The minimum age of the 227 patients was 13 years, maximum age was 90 years and mean age was 47.81 ± 18.23. Furthermore, the minimum, maximum and mean age of the 191 infected patients with H. pylori based on the categorized severity of the H. pylori into high, moderate and low is presented in Table 1. The low state prevalence of H. pylori was highest (111 cases) compared to 17 and 63 cases for high and moderate severity of H. pylori, respectively. This result showed that cases with no detectable infection were 36 (15.86%) out of the 227 patients.
Table 1
Age distribution across severity status of H. pylori.
severity of H. pylori (Number of cases), (%) | High (17), (8.9%) | Moderate (63), (32.98%) | Low (111), (58.12%) |
Age (yrs): min. Max. Average | 16 57 38.59 ± 13.13 | 13 86 45.56 ± 18.26 | 18 90 47.72 ± 18.03 |
Results revealed that all patients had positive rapid urease test and no association between H. pylori severity across various age groups (P = 0.245), and gender (P < 0.961). It was noticed that high prevalence of H. pylori was most likely to occur in patients of 35–60 years old (43.98%) compared to younger or older ages (30.89, 25.13%), respectively (Table 2). The prevalence of H. pylori infection was 50.26% in males 49.74% in females showing similar distribution of H. pylori among the gender. The result showed a statistical significant association between H. pylori severity across various Inflammation (P < 0.001), and Lymphoid aggregate (P < 0.001). Chi square for diagnosis variables of metaplasia, activity which represented by presence or absence of neutrophils, glandular atrophy, rapid urease test, endoscopic finding, and clinical manifestation were highly significant (P < 0.001) across low, moderate, and high H. pylori severity (Fig. 1).
The moderate Inflammation was recorded the highest (71.2%) compared to mild (25.66%) and severe (3.14%). The finding of the positive lymphoid aggregate showed 82.72% compared to 17.28% of the negative tests (Fig. 2).
On the other hand, positive metaplasia was found in 11.52%; neutrophils in 17.8% and positive tests for glandular atrophy in 9.95% of cases.
The distribution of the endoscopic findings showed 64.92% nodular, whereas 35.08% were erosive. Clinical manifestation of most patients (56.02%) had pain, 10.47% had IDA, 16.75% had dyspepsia, and 16.75% had other clinical manifestations.
Table 2
Distribution of H. pylori according to the variables studied.
H. pylori (Number of cases) | No. (%) | High (17) | Moderate (63) | Low (111) | P Value |
Age years: ≤ 35 35–60 >60 | 59 (30.89) 84 (43.98) 48 (25.13) | 6 10 1 | 22 24 17 | 31 50 30 | 0.245* |
Gender: Male Female | 96 (50.26) 95 (49.74) | 8 9 | 32 31 | 56 55 | 0.961* |
Inflammation: mild moderate severe | 49 (25.66) 136 (71.20) 6 (03.14) | 1 15 1 | 8 51 4 | 40 70 1 | 0.001* |
Lymphoid aggregate: positive negative | 158 (82.72) 33 (17.28) | 17 0 | 60 3 | 81 30 | 0.001 |
Metaplasia : positive Negative | 22 (11.52) 169 (88.48) | 4 13 | 4 59 | 14 97 | 0.001 |
Activity: presence of neutrophils absence of neutrophils | 157 (82.20) 34 (17.80) | 17 0 | 57 6 | 83 28 | 0.001 |
Glandular atrophy: positive Negative | 19 (09.95) 172 (90.05) | 0 17 | 3 60 | 16 95 | 0.001 |
Rapid Urease Test: positive Negative | 191 (100) 0 (0) | 17 0 | 63 0 | 111 0 | 0.001 |
Endoscopic finding: nodular granular erosive | 28 (14.66) 96 (50.26) 67 (35.08) | 2 7 8 | 12 25 24 | 14 64 35 | 0.001 |
Clinical manifestation: pain IDA dyspepsia others | 107 (56.02) 20 (10.47) 32 (16.75) 32 (16.75) | 10 3 3 1 | 41 4 13 5 | 56 13 16 26 | 0.012 |
*Chi-square test was calculated as a contingency table. |
A total of 26 patients out of the total 227 were diagnosed as gastric adenocarcinoma. The 26 cases were categorized based on poor or moderate adenocarcinoma together with positive or negative for the presence H. pylori. Four composite groups were initiated: positive H. pylori / moderate grade adenocarcinoma (positive / moderate), positive H. pylori / poor grade adenocarcinoma (positive / poor), negative H. pylori / moderate grade adenocarcinoma (negative / moderate) and negative H. pylori / poor grade adenocarcinoma (negative / poor) with 4, 6, 5 and 11 cases, respectively (Table 3, Fig. 3).
Results presented in Table 3 revealed highly statistically significant (P < 0.001) difference in the number of cases in each category (combinations) of H. pylori and adenocarcinoma with Inflammation, lymphoid aggregate, metaplasia, activity of neutrophils, glandular atrophy, and endoscopic, and rapid urease test. On the other hands, age, gender, and clinical manifestation presence or absent showed no significant associations.
Table 3
Distribution of combination of H. pylori and adenocarcinoma according to the variables studied.
H. pylori /adenocarcinoma (Number of cases) | positive/ moderate (4) | positive / poor (6) | negative/ moderate (5) | negative / poor (11) | P value |
Age years: ≤ 35** 35–60 >60 | 0 3 1 | 0 1 5 | 0 2 3 | 2 4 5 | 0.333* |
Gender: Male Female | 3 1 | 5 1 | 4 1 | 7 4 | 0.814* |
Inflammation: negative mild moderate severe | 0 4 0 0 | 0 4 2 0 | 2 0 0 3 | 10 0 0 1 | 0.001 |
Lymphoid aggregate: positive negative | 0 4 | 2 4 | 0 5 | 0 11 | 0.001 |
Metaplasia : positive Negative | 0 4 | 2 4 | 0 5 | 0 11 | 0.001 |
Neutrophils: presence Absence | 2 2 | 2 4 | 0 5 | 0 11 | 0.001 |
Glandular atrophy: positive Negative | 3 1 | 4 2 | 0 5 | 0 11 | 0.010 |
Rapid Urease Test: positive Negative | 4 0 | 6 0 | 0 5 | 0 11 | 0.001 |
Endoscopic finding: nodule (mass) erosive lesion | 1 3 | 2 4 | 3 2 | 8 3 | 0.001* |
Clinical signs: pain with melena Others | 3 1 | 4 2 | 2 3 | 4 7 | 0.443* |
*Chi-square test was calculated as a contingency table. |
**Excluded from chi square test due to zeros exist in cell values. |
Similarly, it can be seen that lymphoid aggregate status (positive vs. negative tests) has similar trends across H. pylori severity status (Fig. 5). Both positive and negative lymphoid aggregate showed lowest values (17 and 0, respectively) for high H. pylori and both diagnostic tests increased to 60 and 3 cases for the moderate H. pylori status, then both attained the peak cases of their lines when H. pylori status was low(81 and 30, respectively). Such similar trend plots indicate a high significant statistical positive association.
Table 3, Figs. 6 and 7 illustrate highly statistically significant (P < 0.001) findings between a combination of positive and negative H. pylori and poor or moderate adenocarcinoma with rapid urease test, and glandular atrophy. Figure 6 shows fluctuations in number of cases among categorization (combination) of H. pylori and adenocarcinoma with rapid urease test, which represent an inverse association, as the trend of the positive rapid urease test line has opposite direction and magnitude of the negative rapid urease test line. The positive rapid urease test line increased from 4 to 6 then declined to 0, 0 for (positive / moderate), (positive / poor), (negative / moderate) and (negative / poor), respectively. Whereas, negative rapid urease test line increased from 0, 0 to 5 then to 11 for (positive / moderate), (positive / poor), (negative / moderate) and (negative / poor), respectively.
Similarly, Fig. 7 shows fluctuations in number of cases among categorization (combination) of H. pylori and adenocarcinoma with positive and negative glandular atrophy, which represent inverse association, as the trend of the positive glandular atrophy line has opposite direction and magnitude of the negative glandular atrophy line. The negative glandular atrophy line increased from 1 to 2 then to 5and 11 for (positive / moderate), (positive / poor), (negative / moderate) and (negative / poor), respectively. Whereas, positive glandular atrophy line increased from 3, to 4 then declined to 0, 0 for (positive / moderate), (positive / poor), (negative / moderate) and (negative / poor), respectively.