Correlation of endoscopic findings, histopathological features and Helicobacter pylori infection in adult dyspeptic patients from the cold desert tribal region of Spiti Valley, Himachal Pradesh.

Abstract

Introduction: Globally, 20% of the populations have dyspeptic symptoms with an extensive differential diagnosis. Endoscopy is a gold standard investigation for finding the etiology of dyspepsia but can miss mucosal lesions in 15% to 30% of cases. The study aims to determine the endoscopic findings, histopathological features and H. pylori infection in adult dyspeptic patients from the tribal area of Himachal Pradesh (H.P.), India.

Methods: This cross-sectional observational study retrospectively analyzed the data collected during a health camp in the remote Spiti Valley of H.P. Patients aged 18 years and above were included and data of 106 dyspepsia patients who underwent endoscopic examination was analyzed. Endoscopic gastric biopsies taken in each patient were subjected to rapid urease testing (RUT) and histopathological examination. Data analyzed included basic socio-demographic features, endoscopic and histopathological features.

Results: Total 106 patients of dyspepsia were included with a mean age of 46.9 ± 13.4 years and a male to female ratio of 1.4:1. The most common endoscopic abnormality was erosive gastritis followed by peptic ulcer disease. The most common histopathological finding was chronic active gastritis with H. pylori (83.0%). Gastric intestinal metaplasia (GIM) was seen in 48.1%. While endoscopy demonstrated high sensitivity (76.5%), specificity (75.0%) and positive predictive value (PPV, 98.7%) for identifying histopathological abnormalities in gastric biopsy, its negative predictive value (NPV, 11.1%) remained low. The correlation between RUT and histopathological examination for H. pylori was statistically significant.

Conclusion: Erosive gastritis and peptic ulcer disease are prevalent endoscopic findings among adult dyspeptic patients from the tribal region of Spiti Valley in Himachal Pradesh. Histopathologically, H. pylori-related chronic active gastritis and gastric intestinal metaplasia are commonly observed abnormalities. Although endoscopy exhibits high sensitivity, specificity and PPV for detecting histopathological changes in gastric biopsies, its NPV is notably low.

Clinical trial registry number: NA.