Summary auto-generated
This study investigated Helicobacter pylori infection prevalence and antimicrobial resistance patterns in elderly Bulgarian patients with gastroduodenal diseases. Between 1996 and 2003, 127 elderly patients (60-89 years) with various gastric conditions were evaluated using endoscopy and gastric biopsies. H. pylori was identified using culture, Gram staining, urease, oxidase, and catalase tests. Antimicrobial susceptibility of 92 H. pylori isolates was tested using the screening agar method and E-test for multiple drugs including metronidazole, clarithromycin, amoxicillin, and others. The study found H. pylori infection in 81.1% of elderly patients overall, with the highest prevalence (100%) in those with duodenal ulcers. Resistance rates to most antimicrobial agents were similar between elderly and younger adults (19-59 years). Notably, metronidazole-resistant strains from elderly patients showed lower resistance levels compared to younger adults. The findings emphasize that H. pylori infection is common in elderly patients with dyspeptic complaints and that microbiological testing and antimicrobial susceptibility assessment are essential in this understudied population.
Key findings
- H. pylori infection was detected in 81.1% of elderly Bulgarian patients with gastroduodenal diseases, with 100% prevalence in duodenal ulcer cases
- Primary antimicrobial resistance rates in elderly patients were similar to those in younger adults for most drugs tested, including metronidazole, clarithromycin, and tetracycline
- Metronidazole-resistant strains from elderly patients had significantly lower resistance levels (MIC >32 μg/ml in 52.6%) compared to younger adults (78.7%)
- No amoxicillin resistance was detected in elderly patients, versus 1% in younger adults
- The study demonstrates that microbiological testing for H. pylori in elderly patients with dyspeptic symptoms is necessary and beneficial
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Abstract
Helicobacter pylori infection causes chronic gastritis that can trigger peptic ulcer disease and gastric malignancy (Marshall, 1994). The serious complications of peptic ulcers (bleeding or perforation) affect many elderly patients worldwide (Pilotto, 2001). Successful eradication of the infection results in ulcer healing (Adamek et al., 1998) and may prevent the progression of intestinal metaplasia in elderly patients (Pilotto & Malfertheiner, 2002); however, clinical interest in H. pylori infection in elderly people remains low (Pilotto & Salles, 2002). Furthermore, gastroduodenal diseases are associated with other diseases in many old patients. The aim of this study was to evaluate the prevalence of H. pylori infection and primary H. pylori resistance to antimicrobial agents in elderly Bulgarian patients with gastroduodenal diseases.
A total of 127 consecutive elderly patients (6089 years) with gastroduodenal diseases between January 1996 and July 2003 were evaluated. All were admitted because of abdominal complaints, mostly consisting of epigastric pain and dyspepsia. No patient had been treated previously for H. pylori infection. The classification of diseases as chronic gastritis, erosive gastritis, duodenal ulcer, stomach ulcer and stomach cancer was based on endoscopic findings, histology and clinical signs (Table 1). Endoscopy was performed with an Olympus GIF P20 (biopsy forceps K19). Two stomach biopsy specimens per patient were taken at 35 cm from the pylorus. Specimens were transported in Stuart's transport medium (Merck) for less than 5 h. Susceptibility to antimicrobial agents of 92 H. pylori isolates was investigated.