Distribution of upper gastro-intestinal pathology by endoscopic evaluation and assessment of H. pylori colonization in malnourished Bangladeshi population: A descriptive study

Abstract

Abstract Background There is paucity of knowledge on the macroscopic appearance of the gut in malnourished adults. Such data is strikingly lacking in chronic malnourished children aged between 12–24 months. We, therefore, aimed to explore the upper-gastrointestinal (UGI) pathology in both this population, compare differences and evaluate H.pylori colonization in the malnourished adult gut. Methods Data was collected from the BEED (Bangladesh Environmental Enteric Dysfunction) study conducted in Dhaka, Bangladesh. To address the association of environmental enteric dysfunction (EED) with childhood stunting and adult malnutrition, UGI endoscopy was performed in 120 children (60 stunted, length-for-age Z-scores [LAZ]<-2 and 60 at risk of stunting, LAZ <-1 to -2) and 58 malnourished adults (body mass index < 18.5 kg/m2). Presence of pathologies during endoscopy was noted, Rapid Urease Test (RUT) was done on biopsies obtained from distal antrum of adults, clinical features of dyspepsia was recorded, and stool for H. pylori antigen (HpSA) using ELISA was tested. RUT positive dyspeptic patients were treated with 14-day Clarithromycin based triple therapy. Correlation between the findings was analyzed. Results The mean age of the children was 18 ± 2 months and that of adults was 25 ± 7 years. Of the 120 children, only one child revealed lymphoid hyperplasia at the second part of duodenum, while the others had normal findings in upper GI endoscopy. More than half of the malnourished adults (55%) had normal findings, 10 (18%) had antral erosive gastritis, 6 (10%) had antral non-erosive gastritis, 6 (10%) had polyps and 2 (3%) had gastric ulcer. 25 (43%) of these adults had dyspeptic symptoms, 49 (85%) were HpSA positive and 48 (83%) were RUT positive. More than 90% of the RUT positive cases were dyspeptic (p < 0.05). A sub-analysis on the impact of triple therapy on RUT positive symptomatic patients showed, the erosive group responded better than the non-erosive group (p < 0.05). Conclusions Children irrespective of nutritional status exhibited normal UGI endoscopy findings; however, malnourished adults were often diagnosed with abnormal GI findings, antral gastritis being the most prevalent pathology. Erosive gastritis responded significantly better to triple therapy. Both RUT and HpSA yielded significantly similar results in detecting H.pylori infection. ClinicalTrials.gov ID: NCT02812615 (https://clinicaltrials.gov/ct2/results?cond=NCT02812615&term=&cntry=&state=&city=&dist=) Date of first registration: 24/06/2016