title: Clinicopathological assessment of gastric biopsy samples of patients with Helicobacter pylori infection--metronidazole resistance and compliance problems in the United Arab Emirates.
abstract: The significance of Helicobacter pylori (HP) infection was assessed prospectively in forty-two patients with dyspepsia using histological, bacteriological and biopsy urease techniques. Thirty-eight patients (90.5%) were positive for HP infection and were treated with bismuth subcitrate (De Nol), tinidazole and doxycycline. HP was present in the antrum, corpus, fundus, duodenum and gastric juice in 36, 26, 23, 2 and 2 patients respectively (p < 0.01, X2 test). Histological assessment yielded more positive identifications of HP than the urease test (36 vs 28 positive cases, p < 0.01, McNemar's X2 test), while histology and bacteriology were virtually identical (38 vs 37 of 41 pairs, p > 0.5, X2 test). There was a good correlation between bacterial and polymorphonuclear leucocyte (PMNL) counts per high power field (r = 0.8; p < 0.001; n = 34 pairs). There was resistance to metronidazole in 10 out of 16 isolates, but no resistance was recorded against tetracycline (p < 0.001, X2 test). Among the sixteen patients who attended follow-up endoscopy, there was clinical improvement and no evidence of HP in 5 individuals (31.25%). One patient had amelioration of his symptoms, 5 experienced no change and in 5 their symptoms became worse. Metronidazole resistance may be one of the important factors in the United Arab Emirates and elsewhere.
authors.affiliation: Department of Internal Medicine, UAE University, Al Ain.
authors.forename: E O
authors.initials: EO
authors.lastname: Adeyemi
authors.forename: H
authors.initials: H
authors.lastname: Fadlalla
authors.forename: M
authors.initials: M
authors.lastname: al-Homsi
authors.forename: N A
authors.initials: NA
authors.lastname: Nnalue
authors.forename: S
authors.initials: S
authors.lastname: Goodwin
authors.forename: D
authors.initials: D
authors.lastname: Boehme
authors.forename: A J
authors.initials: AJ
authors.lastname: Sim
mesh_terms: D000293:Adolescent; D000328:Adult; D000863:Antacids / Q000627:therapeutic use; D001431:Bacteriological Techniques; D001729:Bismuth / Q000627:therapeutic use; D004318:Doxycycline / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D004415:Dyspepsia / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005756:Gastritis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000473:pathology*; D016480:Helicobacter pylori / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use; D010349:Patient Compliance; D015995:Prevalence; D011446:Prospective Studies; D013270:Stomach / Q000382:microbiology* / Q000473:pathology*; D014011:Tinidazole / Q000627:therapeutic use; D014479:United Arab Emirates
chemical_list: D000863:Antacids; D009942:Organometallic Compounds; D014011:Tinidazole; D008795:Metronidazole; C002791:bismuth tripotassium dicitrate; D004318:Doxycycline; D001729:Bismuth