Pattern of gastritis and Helicobacter pylori colonization of the stomach in Nigerian patients with dyspepsia

Objective: Helicobacter pylori infection of the stomach causes chronic active gastritis. The pattern of gastritis is related to the disease outcome. This study aimed to determine the predominant gastritis pattern in Nigerian dyspeptic patients with a view to predicting gastroduodenal disease outcomes. Methods: Patients referred for upper gastrointestinal endoscopy (UGIE) at a tertiary hospital in Nigeria had gastric mucosal biopsies taken and subjected to histopathology using the updated Sydney System. H. pylori infection, activity, chronicity and atrophy were categorized into absent (scored 0), mild (scored 1), moderate (scored 2) and severe (scored 3). Results: In all, 726 patients (339 males, 387 females) were studied. There were 705 antral biopsies and 409 corporeal biopsies. H. pylori was positive in 487 (69%) and 217 (53%) antral and corporeal biopsies respectively (P < 0.001). Intestinal metaplasia (IM) and/or dysplasia was H. pylori positive in 131 (64%) of antral biopsies and in 17 (38.6%) of corporeal biopsies (P < 0.0001). In the antrum, the total inflammatory score was 3,814 (maximum = 6,336) and in the corpus, the total score was 1,703 (maximum = 3,681) (P < 0.0001). There were 61 (8.6%) benign antral gastric ulcers and 19 (2.7%) gastric cancers of which 13 of them (68.4%) were antral lesions. Conclusions: Gastritis, H. pylori colonization and gastric ulceration are antrum predominant in Nigerian patients. In spite of a sharp rise in intestinal metaplasia and dysplasia after age 40 and high prevalence of H. pylori infection, gastric cancer prevalence appears relatively low. Keywords: Dyspepsia, Antrum-predominant, Corpus-predominant gastritis, Helicobacter pylori , Atrophy, Intestinal metaplasia, Cancer