Graduation Year

2010

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Global Health

Major Professor

Boo Kwa

Co-Major Professor

Ricardo Izurieta

Committee Member

Azliyati Azizan

Committee Member

Lakshminarayan Rajaram

Keywords

H. pylori, Pune, case control study, antigen detection, cohort study

Abstract

Background: Helicobacter pylori (H. pylori) infection is a significant risk factor for peptic ulcer (PU) and gastric cancer (GC). Apart from the virulent CagA genotype of H. pylori environmental and dietary factors influence disease outcomes. There have been no studies addressing these factors in Western India. Hence, we conducted a case control study enrolling PU, GC patients and controls at Pune, India.

Methods: Risk factors for PU and H. pylori infection were assessed in participant interview. H. pylori status was assessed from stool by monoclonal antigen detection. To understand treatment effect, we followed 100 H. pylori positive patients.

Results: We enrolled 190 PU patients, 125 Controls and 35 GU patients. Prevalence of H. pylori was 61% among symptomatic patients and 45% among controls. H. pylori infection (OR: 1.70, 95% CI: 1.03-2.89), meat (OR: 1.10, 95% CI: 1.02-1.75), fish (OR: 1.05, 95% CI: 1.02-1.89) consumption, and family history of ulcer (OR: 1.20, 95% CI: 1.08-1.60) were risk factors for PU. Consumption of snacks with alcohol (OR: 0.32, 95% CI: 0.13-0.78) and history of anti-parasite treatment (OR: 0.51, 95% CI: 0.30-0.86) were protective factors against PU. Lower socioeconomic status (SES) (OR: 1.10, 95% CI: 1.02-1.39), meat consumption (OR: 2.35, 95% CI: 1.30-4.23), smoking (OR: 2.23, 95% CI: 1.24-4.02), eating restaurant food thrice per week (OR: 3.77, 95% CI: 1.39-10.23) and drinking non-filtered or non-boiled water (OR: 1.05, 95% CI: 1.01-1.23) were risk factors for H. pylori infection. Consumption of chili peppers (OR: 0.20, 95% CI: 0.10-0.37) and concurrent parasite infestation (OR: 0.44, 95% CI: 0.24-0.80) were protective against H. pylori infection. H. pylori infection was eradicated only in 53% (40/75) of treated patients.

Conclusion: This study indicates that H. pylori infection is associated PU. Consumption of meat, fish and family history of PU are risk factors for PU. Lower SES, consumption of restaurant food, meat, non filtered water and smoking are risk factors for H. pylori infection. Consumption of chili peppers and concurrent parasite infestation are protective against H. pylori infectionwhile history of anti parasite treatment protects against PU. H. pylori were eradicated only in 53% of patients.

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