Date of Award

10-19-2009

Document Type

Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Michele Barry, MD

Second Advisor

Asghar Rastegar

Abstract

Helicobacter pylori infection causes chronic type B gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tumor. Infection with H. pylori is common in parts of the developing world. The Clínica Misional Nuestra Señora de Guadalupe serves indigenous people of the Ecuadorian Amazon. At the clinic, gastritis is a common diagnosis that is based solely on reported symptoms and is presumed to be due to H. pylori infection. Additionally, gastric cancer, a corollary of H. pylori infection, is the leading cause of cancer deaths in Ecuador and, thus, an important public health concern. To the best of our knowledge, the prevalence of H. pylori infection among the inhabitants of rural Ecuador has never been assessed. The primary aim of this study was to determine the seroprevalence of H. pylori in this population. We compared rates of seropositivity among patients with and without symptoms suggestive of gastritis and among patients who reported untreated and exclusively treated water consumption. Additionally, a sampling of children was tested to begin to assess the age of serological conversion. Using the Quidel QuickVue H. pylori gII test, we found near universal seropositivity among adults aged 18 to 65 years (117/120 = 98%) and among children aged 2 to 18 years (13/14 = 93%). Given the high prevalence of H. pylori and its complications in rural Ecuador, this population may benefit from intervention to eradicate the bacterium. However, there is a lack of evidence to inform management decisions. There is a need for studies with large numbers of patients and long-term follow-up to assess the costs and benefits of population-based treatment.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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