Helicobacter pylori and dyspepsia from a public health perspective : The Sørreisa Gastrointestinal Disorder Study

Abstract

Dyspepsia is a highly prevalent condition, involving substantial health-care resources. Ever since Marshall and Warren in 1984 discovered that Helicobacter pylori could cause peptic ulcer, it has been discussed to what extend Helicobacter pylori play a role in dyspepsia in general. In 2004 a population based survey was carried out in the municipality of Sørreisa, comprising a questionnaire survey on gastrointestinal disorders and upper endoscopy of a subgroup of the population. The results from this survey were compared with a similar survey in Sørreisa from 1987. <br><br>Main Results <br>A diagnostic test, the “Amplified IDEIA Hp StAR®” (DakoCytomation, Denmark) was validated and found to be very accurate, also in patients using proton pump inhibitors. The observer variability in upper endoscopy was studied and found to be considerable. A systematic image documentation of the endoscopy findings, regardless of suspicion of pathology, would improve the quality of the procedure. The prevalence of H. pylori has decreased considerably since 1987, whereas the prevalence of dyspepsia has remained constant, thus questioning any relationship between the two. Helicobacter pylori is only a moderate risk factor for peptic ulcer, whereas other risk factors as smoking seems to be just as important. Helicobacter pylori causes inflammation of the gastric mucosa, but plays a minor role in more chronic changes of the gastric mucosa such as atrophy and intestinal metaplasia. Elimination of Helicobacter pylori infection causes regression of inflammation, but not regression of intestinal metaplasia once it has developed. <br><br>The thesis emanate from the Department of Community and the department of Clinical Medicine, University of Tromsø, Norway