THE FEATURE OF IMUNOGLOBULIN G

ANTI- HELICOBACTER PYLORI

AND ENDOSCOPY
IN DYSPEPSIA AND NON DYSPEPSIA

ARSADI ALI
• Upper abd Pain, Nausea / Vomiting, Anorexia,
Bloating, Belching, Regurgitation, Heart Burn.
• Frequent, Long Suffer, Productivity , Economic
Burden
• Organic & Functional
• Main Cause : HP
• Upper abd pain, nausea / vomiting, anorexia,
bloating, belching, regurgitation, heart burn.
• Frequent, long suffer, productivity , economic
burden
• Organic & functional
• Main cause : HP
• > 50% world population
• Ind : 20 – 86 % dyspepsia,
10 – 50 % nondyspepsia
• Public health problem
• HP(+) nondyspepsia, dyspepsia HP(-)
• Endoscopy abnormality +/-

HP Infection  anti-HP IgG in blood

• Gastroduodenal abn. dt HP endoscopy
1. How Many % Anti – HP IgG (+) In Dyspepsia
& nondyspepsia ?
2. How Many % endoscopy abn In Dyspepsia &
nondyspepsia With Anti – HP IgG (+) ?
3. What Kind Of abn According To endoscopic
Examination In Dyspepsia & nondyspepsia
With Anti – HP IgG (+) ?
1. (+) anti – HP IgG result > in dyspepsia
compare than nondyspepsia.
2.Abn on endoscopic examination > in
dyspepsia compare than nondyspepsia
with anti – HP IgG (+).
General Aim :
To know the feature of the anti HP-IgG
& endoscopic abn in dyspepsia &
nondyspepsia
Special Aim
1. To know % anti – HP IgG (+) in dyspepsia &
nondyspepsia.
2. To know % dyspepsia & nondyspepsia with
anti – HP IgG (+) with abn in endosopic exam
3. To know the abn of endoscopic exam. in
dyspepsia & nondyspepsia with anti – HP IgG
(+).
1.Silent gastroduodenal disorder in
patient with anti-HP IgG could be
predicted
2.Eradication therapy can be considered
in pts with anti-HP IgG (+) although
asymptomatic
Helicobacter Pylori Infection
 HP :
 Gram (-), rod / spiral, 4 – 6 flagel, pleomorphic,
mikroaerofilik
 Produce urease, urea  amoniac & CO2
 Penetrate mucus  adherent in epithel cell
 Western: prevalence  with age
 Ren,Kepel: HP infection each group of age &
gender ~
 The role of HP in dyspepsia
HP Infection

Superficialis
chronic gastritis

Atroficans chronic Superficialis Peptic ulcer

gastritis chronic gastritis

Gastric
Malignancy
Clinical Manifestation of HP Infection
• Asymptomatic
• Non ulcer dyspepsia
• Peptic ulcer
• Gastric malignancy
Serologic Detection of HP Infection
HP Infection stimulate Immune response
Chronic infection  IgG .
Result : (+) : infected
(-) : not infected
Anti – HP IgG detection : ELISA
Endoscopic Feature of HP Infection
Endosopy  to see upper GIT.
 biopsy for further exam.
Endoscopic feature related HP infection : Chronic
erosion, nodularity, erithema in antrum, gastric
area prominent & erithema corpus region.
Endoscopic Feature of HP Infection
Endoscopic result :
• Dyspepsia pt with anti – HP IgG (+) : (Wenas)
GU 42,5 %, DU 35 %, anthral gastritis 32,5 %,
errosiva gastritis 15 %, duodenitis 17,5 %,
pangastritis 10 % & esofagitis 5 %
• Nondyspepsia : (Dooley)
Endoscopy Abn. 14 %
Study Design
Descriptive prospective & comparative
Time and place
In MGH, + 6 months
Population study
- dyspepsia patients
- nondyspepsia respondent
Sample & Sampling
Sample : dyspepsia pts in MGH &
nondyspepsia respondents
Lab. : in Prodia Lab Manado Branch
Endoscopy : in MGH Endoscopy
Installation.
Inclusion criteria
1. Pts with dyspepsia symptoms >2 weeks
2. Respondent without dyspepsia
symptom.
3. Pts / respondent age 20 – 60 of age.
4. Sign the inform consent.
Exclusion Criteria
1. Usage NSAID, steroid, Ca antagonist
2. Pts with inflammation / infection,DM,
renal failure, liver disease, COPD,
miokard iskemi, alcoholism.
5. Gravid.
4. Age < 20 & > 60.
5. Refuse to join the study.
MATERIAL & METHODS
Operational Definition
Dyspepsia criteria: Upper abd pain, nausea /
vomiting, anorexia, bloating, belching,
regurgitation, heart burn.
Respondent nondyspepsia : Partisipant
without dyspepsia symptoms.
Dependent variable :
Dyspepsia pts & nondyspepsia respondent
Independent variable :
- Result of anti-HP IgG exam : (+) / (-)
- Result of endoscopic exam : N / Ab
- Kinds abn of the result endoscopic
exam.
Tools & procedure
Tools :
1. Anti – HP IgG : ELISA methods.
2. Endoscopy : Gastrointestinal fiberscope
Tools & Procedure
Procedure :
1. Established dx dyspepsia, group control:
nondyspepsia.
2. Anti – HP IgG exam. in dyspepsia &
nondyspepsia.
3. Both of group with anti HP IgG (+) 
endoscopy
Data Analysis
- Data are presented in graphic & table
- Is there any significant differences
incidens anti – HP IgG (+) in dyspesia &
nondyspepsia  test Z or X2
- Is there any significant differences
between dyspepsia & nondyspepsia
according to endoscopic result in anti –
HP IgG (+)  X2 / Fisher Exact test
PTS WITH DYSPEPSIA SYMP RESP. WITHOUT DYSPEPSIA

SELECTION

DYSPEPSIA INCLUSION NONDYSPEPSIA

HP(-) HP(+) HP(+) HP(-)

ENDOSCOPY

N ABN N ABN

STATISTIC ANALYSIS

RESULT
Sample characteristic

MALE
44.80% 55.20% FEMALE

Age 21– 60 years, mean age 42,69 year.

29 dyspepsia & 29 nondyspepsia.
Anti-HP IgG in dyspepsia
+
Ind. :20-86%
- Soewignyo 52,3%,
41.40% Simadibrata 20%,
59.60%
Achmad 58,6%, Wenas
18,25-25%, Kepel
25%, Soemohardjo
78,3%
Anti-HP IgG in nondyspepsia

27.60% Foreign countries 20-30%

Dolley 32%
+
- Ind. 10-50%
72.40% Arif 23,5%
Soewignyo 52,2%
 Dyspepsia
Nondyspepsia

Male
Female
Anti-HP IgG (+)

Age
HP infection in dyspepsia & nondyspepsia

• Soewignyo : no significant difference

• Others study : dyspepsia > nondyspepsia.
• This study : no significant difference (p = 0,269)
 Abnormality of endoskopic results
NORMAL 50
25
R.DUODENUM 0 12.5
0
DUODENITIS 8.33 NONDISPEPSIA
12.5 DISPEPSIA
U.LAMBUNG 16.67
50 66.67
GASTRITIS

0 10 20 30 40 50 60 70

Tygat : no significant difference

This study : no significant difference (p=0,356)
Gastritis

THIS 50
STUDY 66
NONDYSPEPSIA
86 DYSPEPSIA
DOLLEY

20
TYGAT 24

0 20 40 60 80 100
 Gastritis location
80 75
70 62.5 DISPEPSIA
60
NONDISPEPSIA
50
37.5
40
25 25
30
20
10
0
0
ANTRUM ANTROPILORI PANGASTRITIS

• HP Infection in antrum

  gastric acid  duodenal ulcer

Ulcer
Tygat : Peptic ulcer 8% dyspepsia
& 4% nondyspepsia,
Wenas : Gastric ulcer 42,5% dyspepsia.
This study: Gastric ulcer 6,67% dispepsia
12,5% nondispepsia
Duodenitis
HP  causes infection of gastric metaplasia
 duodenitis.
Tygat : 20% dyspepsia, 9% nondyspepsia
Wenas : 17,5% dyspepsia
This study: 8,33%
Duodenal reflux
Tygat : 8% dyspepsia & 13%
nondyspepsia
This study : 12,5% nondyspepsia.

Carcinoma
HP  carcinogenes
This study: carcinoma (-).
CONCLUSION
1. Anti-HP IgG (+) in dyspepsia & nondyspepsia
no significant difference.
2. Endoscopic examination in dyspepsia &
nondyspepsia with anti-HP IgG (+) shows no
significant difference
3. Abn.in endoscopic examination : gastritis, gastric
ulcer,duodenitis, duodenal reflux .
Suggestion

1. Anti-HP IgG :
- Basis of HP infection diagnosis
- Predictor of gastroduodenal abnormalities
2. Anti-HP IgG (+)
 consider eradication of HP