Variazione della prevalenza dell'infezione da H. pylori e ulcera peptica in pazienti dispeptici sardi

Background: Over the past 50 years the prevalenceHelicobacter pyloriinfection has fallen as standards of living improved. The changes in the prevalence of infection and it manifestations (peptic ulcer disease and intestinal metaplasia) in a large cohort of Sardinians undergoing upper endoscopy for dyspepsia were investigated.Aim: To analyze the prevalence trend ofH. pyloriinfection and peptic ulcer disease in patients that underwent upper endoscopy for dyspeptic symptoms during the period when the prevalence ofH. pyloriwas rapidly falling.Methods: : A retrospective observational study was conducted involving patients undergoing endoscopy for dyspepsia from 1995 up to 2013.H. pyloristatus was assessed by histology, rapid urease test, and/or 13C-UBT. Gastric atrophy was assessed histologically. Data including non steroidal anti-inflammatory drugs (NSAIDs) use and the presence of peptic ulcers were collected. The prevalence ofH. pyloriwas calculated for each quartile and for each birth cohort from 1910 to 2000. Results: 11,202 records were retrieved for the analysis (62.8% women). The overall prevalence ofH. pyloriinfection was 43.8% (M: 46.6% vs. F: 42.0%; P = .0001). A dramatic decrease in prevalence infection occurred over the 19 year observation period. The birth cohort effect was evident in each category (quartile) reflecting the continuous decline inH. pyloriacquisition. Over time the prevalence of ulcers also declined resulting in an increase in the proportion ofH. pylorinegative/NSAID positive andH. pylorinegative/NSAID negative ulcers. The prevalence of atrophic changes also declined despite aging.Conclusions: The decline inH. pyloriprevalence over time likely reflects the improvement in socioeconomic conditions in Sardinia such thatH. pyloriinfection and its clinical outcomes including peptic ulcer is becoming less frequent even among dyspeptic patients.