[Dyspepsia and Helicobacter pylori infection in employees of a large industry. Results of a prospective BASF Helicobacter pylori prevention campaign].
BACKGROUND
The role of Helicobacter pylori (H. pylori) infection in dyspepsia is controversial. In the course of a health initiative within a large industrial corporation, we investigated the prevalence of both dyspepsia and positive H. pylori serology and the outcome of eradication therapy in symptomatic H. pylori positive employees.


METHODS
H. pylori serology (IgG ELISA) was determined in 6,143 employees of BASF AG Ludwigshafen/Germany who were also asked to complete a standardized health history administered by a physician. Peptic ulcer disease (PUD) and dyspepsia subgroups were defined based on past medical history and symptom profiles using the criteria of Heading. Upper GI endoscopy, abdominal ultrasound and eradication therapy (Italian Triple Therapy) was recommended for symptomatic H. pylori positive individuals. The prognostic value of antibodies against CagA and VacA was evaluated in 37 and 39 employees with PUD and non-ulcer dyspepsia (NUD) confirmed by endoscopy, respectively.


RESULTS
Of 6,143 employees, 1,255 (20.4%) were classified as dyspeptic, 492 (39.2%) of whom were H. pylori positive. The seroprevalence of H. pylori in asymptomatic employees was 35.8%. There were no significant differences in H. pylori seroprevalence among dyspepsia subgroups (reflux only, dysmotility only, reflux/dysmotility, ulcer-like and non-specific). However, individuals reporting severe dyspeptic symptoms were significantly more likely to be H. pylori positive (OR 2.09, CI 1.43-3.05). The seroprevalence of CagA and VacA was not significantly different among employees with NUD compared to referents or among employees with NUD compared to those with PUD. 330 (72%) of 458 employees with dyspepsia received eradication therapy, 128 persons refused therapy. Based on a 12-month follow-up of 402 individuals (300 of whom had received therapy), eradication success was 81.5% as judged by serology. Of the successfully treated employees, 33.2% reported a total absence and 42.8% reported a decrease in symptoms. Among the employees who refused therapy, the corresponding percentages were 37.3% and 16.7%, respectively. An increase in reflux complaints was not observed among treated employees.


CONCLUSIONS
In a large active employee population, at most a very weak association was observed between the prevalence of H. pylori seropositivity and dyspepsia. Frequent and severe dyspeptic symptoms were associated with an increased rate of H. pylori seropositivity. The analysis of the virulence factors is not particularly helpful in discriminating PUD or NUD. Eradication of H. pylori infection leads to a decrease in dyspeptic symptoms after 12 months, but not more often to their complete absence compared to untreated individuals.
Schilling
Dieter
D
Medizinische Klinik C Klinikum der Stadt Ludwigshafen. D-Schilling@t-online.de
Messerer
Peter
P
Ott
M Gerald
MG
Schauwecker
Peter
P
Zober
Andreas
A
Riemann
Jürgen F
JF
D000293:Adolescent; D000328:Adult; D017291:Clarithromycin / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005756:Gastritis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D005858:Germany; D016481:Helicobacter Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008403:Mass Screening; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D009853:Omeprazole / Q000008:administration & dosage; D011446:Prospective Studies; D016896:Treatment Outcome
D008795:Metronidazole; D017291:Clarithromycin; D009853:Omeprazole