. 5: Showing distribution according history of PPI intake Only 17.14% of patients were using NSAIDS. While 80% of patients were using proton pump inhibitors. One Patient was using Benzodiazipines (Alprazolam). Table – 6: Distribution according to endoscopic ndings: Fig. 6: Showing distribution according to Endoscopic ndings. 45.71% of patients were having normal mucosa while 54.29% of patients having gastritis. Histopathology and rapid urease test for H. pylori: Rapid urease test was done immediately after taking biopsy using rapid urease test kit. Results were noted by colour changes. While histopathology examination was done by haematoxylin and eosin and using special stains like Giemsa stain. Table-7: Rapid urease test. Fig.7: Showing H.pylori +ve and –ve Patients. By histopathological examination using special stains, 31 patients were positive for H. pylori and 39 were negative for H. pylori while by rapid urease test 28 patients were positive and 42 were negative. Two patients were positive by rapid urease test alone, ve patients were positive by histopathology alone and twenty six patients were positive by both tests. Final result was considered positive if either histopathology for H. pylori was positive or rapid urease test was positive or both were positive. Overall 33 patients were positive for H. pylori and 37 patients were negative for H. pylori, so percentage of H. pylori positive patients was 47.14%. H. pylori positive patients are more in lower socio-economic class compared to middle socio-economic class and upper socio-economic class. 70.83% patients of lower class are H. pylori positive while 36.36% and 30.77% of middle and upper classes are H. pylori positive respectively. RESULT: The maximum numbers of non ulcer dyspepsia patients were th rd thseen in 4 decade of life followed by 3 and 5 decade of life. th25.71% of cases were seen in 4 decade of life while 24.29% & rd th21.42% of cases were seen in 3 & 5 decade of life respectively. The prevalence of H. pylori infection increases with age. Among 33 H. pylori positive patients, 7 patients are in rd th th3 decade while 9, 8 and 6 patients are in 4 , 5th & 6 decade respectively. Prevalence of H. pylori infection in each age group increases with each decade 41.18%, 50%, 53.33%, 60% rd th th thcases in 3 , 4 , 5 & 6 decades respectively. DISCUSSION: In this study the maximum numbers of non ulcer dyspepsia th rd thpatients were seen in 4 decade of life followed by 3 and 5 thdecade of life. 25.71% of cases were seen in 4 decade of life rd thwhile 24.29% & 21.42% of cases were seen in 3 & 5 decade of life respectively. Number of NUD patients was relatively less in children and patients with above 60 years of age. These ndings are comparable to ndings of Hassan B Abdel Hafeiz et al in 1999 who found that maximum number of non ulcer rd thdyspepsia cases was seen in 3 , 4th & 5 decades 27.5%, 27.5% & 18.8% respectively. In our study prevalence of H. pylori infection increases with age. Among 33 H. pylori rdpositive patients, 7 patients are in 3 decade while 9, 8 and 6 th thpatients are in 4 , 5th & 6 decade respectively. Prevalence of H. pylori infection in each age group increases with each rd th th thdecade 41.18%, 50%, 53.33%, 60% cases in 3 , 4 , 5 & 6 decades respectively. These ndings are consistent with ndings of L. Thermer et al in 1996 who found that H pylori infection rate in patients increases with age. The prevalence of non ulcer dyspepsia in two sexes was almost similar in our study with slightly increasing prevalence in males compared to females (male = 51.43% and female = 48.57%). Results are comparable with the study of Hassan B Abdel Hafeiz et al (1999) where a difference in prevalence of NUD among males and females was statistically insignicant. CONCLUSION: Non ulcer dyspepsia is a common disorder bringing the patient to OPD. Maximum percentage of non ulcer dyspepsia patients was in third decade. Prevalence of H pylori infection increased with age. Prevalence of H pylori in males and females was not signicantly different. Prevalence of H pylori in lower socio-economic class was signicantly different from middle and upper classes suggesting that poor hygiene and overcrowding are responsible for increased prevalence of H pylori in patients of lower socio economic status. Prevalence of H pylori among smokers and non smokers was not signicantly different. Prevalence of H pylori is more in patients with features of gastritis on endoscopy than those with normal mucosa. This suggests that inammatory changes are commonly present in case of H pylori infection. Overall prevalence of H pylori was 47.14%. Infectivity rate with H pylori was more in ulcer like subgroup compared to other VOLUME-8, ISSUE-11, NOVEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra PPI Intake No. of Patients Percentage H/o PPI intake 56 80 No. H/o PPI intake 14 20 Total 70 100 Endoscopic Findings No. of Patients Percentage Features of gastritis 38 54.29 Normal 32 45.71 Total 70 100 No. of H. pylori +ve/ -ve patients Rapid Urease test HPE Total (including both tests) No. of H. pylori +ve patients 28 31 33 No. of H. pylori –ve patients 42 39 37 Total 70 70 70 6 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS subgroups. So non ulcer dyspeptic patients, where predominant symptom is pain, can be beneted more with H pylori eradication treatment. REFERENCES: 1. TalleyN, Non-ulcer dyspepsia: current approaches to diagnosis. American Family Physician, 1993; 47:6. 2. Jones RH, Lipleard S. Prevalence of symptoms of dyspepsia in the community. British Medical Journal, 1989; 298: 30-32. 3. Locke G. The epidemiology of functional gastrointestinal disorders in North America. Gastroenterology Clinics of North America, 1996; 25: 1-9. 4. Talley N, Zinsmester A, Scheck C. Dyspepsia and dyspepsia subgroups: a population based study. Gastroenterology, 1992; 102: 1259-68. 5. Talley NJ, Silverstein MD, Agréus L et al.AGA Technical Review: Evaluation of dyspepsia. Gastroenterology 1998; 114: 582-95. 6. Mc Namara D A, Buckley M, O'Mortain C A. Non-ulcer dyspepsia. Gastroenterol. Clin. Of North America. 2000; 29(4): 807-18. 7. Drossman DA. Functional gastrointestinal disorders and the Rome II process. Gut 1995. AGA Technical Review: Evaluation of dyspepsia. Gastroenterology 1998; 114: 582-95; 45: II 2-5. 8. Talley NJ, Stanghellini V, Heading RC et al. Functional gastro duodenal disorders. Gut 1999; 45 (suppl 2):1137-42. 9. W H C Hu, S K Lam, et al .Functional dyspepsia: recent advances in Pathophysiology HK Pract 1998; 20:327-334. VOLUME-8, ISSUE-11, NOVEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra X 7GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS