Journal of Gastroenterology and Hepatology zyxwvutsr (1992) zyxwvut 1, 355-359 zyxwvuts ALIMENTARY TRACT AND PANCREAS zyx Fluoride as a possible aetiological factor in non-ulcer dyspepsia I. P. GUPTA,* T. K. DAS,+ A. K. SUSHEELA,+ S. DASARATHY* AND R. K. TANDON" Departments of *Gastroenterology and +Anatomy, All India Institute of Medical Sciences, New Delhi, India Abstract A prospective case controlled study was conducted to evaluate the role of fluoride as a possible aetiological factor for non-ulcer dyspepsia (NUD). Twenty patients with NUD and 10 age and sex matched healthy controls were subjected to clinical evaluation, upper gastrointestinal endoscopy and biopsies from the gastric antrum and duodenum. The antral and duodenal mucosa was subjected to a rapid urease test for Helicobacter pylori and histological and electron microscopic examinations. Fluoride levels in the drinking water, serum and urine were estimated using a ION 85 ionanalyser. These levels were significantly higher in patients with NUD than in controls (P zyxwvut < 0.05). Histological abnormalities in the antral and duodenal mucosa were seen in 14 patients (70%) with NUD and 1 control subject (10%) (P < zy 0.05). Electron microscopic abnormalities in the mucosal cells were seen in all patients with NUD but in none of the controls (P < 0.01). The fluoride levels in serum and urine correlated with the symptoms, histological and electron microscopic abnormalities (P c 0.05). It was concluded that chronic exposure to fluoride may result in NUD and should be considered in patients where other known causes of dyspepsia have been excluded. Key words: fluoride, gastritis, non-ulcer dyspepsia. INTRODUCTION Non-ulcer dyspepsia (NUD) is common in any popu- lati~n.'-~ The causes of dyspeptic symptoms are diverse and include biliary stones,* Helicobacter pylori,6 and gastric dysmotility.' Recent recognition of the harmful effect of chronic fluoride toxicity on the gastroduodenal mucosa has caused interest in its aetiological relationship to dyspeptic symptom^.^'^ T h e present study was under- taken to evaluate the role of fluoride in the pathogenesis of non-ulcer dyspepsia. METHODS Twenty consecutive patients with dyspepsia who attended the gastroenterology clinic of a tertiary care centre between June 1988 and June 1989 were included in the study after informed consent was obtained. Patients with documented peptic ulcer, gallstones, hiatus hernia or a previous history of abdominal surgery were excluded from the study. Ten age and sex matched healthy volunteers were taken as controls during the same period. A dietary history was obtained from each subject for the ingestion of food items with a high fluoride content (drinking water, nut of Areca catechu, tobacco etc.)' ',12 All subjects were evaluated clinically. Hepatic and renal function tests and stool examination were per- formed for evidence of parasitic infection. Samples of drinking water were obtained from the patients and the controls for estimation of the ionic fluoride content.13 Blood serum and 24 h urine were collected for estimation of ionic fluoride ~ 0 n t e n t . l ~ All these values were ex- pressed as parts per million (p.p.m.). Radiological evalu- ation was performed for fractures, bone density and calcification of ligaments as evidence of fluor~sis.'~ The skiagrams were evaluated by a radiologist blinded to the clinical symptoms and the group to which the subject belonged. Gallstones were excluded by real time ultrasound using a Toshiba SAL with a 3.5 MHz linear array transducer. Upper gastrointestinal endoscopy was performed using an Olympus GIF-Q10 fibre-optic endoscope. The mucosal findings on endoscopy were classified as erythema, erosions or petechiae.I6 Antral and duodenal biopsies were obtained using punch biopsy forceps. Four biopsies were obtained from the antrum, 5 cm away from the pyloric ring. The biopsies were from the lesser curvature side, greater curvature side, anterior wall and posterior wall. Biopsies were also taken from the first part of the duodenum, one each from the anterior, posterior, superior and inferior walls. Jejunal aspirates were col- lected in each subject for the presence of Giurdia lamblia. A rapid urease test was performed on the antral biopsy for evidence of Helicobacter pylori. ' Histological exami- Correspondence: Dr Rakesh K. Tandon, Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi Accepted for publication 31 March 1992. 110029, India