title: Dyspepsia, Helicobacter pylori, and peptic ulcer in a randomly selected population in India.
abstract: There seems to be a worldwide geographic variation in the prevalence of peptic ulcer disease, although there are few reliable population based studies. This study aimed to determine the prevalence of peptic ulcer disease in a community in southern India and to evaluate the relationship between dyspeptic symptoms, Helicobacter pylori infection, gastritis, and peptic ulcer disease. A sample population was selected randomly from a rural monastic settlement in southern India. Subjects were interviewed using a standardised symptom and demography questionnaire then underwent upper endoscopy and antral biopsy for histology and CLO rapid urease test. Altogether 197 subjects from a population of 1499 (13.1%) were studied. All were male monks and ethnically Tibetan. The median age was 28 years (range: 21-81). None smoked or took NSAIDs. The six month period prevalence of dyspeptic symptoms was 68.5%. Current symptoms were present in 58.9% of subjects. Dyspepsia was more common in subjects aged 40 years or younger (p < 0.0001). H pylori was detected in 77.2% subjects. There was no association between dyspepsia and the presence of H pylori or histological gastritis, although there was a strong correlation between symptoms and ulcer (p < 0.003). The point prevalence of active peptic ulcer was 6.6% (13/197). All ulcers detected were either prepyloric or pyloroduodenal in location. A further 6.6% of subjects had definite evidence of scarring or deformity indicative of ulceration in the past. Subjects with past or present ulcers comprised 17.8% of dyspeptic subjects. H pylori was present in all subjects with active ulcers and in 12/13 of those with scarring. Dyspepsia, H pylori infection, gastritis, and peptic ulcer are all more common in this population than in those from developed countries. Ulcer disease, however, accounts for only a small proportion of subjects with symptoms and neither H pylori infection nor gastritis are significantly associated with the presence of dyspepsia.
authors.affiliation: Department of Gastroenterology, St Bartholomew's Hospital, London.
authors.forename: P H
authors.initials: PH
authors.lastname: Katelaris
authors.forename: G H
authors.initials: GH
authors.lastname: Tippett
authors.forename: P
authors.initials: P
authors.lastname: Norbu
authors.forename: D G
authors.initials: DG
authors.lastname: Lowe
authors.forename: R
authors.initials: R
authors.lastname: Brennan
authors.forename: M J
authors.initials: MJ
authors.lastname: Farthing
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000208:ethnology; D004415:Dyspepsia / Q000208:ethnology* / Q000382:microbiology; D005260:Female; D005756:Gastritis / Q000208:ethnology / Q000382:microbiology; D016481:Helicobacter Infections / Q000208:ethnology* / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000208:ethnology* / Q000382:microbiology; D015995:Prevalence