Brief Article
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World J Gastroenterol. Oct 14, 2012; 18(38): 5404-5411
Published online Oct 14, 2012. doi: 10.3748/wjg.v18.i38.5404
Different risk factors influence peptic ulcer disease development in a Brazilian population
Rodrigo Buzinaro Suzuki, Rodrigo Faria Cola, Larissa Tranquilino Bardela Cola, Camila Garcia Ferrari, Fred Ellinger, Altino Luiz Therezo, Luis Carlos Silva, André Eterovic, Márcia Aparecida Sperança
Rodrigo Buzinaro Suzuki, Rodrigo Faria Cola, Larissa Tranquilino Bardela Cola, Department of Genotyping, Hemocenter, Marilia Medical School, Marilia 17519-030, São Paulo, Brazil
Rodrigo Buzinaro Suzuki, André Eterovic, Márcia Aparecida Sperança, Center for Natural and Human Sciences, Universidade Federal do ABC, Santo André 09210-170, São Paulo, Brazil
Camila Garcia Ferrari, Department of Molecular Biology, Marilia Medical School, Marilia 17519-030, São Paulo, Brazil
Fred Ellinger, Altino Luiz Therezo, Luis Carlos da Silva, Department of Pathology, Marilia Medical School, Marilia 17519-030, São Paulo, Brazil
Author contributions: Suzuki RB contributed to the collection and processing of biopsy samples, epidemiological and molecular comparative analyses; Cola RF and Cola LTB contributed with analytic tools and molecular analysis; Ferrari CG contributed with molecular analysis; Ellinger F, Therezo AL and Silva LC contributed equally to the histopathological analysis; Eterovic A contributed with statistical analysis; and Sperança MA designed the research, wrote the paper and contributed to all comparative analyses.
Supported by Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP), Research Grant 06/01223-0; Fellowship CGF 2001/14509-5
Correspondence to: Márcia Aparecida Sperança, PhD, Center for Natural and Human Sciences, Universidade Federal do ABC, Rua Santa Adélia, 166 Bloco A, Torre 3, 6º andar Sala 625, Bairro Bangu 09210-170, Santo André, São Paulo, Brazil. marcia.speranca@ufabc.edu.br
Telephone: +55-11-49968373 Fax: +55-11-49960090
Received: January 6, 2012
Revised: April 12, 2012
Accepted: April 20, 2012
Published online: October 14, 2012
Abstract

AIM: To investigate age, sex, histopathology and Helicobacter pylori (H. pylori) status, as risk factors for gastroduodenal disease outcome in Brazilian dyspeptic patients.

METHODS: From all 1466 consecutive dyspeptic patients submitted to upper gastroscopy at Hospital das Clinicas of Marilia, antral biopsy specimens were obtained and subjected to histopathology and H. pylori diagnosis. All patients presenting chronic gastritis (CG) and peptic ulcer (PU) disease localized in the stomach, gastric ulcer (GU) and/or duodenal ulcer (DU) were included in the study. Gastric biopsies (n = 668) positive for H. pylori by rapid urease test were investigated for vacuolating cytotoxin A (vacA) medium (m) region mosaicism by polymerase chain reaction. Logistic regression analysis was performed to verify the association of age, sex, histopathologic alterations, H. pylori diagnosis and vacA m region mosaicism with the incidence of DU, GU and CG in patients.

RESULTS: Of 1466 patients submitted to endoscopy, 1060 (72.3%) presented CG [male/female = 506/554; mean age (year) ± SD = 51.2 ± 17.81], 88 (6.0%) presented DU [male/female = 54/34; mean age (year) ± SD = 51.4 ± 17.14], and 75 (5.1%) presented GU [male/female = 54/21; mean age (year) ± SD = 51.3 ± 17.12] and were included in the comparative analysis. Sex and age showed no detectable effect on CG incidence (overall χ2 = 2.1, P = 0.3423). Sex [Odds ratios (OR) = 1.8631, P = 0.0058] but not age (OR = 0.9929, P = 0.2699) was associated with DU and both parameters had a highly significant effect on GU (overall χ2 = 30.5, P < 0.0001). The histopathological results showed a significant contribution of ageing for both atrophy (OR = 1.0297, P < 0.0001) and intestinal metaplasia (OR = 1.0520, P < 0.0001). Presence of H. pylori was significantly associated with decreasing age (OR = 0.9827, P < 0.0001) and with the incidence of DU (OR = 3.6077, P < 0.0001). The prevalence of m1 in DU was statistically significant (OR = 2.3563, P = 0.0018) but not in CG (OR = 2.678, P = 0.0863) and GU (OR = 1.520, P= 0.2863).

CONCLUSION: In our population, male gender was a risk factor for PU; ageing for GU, atrophy and metaplasia; and H. pylori of vacA m1 genotype for DU.

Keywords: Helicobacter pylori; Gastric ulcer disease; Duodenal ulcer disease; Gastric atrophy; Helicobacter pylori vacuolating cytotoxin A medium region mosaicism