engleski

Time trends in the incidence of endoscopic findings and prevalence 0f H. pylori infection in Croatia ; results of 15-year comparison study

INTRODUCTION: The etiology of peptic disease is slowly changing over the last few decades, as the rate of H.pylori infection has declined and prescriptions for PPI and NSAIDs have increased. AIMS & METHODS: The purpose of this study was to evaluate time trends in the incidence of various findings in patients undergoing first endoscopy (EGD) for dyspepsia, naive to any H.pylori treatment, by comparing two time periods of five years: 1994-1998 (period-A) and 2006- 2010 (period-B). A retrospective study was performed among all dyspeptic out-patients afferent to the Endoscopic Laboratory Univ. Hosp. Merkur, Zagreb, Croatia, in two time period. From 18147 of all patients in Period-A, 1647 patients were untreated and examined for the first time. The same number in Period-B was 1224 from 18529 patients. For the evaluation of H. pylori infection, 1-2 biopsy specimens were obtained from the antrum and corpus. Data were analyzed by chi square test. A value of p < 0.05 was considered significant. RESULTS: The proportion of naive patients in Period-A was 9.1%, and in Period-B significantly lower - 6.6% (-25.7% p < 0.0001). Number of both ulcers/scars were significantly lower in Period-B too ; ventricular for 40.8% (414 to 245), and duodenal for 50.8% (752 to 370) (p < 0.0001). Although, the number of stomach cancers was 16.4% lower (116 to 97), difference was not significant, as well as for MALT lymphoma (8 to 10). Clear increase of 65.1% was seen in number of normal gastroduodenal findings (in patients mostly with GERD symptoms), (278 to 459, p < 0.0001). In all category, except for Ca and MALT, incidence of H. pylori infection has declined significantly ; altogether from 76.9% in Period-A to 38.2% in Period-B (p < 0.0001). CONCLUSION: Both, the incidence of peptic ulcers and H.pylori infection, among patients undergoing EGD for dyspepsia, naive to anti-H.pylori treatment, has decreased markedly in the 15-year follow-up in Croatia. Improved early recognition and treatment of H.pylori infection and earlier proton pump inhibitor use, may contribute to this decline. The decline in the incidences of these conditions may lead to a decline in the prevalence of gastric cancer in the future. As we expected from West World experiance, the incidence of GERD showed clear increase.

Endoscopic finding; H. pylori; time trends

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