THE FEATURE OF IMUNOGLOBULIN G

ANTI- HELICOBACTER PYLORI

AND ENDOSCOPY
IN DYSPEPSIA AND NON DYSPEPSIA

ARSADI ALI
 DYSPEPSIA
• Upper abd pain, nausea / vomiting, anorexia,
bloating, belching, regurgitation, heart burn.
• Frequent, long suffer, productivity , economic
burden
• Organic & functional
• Main cause : HP
 DYSPEPSIA
• Upper abd pain, nausea / vomiting, anorexia,
bloating, belching, regurgitation, heart burn.
• Frequent, long suffer, productivity , economic
burden
• Organic & functional
• Main cause : HP
HELICOBACTER PYLORI

• > 50% world population

• Ind : 20 – 86 % dyspepsia,
10 – 50 % nondyspepsia
• Public health problem
 CONTROVERSI HP
• HP(+) nondyspepsia, dyspepsia HP(-)
• Endoscopy abnormality +/-

DETECTION OF HP
• HP Infection  anti-HP IgG in blood
• Gastroduodenal abn. dt HP endoscopy
RESEARCH QUESTION
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 (+) ?
HYPOTHESIS

1. (+) anti – HP IgG result > in dyspepsia

compare than nondyspepsia.
2.Abn on endoscopic examination > in
dyspepsia compare than nondyspepsia
with anti – HP IgG (+).
AIM

General Aim :
To know the feature of the anti HP-IgG
& endoscopic abn in dyspepsia &
nondyspepsia
AIM
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
(+).
 BENEFIT

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
 LITERATURE REVIEW
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 ~
LITERATURE REVIEW
 LITERATURE REVIEW
The role of HP in dyspepsia
HP Infection

Superficialis
chronic gastritis

Atroficans Superficialis Peptic ulcer

chronic gastritis chronic gastritis

Gastric
Malignancy
 LITERATURE REVIEW
Clinical Manifestation of HP Infection
• Asymptomatic
• Non ulcer dyspepsia
• Peptic ulcer
• Gastric malignancy
 LITERATURE REVIEW
Serologic Detection of HP Infection
HP Infection stimulate Immune response
Chronic infection  IgG .
Result : (+) : infected
(-) : not infected
Anti – HP IgG detection : ELISA
 LITERATURE REVIEW
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.
 LITERATURE REVIEW
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 %
MATERIAL & METHODS

Study Design
Descriptive prospective & comparative
Time and place
In MGH, + 6 months
Population study
- dyspepsia patients
- nondyspepsia respondent
 MATERIAL & METHODS

Sample & Sampling

Sample : dyspepsia pts in MGH &
nondyspepsia respondents
Lab. : in Prodia Lab Manado Branch
Endoscopy : in MGH Endoscopy
Installation.
MATERIAL & METHODS

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.
MATERIAL & METHODS
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.
 MATERIAL & METHODS
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.
MATERIAL & METHODS

Tools & procedure

Tools :
1. Anti – HP IgG : ELISA methods.
2. Endoscopy : Gastrointestinal fiberscope
MATERIAL & METHODS

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
MATERIAL & METHODS
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
STUDY DESIGN
PTS WITH DYSPEPSIA SYMP RESP. WITHOUT DYSPEPSIA

SELECTION

DYSPEPSIA INCLUSION NONDYSPEPSIA

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

ENDOSCOPY

N ABN N ABN

STATISTIC ANALYSIS

RESULT
RESULT AND DISCUSSION
Sample characteristic

MALE
44.80% 55.20% FEMALE

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

29 dyspepsia & 29 nondyspepsia.
 RESULT AND DISCUSSION

Anti-HP IgG in dyspepsia

+ Ind. :20-86%
-
Soewignyo 52,3%,
41.40%
59.60% Simadibrata 20%,
Achmad 58,6%, Wenas
18,25-25%, Kepel
25%, Soemohardjo
78,3%
RESULT AND DISCUSSION
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
 RESULT AND DISCUSSION

HP infection in dyspepsia & nondyspepsia

• Soewignyo : no significant difference

• Others study : dyspepsia > nondyspepsia.
• This study : no significant difference (p = 0,269)
 RESULT AND DISCUSSION
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)
 RESULT AND DISCUSSION
Gastritis

THIS 50
STUDY 66
NONDYSPEPSIA
86 DYSPEPSIA
DOLLEY

20
TYGAT 24

0 20 40 60 80 100
 RESULT AND DISCUSSION
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

 RESULT AND DISCUSSION

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

Carcinoma
HP  carcinogenes
This study: carcinoma (-).
 CONCLUSION & SUGGESTION
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 .
 CONCLUSION & SUGGESTION
Suggestion
1. Anti-HP IgG :
- Basis of HP infection diagnosis
- Predictor of gastroduodenal abnormalities
2. Anti-HP IgG (+)
 consider eradication of HP