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Borka Balas R, Meliț LE, Mărginean CO. Worldwide Prevalence and Risk Factors of Helicobacter pylori Infection in Children. CHILDREN 2022; 9:children9091359. [PMID: 36138669 PMCID: PMC9498111 DOI: 10.3390/children9091359] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/22/2022] [Accepted: 09/03/2022] [Indexed: 01/17/2023]
Abstract
Helicobacter pylori is usually acquired during childhood. The reports from the last two decades pointed out a decrease in H. pylori prevalence across geographical areas worldwide compared to previously reported data. Most of the studies performed in America found an overall H. pylori infection prevalence of approximately 50%. The most important risk factors in America include being male, poor adherence or difficult access to treatment, and the lack of in-home water service. Despite the descending trend in prevalence worldwide, the overall prevalence in Africa remains very high (70%). Nevertheless, the prevalence of H. pylori in children without gastrointestinal who underwent screening was reported to be only 14.2%. The main risk factors in Africa are having a traditional pit or no toilet, poverty, birth order, source of drinking water, or being a farmer. Asia seems to have the widest variations in terms of H. pylori prevalence. Several risk factors were reported in Asia to be associated with this infection, such as lower income and educational level, house crowding, rural residence, ethnicity, the use of tanks as water supplies, alcohol drinking, active smoking, eating spicy food or raw uncooked vegetables, poor living conditions and sanitation. The overall prevalence of H. pylori infection in European children is almost 25%. Portugal has the highest prevalence of all European countries at 66.2% in children 13 years of age. The risk factors in European individuals consist of living in rural areas, eating unwashed fruits and vegetables, not washing hands after school, low parental education and unemployment, and short education duration. Further studies are required to identify the precise mechanisms involved in the discrepancies of H. pylori prevalence worldwide.
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Comprehensive Studies of Different Cancer Diseases among Less-Developed Countries. Healthcare (Basel) 2022; 10:healthcare10030424. [PMID: 35326902 PMCID: PMC8949682 DOI: 10.3390/healthcare10030424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 02/06/2023] Open
Abstract
Recently, the rate of cancer deaths in less-developed countries such as Bangladesh has significantly increased day by day, making it a major health issue. The most predominant types of cancers among the populations of less-developed countries (especially Bangladesh) are lung, throat, colon, gastric, ovarian, breast, and skin cancers. The mortality rate is increasing for both males and females. The main common factors are smoking, use of tobacco leaves, bacterial or viral infection, hereditary disorders, food adulterations, and environmental factors, which are highly responsible for the development of carcinoma in the young to adult population in this region. Raising consciousness among people regarding early diagnosis, decreasing the use of chemicals such as formalin for food preservation, and reducing environmental pollution such as arsenic as well as air pollution might help to reduce the number of deaths. Education and public campaigns can also reduce the intensity of cancer occurrence. Breast, esophagus, and cervical cancer are common diseases in less-developed countries such as Bangladesh.
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Rahman MM, Ghoshal UC, Kibria MG, Sultana N, Yusuf MA, Nahar S, Ahmed F, Rowshon AHM, Hasan M. Functional Dyspepsia, Peptic Ulcer, and Helicobacter pylori Infection in a Rural Community of South Asia: An Endoscopy-Assisted Household Survey. Clin Transl Gastroenterol 2021; 12:e00334. [PMID: 33878048 PMCID: PMC8052092 DOI: 10.14309/ctg.0000000000000334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/17/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Functional dyspepsia (FD), although commoner than organic dyspepsia (OD) in-hospital studies, community data, particularly from rural areas, are lacking. We performed a rural community study in Bangladesh with the primary aims to evaluate (i) the prevalence of uninvestigated dyspepsia (UD), FD, and OD and (ii) the risk factors for UD. METHODS This house-to-house survey was performed using a translated-validated enhanced Asian Rome III questionnaire and endoscopy with Helicobacter pylori tests, including genotyping. RESULTS Of 3,351/3,559 responders ([94.15%], age 40.41 ± 16.05 years, female 1924 [57.4%]), 547 (16.3%) had UD (female 346 [18%] vs male 201 [14%]; P = 0.002); 201 (6%), 88 (2.6%), and 258 (7.7%) had postprandial distress (PDS), epigastric pain syndromes (EPS) and PDS-EPS overlap, respectively. On multivariate analysis, age >50 years (adjusted odds ratio [AOR] 1.34 [1.07-1.68]), female sex (AOR 1.42 [1.17-1.74]), being married (AOR 1.57 [1.21-2.07]), lower family income (AOR 1.79 [1.43-2.26]), nonsteroidal anti-inflammatory drug use (AOR 7.05 [2.11-23.55]), previous acute gastroenteritis (AOR 5.42 [1.83-16]), and psychological distress (AOR 5.02 [2.87-8.76]) were risk factors for UD. Of 346/547 (63.25%) undergoing endoscopy, 232 (67.05%) and 114 (32.95%) had FD and OD (peptic ulcers [PU] 99 [28.61%] and erosive esophagitis 13 [3.76%]). About 53% of FD subjects had EPS-PDS overlap, 32% had PDS, and only 15% had EPS. H. pylori was detected in 266/342 (78%) dyspeptics (FD 173/230 [75.2%], vs OD 92/114 [82.1%], P = 0.169). DISCUSSION Sixteen percent, 11% and 5% of rural Bangladeshi Asian adults had UD, FD, and PU, respectively. One-third of UD subjects had OD, mostly PU.JOURNAL/cltg/04.03/01720094-202104000-00016/inline-graphic1/v/2021-04-15T161418Z/r/image-tiff.
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Affiliation(s)
- M. Masudur Rahman
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - Uday C. Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Md. Golam Kibria
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - Nigar Sultana
- Department of Gastroenterology, Delta Medical College and Hospital, Dhaka, Bangladesh
| | - M. Abdllah Yusuf
- Department of Microbiology, National Institute of Neuroscience and Hospital, Dhaka, Bangladesh
| | - Shamsun Nahar
- Laboratory Science and Service Division, icddr,b, Dhaka, Bangladesh
| | - Faruque Ahmed
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - AHM Rowshon
- Department of Gastroenterology, Shaheed Suhrawardy Medical College, Dhaka, Bangladesh
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Rahman MM, Kibria MG, Sultana N, Akhter M, Begum H, Haque MA, Haque R, Sarker SA, Ahmed F, Hasan M. Seroprevalence of Helicobacter pylori and its association with metabolic syndrome in a rural community of Bangladesh. JGH Open 2021; 5:64-72. [PMID: 33490615 PMCID: PMC7812465 DOI: 10.1002/jgh3.12448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND AIM As the interrelationship between Helicobacter pylori, metabolic syndrome (MetS), and non-alcoholic fatty liver disease (NAFLD) is controversial, we undertook a community-based study with the aim to find the seroprevalence of H. pylori and its relationship with MetS and NAFLD. METHODS This door-to-door survey was conducted among the adult subjects (≥18 years) of two villages (Charcharia of Dhaka district and Kharrah of Munshiganj district) of Bangladesh. Interviews using a structured questionnaire, clinical examination, anthropometric measurements, ultrasonogram of the liver, and biochemical tests were performed. RESULTS Of 1021 subjects, 781 responded (76.49%), and 767 were included in the final analysis (mean age 40.35 ± 15.56 years; female 63.5%). Anti-H. pylori antibodies were found in 418 of 767 (54.5%). There were no H. pylori serostatus association with MetS and diabetes mellitus (DM) in univariate or multivariate analysis (all P > 0.05). However, H. pylori seropositive subjects had lower systolic blood pressure (odds ratio [OR] = -2.95 [-5.58, -0.32]) and low density lipoprotein -cholesterol (OR -7.79 [-15, -0.57]) compared to seronegative subjects in the linear regression model. Seronegativity of H. pylori was associated with NALFD in univariate (P = 0.007) but not multivariate analysis (P = 0.086). There were no differences in the frequency of H. pylori seropositivity among the participants with nonobese compared to obese NAFLD (19/42 [45%] vs 43/99 [43.4%], P = 0.844). CONCLUSION In a rural community of Bangladesh, about 55% of the population were H. pylori seropositive, which was more common among the underweight than normal or obese subjects. However, there was no relationship observed between H. pylori seroprevalence and MetS, DM, or NAFLD.
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Affiliation(s)
- M. Masudur Rahman
- Department of GastroenterologySheikh Russel National Gastroliver Institute and HospitalDhakaBangladesh
| | - Md. Golam Kibria
- Department of GastroenterologySheikh Russel National Gastroliver Institute and HospitalDhakaBangladesh
| | - Nigar Sultana
- Department of GastroenterologyDelta Medical College and HospitalDhakaBangladesh
| | - Mahfuza Akhter
- Department of GastroenterologyMughda Medical College and HospitalDhakaBangladesh
| | - Hasina Begum
- Department of Radiology and ImagingSheikh Russel National Gastroliver Institute and HospitalDhakaBangladesh
| | - Md. Ahshanul Haque
- Nutrition and Clinical Service DivisionInternational Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Rashidul Haque
- Infectious Disease DivisionInternational Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Shafiqul Alam Sarker
- Nutrition and Clinical Service DivisionInternational Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Faruque Ahmed
- Department of GastroenterologySheikh Russel National Gastroliver Institute and HospitalDhakaBangladesh
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Hossain MS, Das S, Begum SMKN, Rahman MM, Mazumder RN, Gazi MA, Fahim SM, Mahfuz M, Haque R, Petri WA, Sarker SA, Ahmed T. Asymptomatic Duodenitis and Helicobacter pylori associated Dyspepsia in 2-Year-Old Chronic Malnourished Bangladeshi Slum-Dwelling Children: A Cross-Sectional Study. J Trop Pediatr 2020; 67:5939797. [PMID: 33099650 PMCID: PMC7948384 DOI: 10.1093/tropej/fmaa079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM There is insufficient knowledge on the * duodenal histology and Helicobacter pylori infection in malnourished Bangladeshi children. Therefore, we attempted to explore the prevalence of H. pylori infection and duodenal histopathology in 2-year-old chronic malnourished Bangladeshi slum-dwelling children and investigate their association with dyspeptic symptoms. METHODS This cross-sectional study was conducted using the data of the Bangladesh Environmental Enteric Dysfunction study in an urban slum of Dhaka, Bangladesh. With a view to address the association of environmental enteric dysfunction (EED) with stunting, upper gastrointestinal endoscopy was performed on 54 chronic malnourished children {31 stunted [length-for-age Z-scores (LAZ) <-2] and 23 at risk of stunting (LAZ <-1 to -2)} aged between 12-24 months and the mucosal biopsies were subjected to histopathological examination after obtaining proper clinical history. Stool antigen for H. pylori (HpSA) was assessed to determine H. pylori status. RESULTS In all, 83.3% (45/54) of the children had histopathological evidence of duodenitis. Chronic mild duodenitis was found to be the most prevalent form of duodenitis (53.7%) in the children. Only 8.9% (4/45) of the children with duodenitis had dyspepsia (p < 0.05). The 14.8% (8/54) of the children were found positive for H. pylori infection. Logistic regression analysis revealed children positive for HpSA had significant association with dyspepsia (OR 9.34; 95% CI 1.54-56.80). CONCLUSIONS The number of chronic malnourished children suffering from duodenitis was found to be very high. Majority of these children was asymptomatic. Children positive for HpSA had significant association with dyspeptic symptoms.
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Affiliation(s)
- Md Shabab Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh,Correspondence: Md. Shabab Hossain, Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), GPO Box 128, Dhaka 1212, Bangladesh. E-mail <>
| | - Subhasish Das
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | | | - M Masudur Rahman
- Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka 1000, Bangladesh
| | - Ramendra Nath Mazumder
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Md Amran Gazi
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Shah Mohammad Fahim
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Rashidul Haque
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - William A Petri
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22908, USA
| | - Shafiqul Alam Sarker
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
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Altamimi E, Alsharkhat N, AlJawarneh A, Abu Hamad MR, Assi AA, Alawneh S, Al-Ahmad M. Declining prevalence of Helicobacter pylori infection in Jordanian children, report from developing country. Heliyon 2020; 6:e04416. [PMID: 32715122 PMCID: PMC7378580 DOI: 10.1016/j.heliyon.2020.e04416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 04/20/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Helicobacter pylori (H. pylori) is a Gram-negative bacteria that is harbored in the stomach and linked to chronic gastritis, peptic ulcer disease, and gastric malignancy. Most Helicobacter infections are acquired during early infancy. This study aimed to establish the prevalence of H. pylori infection in Jordanian children using the 13C-urea breath test. MATERIALS AND METHODS We prospectively enrolled children between the ages of 4 and 17 years from April 2019 to July 2019. Enrolled children were patients with nongastrointestinal complaints at the pediatric clinics of two hospitals and at community centers caring for healthy children in Irbid, Jordan. Questionnaires obtaining data on sociodemographics, clinical symptomatology, and hygienic risk factors were completed. Recruited children underwent a urea breath test (UBT). RESULTS Of 340 children who were recruited, 328 (96.5%) were included in the final analysis. The mean age (±standard deviation) was 9.56 (±3.98) years (range, 4.0-17 years), and 168 (51.2%) were males. Only 48 children (14.6%) tested positive. There were no gender differences. Living in an urban area and a family history of previous H. pylori infection were risk factors for the acquisition of infection (P = 0.007 and 0.001, respectively). Although gastrointestinal symptoms were more common in H. pylori-infected children, only hiccups and constipation were statistically significant (P = 0.035 and 0.038, respectively). CONCLUSION H. pylori infects at least 15% of Jordanian children, suggesting a significant drop in infection rates in this group. Larger-scale studies combined with clinical evaluations will be important for further understanding the reasons for the observed decrease in H. pylori infections in Jordanian children.
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Affiliation(s)
- Eyad Altamimi
- Pediatric Department, Jordan University of Science and Technology, Irbid, Jordan
- Pediatric Department, King Abdullah University Hospital, Irbid, Jordan
| | | | | | | | - Anas Abu Assi
- King Hussein Cancer Foundation and Center, Amman, Jordan
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Fahim SM, Das S, Gazi MA, Alam MA, Hasan MM, Hossain MS, Mahfuz M, Rahman MM, Haque R, Sarker SA, Mazumder RN, Ahmed T. Helicobacter pylori infection is associated with fecal biomarkers of environmental enteric dysfunction but not with the nutritional status of children living in Bangladesh. PLoS Negl Trop Dis 2020; 14:e0008243. [PMID: 32324737 PMCID: PMC7200013 DOI: 10.1371/journal.pntd.0008243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 05/05/2020] [Accepted: 03/23/2020] [Indexed: 12/16/2022] Open
Abstract
Background Because Helicobacter pylori (H. pylori) infection and Environmental Enteric Dysfunction (EED) follow a similar mode of transmission, there can be a complex interplay between H. pylori infection and EED, both of which can influence childhood growth. We sought to investigate the factors associated with H. pylori infection and identify its relationship with the fecal biomarkers of EED including Myeloperoxidase (MPO), Neopterin (NEO), Calprotectin, Reg1B and Alpha-1 antitrypsin (AAT), and nutritional status of the children. Methodology Data from an on-going community-based nutrition intervention study was used for this analysis. Total 319 children aged between 12–18 months were evaluated at enrolment and at the end of a 90-day nutrition intervention. Multivariable linear regression with generalized estimating equations was done to examine the association of H. pylori infection with stool biomarker of EED and nutritional status of the children. Principal findings One-fifth of the participants had H. pylori infection at both the time points, with 13.8% overall persistence. Children living in crowded households had higher odds of being infected by H. pylori (AOR = 2.02; 95% CI = 1.02, 4.10; p-value = 0.045). At enrolment, 60%, 99%, 69% and 85% of the stool samples were elevated compared to the reference values set for MPO, NEO, AAT and Calprotectin in the non-tropical western countries. The proportions reduced to 52%, 99%, 67%, and 77% for the same biomarkers after the nutrition intervention. Infection with H. pylori had significant positive association with fecal AAT concentrations (Coefficient = 0.26; 95% CI = 0.02, 0.49; p-value = 0.03) and inverse relationship with Reg1B concentrations measured in the stool samples (Coefficient = -0.32; 95% CI = -0.59, -0.05; p-value = 0.02). However, H. pylori infection was not associated with the indicators of childhood growth. Conclusions The study findings affirmed that the acquisition and persistence of H. pylori infection in the early years of life may exert an adverse impact on intestinal health, induce gut inflammation and result in increased intestinal permeability. Infection with H. pylori, a substantial public health burden in the tropical countries, follows the similar mode of transmission analogous to Environmental Enteric Dysfunction (EED). There can be a complex interplay between H. pylori infection and EED–both of which can influence childhood growth–but the definite role of H. pylori infection contributing to EED and subsequent growth failure is poorly understood. In this study, the authors present data from an ongoing community-based nutrition intervention study and investigated the factors associated with H. pylori infection and identify its relationship with fecal biomarkers of EED and indicators of the nutritional status of the children hailing from a resource-poor urban settlement. They demonstrated the acquisition and persistence of H. pylori infection during early childhood. The study results also corroborate that infection with H. pylori had significant positive association with fecal Alpha-1 antitrypsin concentrations and an inverse relationship with Reg1B concentrations measured in stool samples of the children. The findings revealed in this study may contribute to a better understanding of the role of H. pylori infection in contributing to EED as well as alteration of gut function in the early years of life.
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Affiliation(s)
- Shah Mohammad Fahim
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- * E-mail:
| | - Subhasish Das
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Amran Gazi
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Ashraful Alam
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Mehedi Hasan
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Shabab Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - M Masudur Rahman
- Department of Gastroenterology, Sheikh Russel National Gastro Liver Institute & Hospital, Dhaka, Bangladesh
| | - Rashidul Haque
- Infectious Diseases Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shafiqul Alam Sarker
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ramendra Nath Mazumder
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Prevalence and Risk Factors of Helicobacter pylori Infection among Children Aged 1 to 15 Years at Holy Innocents Children's Hospital, Mbarara, South Western Uganda. J Trop Med 2019; 2019:9303072. [PMID: 30984271 PMCID: PMC6431523 DOI: 10.1155/2019/9303072] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 02/20/2019] [Indexed: 02/07/2023] Open
Abstract
Background Helicobacter pylori infection affects more than half of the world's population. The infection is generally acquired during childhood but can remain asymptomatic, with long-term clinical sequelae including gastritis, peptic ulcer disease, and stomach cancer. Methods The study was approved by Institutional Review Committee of Mbarara University of Science and Technology. After obtaining informed consent from parents/legal guardians, illegible children who presented with gastrointestinal complaints at Holy Innocents Children's Hospital were recruited; structured questionnaires were administered to the parents/guardians to collect information on sociodemographic data and risk factors of H. pylori infection. Four (4) millilitres of blood was collected from each child and tested for H. pylori blood Antibody test and stool specimens were used for H. pylori antigen test. Results The prevalence of H. pylori infection among the study participants was 24.3%. The infection rate increased with increase in age of the participants, from 16.2% among 1to 5 years old to 27.2% among 6 to 10 years. Infections were higher among school going children (68/74, p=0.003, OR 3.9; CI: 1.5 to 10.6) and children from crowded households (59/74, p<0.001, OR 2.6, and CI 1.3 to 5.0), unsafe source of drinking water at schools (46/74, p=0.003), and lack of sanitary facility at homes (57/74, p=0.001, and OR 1.6 CI 0.7 to 3.6). Conclusion The prevalence of H. pylori infection among children aged 1 to 15 years at Holy Innocents Children's Hospital was high and increases with age. School attendance, lack of sanitary facility, lack of safe drinking water, and overcrowding were the risk factors associated with H. pylori infection.
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Abstract
BACKGROUND In adults, Helicobacter pylori is aetiologically associated with peptic ulcer disease and gastric cancer. However, the relationship between this bacteria and gastro-intestinal symptoms in children is less clear. AIMS To review the recent literature on H. pylori in children and to outline the approach to diagnosis and management. METHODS The English language literature was searched for articles on H. pylori in children. Special attention was paid to prevalence, diagnosis and management pertinent to low- and middle-income countries (LMIC). RESULTS Although the prevalence of H. pylori is 60-80% in LMIC, only 5% of infected children develop peptic ulcer disease. The virulence of the organism determines the outcome. There is a suggestion that H. pylori causes iron deficiency anaemia, growth retardation and idiopathic thrombocytopenic purpura, but the evidence is not sufficiently strong to justify screening. There is no evidence to suggest a link between H. pylori infection and recurrent abdominal pain. Endoscopy (with invasive tests) is the preferred method of investigation as the primary goal is to determine the underlying cause of the symptoms. Children with H. pylori-related diseases should be treated with a standard triple-drug regimen consisting of a protein pump inhibitor and two antibiotics for 10-14 days. All treated patients should be monitored for eradication with non-invasive tests such as the urea (13-C) breath test or stool antigen tests. CONCLUSIONS Although H. pylori infection is common in LMIC, most children are asymptomatic. There is no association between H. pylori and recurrent abdominal pain. Invasive tests are preferred for diagnosis and a triple-drug regimen is the treatment of choice.
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Affiliation(s)
- Ujjal Poddar
- a Department of Paediatric Gastroenterology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
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H. pylori infection and gastric cancer in Bangladesh: a case-control study. INTERNATIONAL JOURNAL OF SURGERY-ONCOLOGY 2017; 2:e44. [PMID: 29177209 PMCID: PMC5680990 DOI: 10.1097/ij9.0000000000000044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/15/2017] [Indexed: 12/13/2022]
Abstract
Background: Like that of other Asian countries gastric cancer (GC) is also a leading cancer in Bangladesh and also a cause for cancer-related mortality. Infection with Helicobacter pylori (H. pylori) is the strongest recognized risk factor for gastric adenocarcinoma. The infection is also prevalent in common people. This case-control study was carried out to find an association between GC and H. pylori infection in the community. Materials and Methods: To evaluate association of H. pylori and carcinoma of stomach this study was conducted at National Institute of Cancer Research & Hospital, Dhaka from January 2013 to December 2014. H. pylori status was determined serologically by using H. pylori kit in the department of Biochemistry laboratory of Bangabandhu Sheikh Mujib Medical University. In total, 114 patients with GC and 520 patients not having GC were studied as controls. Logistic regression method was used to calculate the odds ratio. Results: Significantly more patients in the case group (86.8%) were found to be seropositive for H. pylori antigen in contrast to the control group (67.5%). All of the cases in the present study were in advanced stage. No significant association between H. pylori seropositivity and tumor location was found. It was noted that undifferentiated gastric carcinoma had slightly more association with H. pylori infection. Younger H. pylori–infected patients had been found to be at higher relative risk for GC than older patients. Conclusion: As there is a strong association found between GC and H. pylori infection special emphasis to eradicate H. pylori infection might reduce the incidence of this dreadly disease.
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Sarker SA, Ahmed T, Brüssow H. Hunger and microbiology: is a low gastric acid-induced bacterial overgrowth in the small intestine a contributor to malnutrition in developing countries? Microb Biotechnol 2017; 10:1025-1030. [PMID: 28714103 PMCID: PMC5609274 DOI: 10.1111/1751-7915.12780] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 12/17/2022] Open
Abstract
Underproduction of hydrochloric acid into the stomach is frequently encountered in subjects from developing countries. We explore the hypothesis that hypochlorhydria compromises the gastric barrier and favours bacterial overgrowth in the proximal parts of the small intestine where nutrient absorption takes place. Food calories are thus deviated into bacterial metabolism. In addition to an adequate caloric supply, correcting hypochlorhydria might be needed to decrease childhood malnutrition.
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Affiliation(s)
- Shafiqul A Sarker
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Harald Brüssow
- Nutrition and Health Institute, Gut Ecosystem Department, Host- Microbe Interaction Group, Nestlé Research Centre, CH-1000, Lausanne 26, Switzerland
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Habib AM, Alam MJ, Rudra B, Quader MA, Al-Forkan M. Analysis of Helicobacter pylori Prevalence in Chittagong, Bangladesh, Based on PCR and CLO Test. Microbiol Insights 2016; 9:47-50. [PMID: 27891051 PMCID: PMC5116947 DOI: 10.4137/mbi.s39858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 01/01/2023] Open
Abstract
The pathogenic bacterium Helicobacter pylori is a causative agent of gastric diseases in Bangladesh as well as throughout the world. This study aimed at analyzing the prevalence of H. pylori infection among dyspeptic patients in Chittagong, the second most populous city of Bangladesh, using 16S rRNA-based H. pylori-specific Polymerase Chain Reaction and Campylobacter-like organism test. We found that 67% of the population under study was positive for H. pylori infection. Gastric ulcer and duodenal ulcer disease showed statistically significant association with H. pylori infection; however, no association of H. pylori infection was observed in terms of age and gender. This study would play a crucial role in managing H. pylori-induced gastric diseases by understanding the current trend of H. pylori infection in the Chittagong region of Bangladesh.
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Affiliation(s)
- Abdul Musaweer Habib
- Department of Genetic Engineering and Biotechnology, University of Chittagong, Chittagong, Bangladesh
| | - Md Jibran Alam
- Department of Genetic Engineering and Biotechnology, University of Chittagong, Chittagong, Bangladesh
| | - Bashudev Rudra
- Department of Genetic Engineering and Biotechnology, University of Chittagong, Chittagong, Bangladesh
| | - Md Abdul Quader
- Department of Gastroenterology, Chittagong Medical College, Chittagong, Bangladesh
| | - Mohammad Al-Forkan
- Department of Genetic Engineering and Biotechnology, University of Chittagong, Chittagong, Bangladesh
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Abstract
OBJECTIVES Helicobacter pylori infection is acquired in early childhood, yet its role in children's health is still not fully clear. In this narrative review, we focused on the association between H pylori infection and children's growth. METHODS A literature search of the Ovid MEDLINE (till June 2015) and EMBASE (till August 2015) databases was performed using the terms "Helicobacter pylori, growth, body height, growth disorders and child development." Original studies that addressed the association between H pylori infection or eradication and children's growth were reviewed and the risk of bias of each study was assessed. RESULTS The existing evidence is based on observational studies (N = 48) and suggests that H pylori infection may adversely influence children's growth; findings were more consistent across studies with low risk of bias. Regarding linear growth, observational studies have repeatedly linked between H pylori infection and slower or diminished linear growth; yet, it is not known whether this association is causal. The association between H pylori infection and ponderal growth has been less consistent. Scarce evidence exists on the effect of H pylori eradication on children's skeletal growth and weight gain, but there is an indication that H pylori eradication may benefit nutritional status. CONCLUSIONS H pylori infection may impair children's growth. Additional studies, especially clinical trials, are needed to elucidate the role of H pylori eradication in children's growth, and the mechanisms that may be involved in such.
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Ansari S, Gautam R, Nepal HP, Subedi SN, Shrestha S, Mandal F, Rimal B, Chhetri MR. Helicobacter pylori colonization in Nepal; assessment of prevalence and potential risk factors in a hospital-based patient cohort. BMC Res Notes 2016; 9:59. [PMID: 26833400 PMCID: PMC4736165 DOI: 10.1186/s13104-016-1867-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/15/2016] [Indexed: 01/05/2023] Open
Abstract
Background Helicobacter pylori, a gram-negative bacterium, can cause gastritis, peptic and duodenal ulcers. It is considered an important public health problem for both developed and developing world. This bacterium is classified as the class 1 carcinogen because it can cause cancer. Methods A hospital based study was conducted at Chitwan Medical College Teaching Hospital (CMCTH) from May to October 2014. Stool samples were collected from the suspected patients and were subjected to detection of the H. pylori stool antigen (HpSAg) following the procedures recommended by the manufacturer. A standard questionnaire on the potential risk factors was also designed and completed. Result HpSAg was detected in 16 % of suspected patients. The children up to 10 years of age were found to be highly infected (36 %). The patients living in urban area were found more susceptible to develop H. pylori infection (P < 0.05). Tea drinking and repeated eating habit (more than twice a day) were listed as the important factors that can limit the H. pylori infections significantly (P < 0.05). Conclusion In this hospital based study, a significant rate of prevalence was evaluated. However, we recommend a community based extensive study to reveal the real scenario of H. pylori infection in Nepalese populations.
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Affiliation(s)
- Shamshul Ansari
- Department of Microbiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
| | - Rajendra Gautam
- Department of Microbiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
| | - Hari Prasad Nepal
- Department of Microbiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
| | - Shankar Nand Subedi
- School of Public Health and Community Medicine, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
| | - Sony Shrestha
- Department of Microbiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
| | - Fuleshwar Mandal
- Department of Biochemistry, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
| | - Brihaspati Rimal
- Department of Biochemistry, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
| | - Muni Raj Chhetri
- School of Public Health and Community Medicine, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
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Abstract
BACKGROUND There are conflicting results regarding the role of H. pylori in children's growth. We examined differences in growth indices at school age according to H. pylori infection acquisition in preschool age. MATERIALS AND METHODS A prospective study was undertaken between 2004 and 2009, in which of healthy children (N = 139, ages 3-5 years at baseline) were tested for the presence of H. pylori antigen in their stool using enzyme-linked immunoassay and followed-up till age 6-9 years (median follow-up time 45 months). Height, weight, and hemoglobin levels were measured, and socioeconomic data were obtained. Z scores of height for age, weight for age, and body mass index for age at baseline and follow-up were calculated using the 2000 Center for Disease Control and Prevention growth reference curves. Growth velocity (cm/month) between preschool and school age was compared between H. pylori-infected and uninfected children using mixed models. RESULTS Fifty-three percent of the children were H. pylori positive at baseline, and all except one child tested positive at follow-up. The adjusted mean Z score of height for age at follow-up was significantly lower among H. pylori-infected children than uninfected ones: 0.15 (95% confidence intervals (CIs) 0.02, 0.29) and 0.45 (95% CI 0.29, 0.60), respectively (p = .002). Growth velocity was slower in the former group -0.0264 cm/month (95% CI -0.047, -0.005) (p = .014), after adjusting for baseline height and age. H. pylori infection was not associated with body weight. CONCLUSIONS Helicobacter pylori infection acquired in early childhood may have long-term adverse influence on linear growth at school age.
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Affiliation(s)
- Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Sophy Goren
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Dani Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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Yucel O. Prevention of Helicobacter pylori infection in childhood. World J Gastroenterol 2014; 20:10348-10354. [PMID: 25132751 PMCID: PMC4130842 DOI: 10.3748/wjg.v20.i30.10348] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/04/2013] [Accepted: 04/16/2014] [Indexed: 02/07/2023] Open
Abstract
Helicobacter pylori (H. pylori) infection is one of the most common infections worldwide. Although infection rates are falling in the developed and developing countries, H. pylori is still widespread in the world. This article has reviewed the important publications on H. pylori in childhood with a focus on its evolving transmission route and the source of infection and preventive strategies in childhood, PubMed was searched up to identify eligible studies. Relevant publications were searched using the following.
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Breast-feeding and Helicobacter pylori infection: systematic review and meta-analysis. Public Health Nutr 2014; 18:500-20. [DOI: 10.1017/s1368980014000500] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AbstractObjectiveTo quantify the association between breast-feeding and Helicobacter pylori infection, among children and adolescents.DesignWe searched MEDLINETM and ScopusTM up to January 2013. Summary relative risk estimates (RR) and 95 % confidence intervals were computed through the DerSimonian and Laird method. Heterogeneity was quantified using the I2 statistic.SettingTwenty-seven countries/regions; four low-income, thirteen middle-income and ten high-income countries/regions.SubjectsStudies involving samples of children and adolescents, aged 0 to 19 years.ResultsWe identified thirty-eight eligible studies, which is nearly twice the number included in a previous meta-analysis on this topic. Fifteen studies compared ever v. never breast-fed subjects; the summary RR was 0·87 (95 % CI 0·57, 1·32; I2=34·4 %) in middle-income and 0·85 (95 % CI 0·54, 1·34; I2=79·1 %) in high-income settings. The effect of breast-feeding for ≥4–6 months was assessed in ten studies from middle-income (summary RR=0·66; 95 % CI 0·44, 0·98; I2=65·7 %) and two from high-income countries (summary RR=1·56; 95 % CI 0·57, 4·26; I2=68·3 %). Two studies assessed the effect of exclusive breast-feeding until 6 months (OR=0·91; 95 % CI 0·61, 1·34 and OR=1·71; 95 % CI 0·66, 4·47, respectively).ConclusionsOur results suggest a protective effect of breast-feeding in economically less developed settings. However, further research is needed, with a finer assessment of the exposure to breast-feeding and careful control for confounding, before definite conclusions can be reached.
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Matsuhisa T, Aftab H. Observation of gastric mucosa in Bangladesh, the country with the lowest incidence of gastric cancer, and Japan, the country with the highest incidence. Helicobacter 2012; 17:396-401. [PMID: 22967124 PMCID: PMC3469740 DOI: 10.1111/j.1523-5378.2012.00967.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence of Helicobacter pylori (H. pylori) infection is high, but the incidence of gastric cancer is low in natives of Bangladesh. The gastric mucosa was observed in Bangladeshi patients to investigate the differences between Bangladeshis and Japanese. MATERIALS AND METHODS The study involved 418 Bangladeshi and 2356 Japanese patients with abdominal complaints who underwent endoscopy examinations and had no history of H. pylori eradication. The prevalence of H. pylori infection and the gastric mucosa in H. pylori-positive patients were compared between age-, gender-, and endoscopic diagnosis-matched Bangladeshi and Japanese subjects. RESULTS The prevalence of H. pylori infection was higher in Bangladeshi than in Japanese subjects (60.2 and 45.1%, respectively). All the scores for chronic inflammation, neutrophil activity, glandular atrophy, and intestinal metaplasia were significantly lower in H. pylori-positive Bangladeshis than in H. pylori-positive Japanese. The ratio of the corpus gastritis score (C) to the antrum gastritis score (A) (C/A ratio) was <1 (antrum-predominant gastritis) in all age groups of Bangladeshi subjects, whereas the C/A ratio changed from <1 to more than 1 (corpus-predominant gastritis) with aging in Japanese subjects. CONCLUSIONS The scores for glandular atrophy and intestinal metaplasia in H. pylori-positive Bangladeshis were significantly lower than those in Japanese. All age groups of Bangladeshis had antrum-predominant gastritis, whereas corpus-predominant gastritis was more common than antrum-predominant gastritis in older Japanese age groups. These results may explain the low incidence of gastric cancer in Bangladeshis and the high incidence in Japanese.
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Affiliation(s)
- Takeshi Matsuhisa
- Department of Gastrointestinal Endoscopy, Tama-Nagayama University Hospital of Nippon Medical School1-7-1 Nagayama, Tama-city, Tokyo, 206-8512, Japan
| | - Hafeza Aftab
- Department of Gastroenterology, Dhaka Medical CollegeDhaka, Bangladesh
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Jafri W, Yakoob J, Abid S, Siddiqui S, Awan S, Nizami SQ. Helicobacter pylori infection in children: population-based age-specific prevalence and risk factors in a developing country. Acta Paediatr 2010; 99:279-82. [PMID: 19839955 DOI: 10.1111/j.1651-2227.2009.01542.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM We estimated the prevalence, age of acquisition and risk factors for Helicobacter pylori (H. pylori) seroprevalence in children aged 1-15 years. METHODS Exposure was assessed using ELISA. Parents responded to a questionnaire regarding number of individuals sharing house, rooms, water source, latrines, housing and assessment of socioeconomic status (SES) by Hollingshead Index. RESULTS Serum of 1976 children was tested. Helicobacter pylori seropositivity in children aged 11-15 years was 53.5% (OR: 2.0, 95% CI: 1.58-2.5). It increased with moderate crowding index (CRI) of 2-4 to 45.9% (OR: 1.23, 95% CI: 0.92-1.63) and to 51.2% with CRI >4 (OR: 1.52, 95% CI: 1.12-2.06). In middle SES, seropositivity was 50.5% (331/655) (OR: 1.7, 95% CI: 1.29-2.35), whereas in lower SES, it was 47.1% (500/1062) (OR: 1.5, 95% CI: 1.1-2.0). Multivariate analysis showed that Helicobacter pylori seroprevalence was high in children aged 6-10 and 11-15 years (OR: 1.5, 95% CI: 1.2-1.9 and OR: 1.9, 95% CI: 1.56-2.47 respectively), in lower-middle SES (OR: 1.6, 95% CI: 1.2-2.1 and OR: 1.5, 95% CI: 1.10-2.0 respectively) and in uneducated fathers (OR: 1.58, 95% CI: 1.27-1.95). CONCLUSION Helicobacter pylori seropositivity increases with age, in low-middle SES and is related to father's educational status. Reducing H. pylori seroprevalence will require improvement in sanitary conditions and educational status of the population.
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Affiliation(s)
- W Jafri
- Department of Medicine and Pediatrics, Aga Khan University, Karachi, Pakistan
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Chak E, Rutherford G, Steinmaus C. The Role of Breast‐Feeding in the Prevention ofHelicobacter pyloriInfection: A Systematic Review. Clin Infect Dis 2009; 48:430-7. [DOI: 10.1086/596499] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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21
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Nahar S, Kibria KMK, Hossain ME, Sultana J, Sarker SA, Engstrand L, Bardhan PK, Rahman M, Endtz HP. Evidence of intra-familial transmission of Helicobacter pylori by PCR-based RAPD fingerprinting in Bangladesh. Eur J Clin Microbiol Infect Dis 2009; 28:767-73. [PMID: 19190943 DOI: 10.1007/s10096-008-0699-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 12/26/2008] [Indexed: 12/22/2022]
Abstract
Helicobacter pylori is a genetically diverse bacterial species, which has facilitated adaptation to new hosts and persists worldwide. The main objective of this study was to explore intra-familial transmission of H. pylori in Bangladesh. We characterized H. pylori in 35 families including 138 family members using random amplified polymorphic DNA (RAPD) fingerprinting. Forty-six percent of H. pylori isolated from the mother shared a related genotype with strains isolated from their children. Twenty-nine percent of H. pylori isolates of the mother are related to the youngest children. Only 6% of the parents shared related genotype of H. pylori. These findings suggest that mother-to-child transmission occurs in early childhood and is the most probable route of transmission of H. pylori in Bangladesh.
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Affiliation(s)
- S Nahar
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
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22
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Infection by Helicobacter pylori in Bangladeshi children from birth to two years: relation to blood group, nutritional status, and seasonality. Pediatr Infect Dis J 2009; 28:79-85. [PMID: 19116602 DOI: 10.1097/inf.0b013e31818a5d9d] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND A birth cohort of 238 children was followed in an urban slum in Dhaka, Bangladesh, to determine incidence, prevalence, and epidemiologic factors related to Helicobacter pylori infection. METHODS H. pylori infection was determined by a specific stool antigen test as well as enzyme-linked immunosorbent assay for detecting specific IgA and IgG antibodies in sera in children who completed 2 years of follow-up. RESULTS Using the stool antigen test and serology, 50% and 60% of infants respectively, were positive for H. pylori by 2 years; an increase in the infection rate was seen after 6 months of age. Determination of specific antibodies in sera and detection of H. pylori antigen in stool were comparable. A typical seasonality, peaking in spring and autumn, was observed for acquisition of initial H. pylori infection. Children with blood group "A" were more susceptible to H. pylori infection than those with other ABO blood groups. Malnutrition did not seem to promote colonization by H. pylori. However, H. pylori-infected children were more often infected by multiple enteropathogens, often isolated at different time points. CONCLUSIONS This study shows that noninvasive diagnostic methods such as serology and the stool antigen test are suitable for the study of acquisition of H. pylori infections in infants and can be used in field settings as well as in laboratories and clinical setting having less well equipped facilities. The study also shows seasonality for initial H. pylori infection and a relationship between blood group "A" and infection.
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Rodrigues MN, Queiroz DMM, Braga ABC, Rocha AMC, Eulailo EC, Braga LLBC. History of breastfeeding and Helicobacter pylori infection in children: results of a community-based study from northeastern Brazil. Trans R Soc Trop Med Hyg 2006; 100:470-5. [PMID: 16269161 DOI: 10.1016/j.trstmh.2005.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2005] [Revised: 07/31/2005] [Accepted: 08/01/2005] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to evaluate the role of breastfeeding and the infection status of the mother in the acquisition of Helicobacter pylori infection in a poor urban community in northeastern Brazil. Helicobacter pylori status was evaluated by 13C-urea breath test in individuals under the age of 14 years and by ELISA in the mothers. The prevalence of H. pylori infection was 55.8% (197/353) in the children and it increased with age (P<0.0001). Of the children in whom breastfeeding status was known, 93.2% (316/339) were breastfed. The H. pylori prevalence did not differ between breastfed and never breastfed children (55% vs. 52%) even when children were breastfed for >6 months. The prevalence of infection was much higher in children whose mothers were H. pylori infected than in children whose mothers were not infected, resulting in a crude odds ratio (OR) of 3.11 (95% CI 1.57-6.19) and 2.40 after adjustment for potential confounders (95% CI 1.12-5.15). This study suggests that breastfeeding does not protect against acquisition of H. pylori in northeastern Brazil; conversely, an infected mother may have an important role in transmission of the disease to the child.
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Affiliation(s)
- Maria N Rodrigues
- Clinical Research Unity, University Hospital Walter Cantideo, Department of Internal Medicine, Federal University of Ceara, Av. José Bastos 3390, sala 90, 60436-170 Porangabussu, Fortaleza Ce, Brazil
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MUHSEN KH, ATHAMNA A, ATHAMNA M, SPUNGIN-BIALIK A, COHEN D. Prevalence and risk factors of Helicobacter pylori infection among healthy 3- to 5-year-old Israeli Arab children. Epidemiol Infect 2006; 134:990-6. [PMID: 16512967 PMCID: PMC2870488 DOI: 10.1017/s0950268806006030] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2005] [Indexed: 01/05/2023] Open
Abstract
We determined the prevalence and risk factors of H. pylori infection among 197 healthy 3- to 5-year-old Israeli Arab children, in a population under socioeconomic and environmental transition. Data on the socioeconomic and environmental characteristics were obtained by personal interviews. The presence of H. pylori infection was identified using an ELISA kit for detection of H. pylori antigens in stool specimens. The prevalence rate of H. pylori infection was 49.7% (95% CI 42.8-56.67). It varied significantly among the different villages. In the univariate analysis stratified by village, the risk of infection increased according to household crowding, number of siblings younger than 5 years and siblings' H. pylori positivity. In the multivariate analysis the village of residence and siblings' H. pylori positivity were the only variables that remained strongly associated with H. pylori infection. In a population such as that described in this study the socioeconomic and living conditions are major risk factors of H. pylori infection and the intra-familial transmission of H. pylori in early childhood has an important role.
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Affiliation(s)
- KH. MUHSEN
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University
- The Meshulash Research & Development Center, Kfar Qaraa, Israel
| | - A. ATHAMNA
- The Meshulash Research & Development Center, Kfar Qaraa, Israel
| | - M. ATHAMNA
- The Meshulash Research & Development Center, Kfar Qaraa, Israel
| | - A. SPUNGIN-BIALIK
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University
| | - D. COHEN
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University
- Author for correspondence: Professor D. Cohen, Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv 69978, Israel.
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Mahalanabis D, Islam MA, Shaikh S, Chakrabarty M, Kurpad AV, Mukherjee S, Sen B, Khaled MA, Vermund SH, Varmund SH. Haematological response to iron supplementation is reduced in children with asymptomatic Helicobacter pylori infection. Br J Nutr 2006; 94:969-75. [PMID: 16351775 PMCID: PMC1361282 DOI: 10.1079/bjn20051586] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We evaluated the adverse effect of asymptomatic Helicobacter pylori infection in children on the response to Fe supplementation. One hundred and sixty-nine children aged 1-10 years from the urban poor community underwent a [13C]urea breath test for H. pylori and haematological tests at admission and after 8 weeks. Both H. pylori-positive and -negative children were randomly assigned to receive ferrous fumarate syrup (20 mg elemental Fe twice daily) or placebo for 8 weeks and a single dose of vitamin A (33,000 microg). Admission findings were compared between H. pylori-positive and -negative children. Response to Fe was compared between Fe-supplemented H. pylori-positive and -negative children. Seventy-nine per cent of the children were aged 1-5 years and half of them were boys. In eighty-five H. pylori-positive and eighty-four H. pylori-negative children, the differences in mean Hb (112 (sd 12.6) v. 113 (sd 12.0) g/l), haematocrit (34 (sd 3.5) v. 35 (sd 3.2) %) and ferritin (23.8 v. 21.0 microg/l) were similar. After 8 weeks of Fe supplementation, mean Hb was 5.3 g/l more (95 % CI 1.59, 9.0) and haematocrit was 1.4 % more (95 % CI 0.2, 2.6) in H. pylori-negative (n 44) compared with H. pylori-positive (n 42) children. Mean ferritin was similar at admission and improved in both H. pylori-positive and -negative children. Asymptomatic H. pylori infection was not associated with higher rates of anaemia or Fe deficiency in children, but had a significant adverse effect on response to Fe therapy. However, this result is based on exploratory analysis and needs confirmation.
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Affiliation(s)
- Dilip Mahalanabis
- Society for Applied Studies, 108 Maniktala Main Road, Flat-3/21, Kolkata, India.
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Tsai CJ, Perry S, Sanchez L, Parsonnet J. Helicobacter pylori infection in different generations of Hispanics in the San Francisco Bay Area. Am J Epidemiol 2005; 162:351-7. [PMID: 16014772 DOI: 10.1093/aje/kwi207] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
To quantify the contributions of household and environmental factors to Helicobacter pylori infection, the authors examined H. pylori infection among several generations of Hispanics in the San Francisco Bay Area. Between 2000 and 2004, household members were tested for H. pylori and interviewed about demographic factors and household pedigree. An immigrant was defined as someone born in Latin America with at least one Latin America-born parent; a first-generation US-born Hispanic was defined as someone born in the United States with at least one Latin America-born parent; and a second-generation US-born Hispanic was defined as someone born in the United States with at least one US-born parent. Prevalences of H. pylori in immigrants and first- and second-generation US-born Hispanics were 31.4% (102/325), 9.1% (98/1,076), and 3.1% (2/64), respectively. Compared with second-generation US-born Hispanics, the age-adjusted odds ratios for H. pylori were 9.70 (95% confidence interval (CI): 1.57, 60.00) for immigrants and 4.32 (95% CI: 0.69, 26.96) for first-generation US-born Hispanics (p(trend) < 0.001). These odds ratios decreased to 6.19 (95% CI: 1.13, 33.77) and 3.24 (95% CI: 0.59, 17.82), respectively, after adjustment for parental infection (odds ratio (OR) = 2.94, 95% CI: 1.59, 4.38), low education (OR = 1.76, 95% CI: 1.20, 2.68), and crowding (OR = 1.23, 95% CI: 0.84, 1.79). Both the household and birth-country environments probably contributed to declining H. pylori prevalence among successive generations of Hispanics.
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Affiliation(s)
- Chiaojung J Tsai
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA 94305-5107, USA
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Nizami SQ, Bhutta ZA, Weaver L, Preston T. Helicobacter pylori colonization in infants in a peri-urban community in Karachi, Pakistan. J Pediatr Gastroenterol Nutr 2005; 41:191-4. [PMID: 16056098 DOI: 10.1097/01.mpg.0000172263.12920.6b] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The prevalence and incidence of Helicobacter pylori in children in Pakistan is not known. OBJECTIVES To measure the prevalence and age of acquisition of Helicobacter pylori infection/colonization in infants in a peri-urban community in Karachi, Pakistan. SETTING Field based epidemiologic study in a peri-urban community in Karachi, Pakistan. METHODS Infants aged 1 to 3 months were recruited from a birth cohort from the community. C-urea breath test (C-UBT) was performed on recruitment, and the test was repeated at 2, 3, 6, and 9 months of age. RESULTS One hundred forty-eight infants were recruited and had C-UBT on 319 occasions over a period of 2 years. Two hundred thirty-one=(72%) tests were positive: 80% (49/61) infants at 1 month of age, 79% (33/42) at 2 month of age, 76% (92/121) at 3 month of age, 58% (37/64) at 6 months of age, and 67% (20/30) at 9 months of age. CONCLUSIONS The study reveals an early colonization/infection of infants and a high prevalence of Helicobacter pylori in a peri-urban community in Karachi, Pakistan.
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Abstract
The normal indigenous intestinal microflora consists of about 10(15) bacteria that under physiological conditions reside mainly in the lower gastrointestinal tract. Bacterial overgrowth implies abnormal bacterial colonization of the upper gut, resulting from failure of specific defense mechanisms restricting colonization under physiological conditions. At present two types of bacterial overgrowth with defined pathogenesis can be distinguished: (1) gastric overgrowth with upper respiratory tract microflora resulting from selective failure of the gastric acid barrier, and (2) gastrointestinal overgrowth with Gram-negative bacilli (enteric bacteria) resulting from failure of intestinal clearance. Helicobacter pylori-induced gastritis of the oxyntic mucosa is the main cause of acquired failure of the gastric acid barrier, which is common among the healthy elderly. Intestinal clearance may fail as the result of impaired intestinal peristalsis or anatomical abnormalities that alter luminal flow. Impaired peristalsis is associated with conditions interfering with intestinal neuromuscular function including myopathic, neuropathic, autoimmune, infectious, inflammatory, metabolic, endocrine, and neoplastic diseases. Anatomical abnormalities are mainly the result of gastrointestinal surgery, intestinal diverticula or fistula. Combined failure of intestinal clearance and the gastric acid barrier results in more severe colonization with Gram-negative bacilli. Gram-negative bacilli are uncommon in the upper gut of otherwise healthy individuals with gastric hypochlorhydria, being acquired (H. pylori) or drug-induced. Significant bacterial overgrowth with Gram-negative bacilli is a rational in the search for an explanation to optimize clinical management. The clinical significance of colonization with upper respiratory tract microflora remains unclear. Translocation of live bacteria, their metabolic products, or antigens from a small bowel colonized by Gram-negative bacilli play a role in the pathogenesis of spontaneous bacterial peritonitis in hepatic disease and in certain types of sepsis, indicating that further studies can point to new patient populations with potential benefit from medical treatment.
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Affiliation(s)
- Einar Husebye
- Clinic of Medicine, Hospital of Buskerud HF, Drammen, and Division of Medicine, Ullevaal University Hospital of Oslo, Oslo, Norway.
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Shaikh S, Khaled MA, Islam A, Kurpad AV, Mahalanabis D. Evaluation of stool antigen test for Helicobacter pylori infection in asymptomatic children from a developing country using 13C-urea breath test as a standard. J Pediatr Gastroenterol Nutr 2005; 40:552-4. [PMID: 15861014 DOI: 10.1097/01.mpg.0000150093.12457.0d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Prevalence of asymptomatic Helicobacter pylori infection is very high in infants and children in developing countries. C urea breath test (UBT) is a reliable non-invasive diagnostic test for H. pylori infection in children that avoids invasive endoscopy. We compared a newly introduced H. pylori stool antigen test (with a high sensitivity and specificity in symptomatic children) with UBT in asymptomatic children mostly 1-5 years old, from a population with a high prevalence of infection. METHOD Eighty six asymptomatic children (42 boys and 44 girls) were tested for H. pylori infection using the UBT and a stool antigen test (HpSA) based on a sandwich enzyme immunoassay for antigen detection. RESULTS Forty five of the eighty-six (52.3%) children tested positive for H. pylori using the breath test. In 34 of these forty-five children, H. pylori antigen was detected in stool (sensitivity = 75.6%, 95% CI = 63 to 88%). Of the 50 of 86 (58%) children positive by HpSA test, 34 were positive for breath test. Of the 41 children with negative UBT test 25 were negative for stool antigen test (specificity = 61%, 95% CI = 46 to 76%). CONCLUSION The sensitivity and specificity of the new stool antigen test are lower in asymptomatic children with high H. pylori prevalence rate compared to those reported for children with gastrointestinal symptoms. Its usefulness is limited for diagnosis in an asymptomatic child with H. pylori infection.
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Joseph IM, Kirschner D. A model for the study of Helicobacter pylori interaction with human gastric acid secretion. J Theor Biol 2004; 228:55-80. [PMID: 15064083 DOI: 10.1016/j.jtbi.2003.12.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2003] [Revised: 12/05/2003] [Accepted: 12/08/2003] [Indexed: 12/21/2022]
Abstract
We present a comprehensive mathematical model describing Helicobacter pylori interaction with the human gastric acid secretion system. We use the model to explore host and bacterial conditions that allow persistent infection to develop and be maintained. Our results show that upon colonization, there is a transient period (day 1-20 post-infection) prior to the establishment of persistence. During this period, changes to host gastric physiology occur including elevations in positive effectors of acid secretion (such as gastrin and histamine). This is promoted by reduced somatostatin levels, an inhibitor of acid release. We suggest that these changes comprise compensatory mechanisms aimed at restoring acid to pre-infection levels. We also show that ammonia produced by bacteria sufficiently buffers acid promoting bacteria survival and growth.
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Affiliation(s)
- Ian M Joseph
- Department of Microbiology and Immunology, The University of Michigan Medical School, 6730 Medical Science Building II, Ann Arbor, MI 48109-0620, USA
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31
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Abstract
Helicobacter pylori in the developing world is associated with many unique challenges not encountered in an industrialized setting. The 20% prevalence of infection with H. pylori among adolescents in the United States pales in comparison to infection rates exceeding 90% by 5 years of age in parts of the developing world. While H. pylori within the developed world is associated with gastritis, which may lead to peptic ulcer and gastric carcinoma, the infection in the developing world appears to also be linked with chronic diarrhea, malnutrition and growth faltering as well as predisposition to other enteric infections, including typhoid fever and cholera. Once identified, treatment of H. pylori within the developing world presents increased difficulties due to the frequency of antibiotic resistance as well as the frequency of recurrence after successful treatment. Control, and possibly eradication, of H. pylori could likely be achieved through increased standards of living and improved public health, as it has in the industrialized world. However, these measures are distant objectives for most developing countries, making long-term control of the organism dependent on the development and administration of an effective vaccine.
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Affiliation(s)
- Robert W Frenck
- Enteric Disease Research Program, US Naval Medical Research Unit #3, Cairo, Egypt.
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Rahman M, Mukhopadhyay AK, Nahar S, Datta S, Ahmad MM, Sarker S, Masud IM, Engstrand L, Albert MJ, Nair GB, Berg DE. DNA-level characterization of Helicobacter pylori strains from patients with overt disease and with benign infections in Bangladesh. J Clin Microbiol 2003; 41:2008-14. [PMID: 12734242 PMCID: PMC154730 DOI: 10.1128/jcm.41.5.2008-2014.2003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2002] [Revised: 01/09/2003] [Accepted: 01/31/2003] [Indexed: 12/16/2022] Open
Abstract
The complex relation between the genotype of Helicobacter pylori and its association with clinical outcome is not well understood. Studies in the West have showed that strains expressing certain virulence factors (vacAs1, vacAm1, and cagA) are associated with duodenal ulcer disease. However, the H. pylori genotype is known to vary with geographic region. In the present study, we compared several virulence markers (cagA, vacA, and iceA) and neutral markers (IS605, IS606, and IS608) in H. pylori strains isolated from 65 adult patients with peptic ulcer (PU) and 50 patients with nonulcer dyspepsia (NUD). PCR tests indicated that cagA is present in 75% of the strains from patients with PU compared to 55% in patients with NUD, and 80% of the isolates from patients with PU carried potentially toxigenic vacAs1 alleles of the vacuolating cytotoxin gene (vacA) compared to 60% in isolates from patients with NUD. However, no significant difference in any other virulence marker was observed in isolates from both groups. Phylogenetic analysis of the vacA middle region and the 5' end of the cagA gene indicates that Bangladeshi isolates are more closely related to H. pylori isolates from India and are different from isolates from East Asia.
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Affiliation(s)
- Motiur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Melo ETC, Lopes EPA, Almeida JR, Albuquerque MFPM, Moura IMF. Seroprevalence of Helicobacter pylori antibodies in medical students and residents in Recife, Brazil. J Clin Gastroenterol 2003; 36:134-8. [PMID: 12544196 DOI: 10.1097/00004836-200302000-00009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND The epidemiology of Helicobacter pylori (Hp) still constitutes a relevant subject of investigation. GOAL The goal of this study was to determine the seroprevalence rate of Hp antibodies in medical students and residents, and its relationship with medical practice, age, gender and parents' formal education level. STUDY The study was carried out from March 1999 to March 2000, on a population of 1,119 medical students and residents, from which a randomized and stratified sample was drawn. Each stratum comprised students attending the basic training level, students attending the professional training level, and residents. Independent samples were calculated for each group, making a total of 405 subjects. Each participant was interviewed using a questionnaire. After the interview, serum samples were collected and stored at -20 degrees C for detecting IgG antibodies against Hp by an enzyme-linked immunosorbent assay. RESULTS A 31.4% seroprevalence rate of Hp antibodies was observed, which significantly increased during the graduation course according to the medical practices, ranging from 23.4% in students up to 38.6% in residents. Seroprevalence rate increased according to the age (p = 0.002), where older individuals had spent more time in practical activities. Seroprevalence was higher in males and was smaller among those whose parents had a university degree. CONCLUSION The seroprevalence rate of Hp antibodies amongst medical students and residents increases from the basic up to residence level, suggesting that contact with patients during clinical practice may constitute a risk factor for acquiring Hp infection.
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Affiliation(s)
- Ene T C Melo
- Departmento Medicina Clínica, Faculdade de Ciências Médicas, Univeridade de Pernambuco, Recife, Brazil.
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Rothenbacher D, Bode G, Brenner H. History of breastfeeding and Helicobacter pylori infection in pre-school children: results of a population-based study from Germany. Int J Epidemiol 2002; 31:632-7. [PMID: 12055166 DOI: 10.1093/ije/31.3.632] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Helicobacter pylori infection is predominantly acquired in early childhood. Therefore, childhood nutrition may be related to acquisition of infection. However, there are few current data from developed countries to elucidate this association. We investigated the relation between history of breastfeeding and H. pylori infection in a large population-based sample. METHODS Study subjects were all pre-school children in the city of Ulm, located in southern Germany and two nearby communities who were screened for school fitness between January and July 1997. The infection status of the children and of the accompanying mother was determined by the 13C-urea breath test. The parents provided additional information through a standardized questionnaire. RESULTS In all, 946 children (mean age 5.9 years) and their mothers were included in the final analysis (response in study population 80.2%). Overall, H. pylori prevalence was 9.8% in children and 34.7% in their mothers; there was a strong association between children's and mother's infection. Of the children, 82.5% had ever been breastfed. Prevalence of H. pylori infection was higher in children breastfed compared to never breastfed children (10.1% versus 8.4%) and showed a positive relationship with duration of breastfeeding. After controlling for covariates, including mother's H. pylori status, by means of multivariable analysis, the odds ratio (OR) for children's H. pylori infection was 1.56 (95% CI: 0.79-3.11) for any versus never breastfeeding and 2.57 (95% CI: 1.19-5.55) given the child was breastfed > or =6 months. CONCLUSIONS These data suggest that breastfeeding in infancy does not protect against H. pylori infection among pre-school children in industrialized countries.
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Affiliation(s)
- Dietrich Rothenbacher
- Department of Epidemiology, German Centre for Research on Ageing, Heidelberg, Germany.
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Bontems P, Devaster JM, Corvaglia L, Dezsöfi A, Van Den Borre C, Goutier S, Butzler JP, Cadranel S. Twelve year observation of primary and secondary antibiotic-resistant Helicobacter pylori strains in children. Pediatr Infect Dis J 2001; 20:1033-8. [PMID: 11734707 DOI: 10.1097/00006454-200111000-00006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The effectiveness of Helicobacter pylori eradication regimens is influenced by antibiotic susceptibility of infecting strains. Data concerning antibiotic resistance in children are limited. We report the evolution of primary and secondary resistance in a series of Belgian children during the last 12 years. PATIENTS AND METHODS From 1989 through 2000, H. pylori gastritis was diagnosed in 569 children, and antibiotic susceptibility tests were performed in 555. Eradication, using different schemes, failed in 128 of 457 treated children. After eradication failure antibiotic susceptibility determination was performed in 87 of 128. Comparison of antibiotic susceptibility of strains isolated from the gastric body and from the antrum was performed in 238 samples. RESULTS Resistance to amoxicillin was not observed. The rate of primary resistance to nitroimidazole derivatives was 18.0% (101 of 555) and remained constant throughout this period, whereas primary resistance to macrolides increased from an average of 6.0% (range, 0 to 10%) before 1995 to 16.6% (range, 10 to 25%, P < 0.001) thereafter. Antibiotic consumption in Belgium, especially macrolides, did not show important fluctuations during the study period. Secondary resistance developed in 39 of 87 patients (46%). Strains isolated from different gastric locations show identical susceptibility testing in all but 5 of 238. CONCLUSIONS Resistance of H. pylori to macrolides increased in our pediatric population which did not appear to correlate with macrolides prescription habits in our country. After eradication failure acquired secondary resistance was observed in one-half of the patients.
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Affiliation(s)
- P Bontems
- Department of Pediatric Gastroenterology-Hepatology, Queen Fabiola Children's Hospital, Université Libre de Bruxelles, Brussels, Belgium
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36
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Hildebrand P, Bardhan P, Rossi L, Parvin S, Rahman A, Arefin MS, Hasan M, Ahmad MM, Glatz-Krieger K, Terracciano L, Bauerfeind P, Beglinger C, Gyr N, Khan AK. Recrudescence and reinfection with Helicobacter pylori after eradication therapy in Bangladeshi adults. Gastroenterology 2001; 121:792-8. [PMID: 11606492 DOI: 10.1053/gast.2001.28018] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND & AIMS In developing countries where Helicobacter pylori infection is widespread, posttherapeutic recurrence rates may be high. Many of the limited studies available have methodological problems and show varied recurrence rates. We determined late recrudescence rates, true reinfection, and ulcer recurrence. METHODS One hundred five Bangladeshi patients with H. pylori infection and duodenal ulcer disease were treated with a triple therapy. Follow-up included 13C-urea breath tests, endoscopy, and biopsy-based tests. In reinfected patients, genomic typing compared pretherapeutic and posttherapeutic strains. RESULTS Recrudescence, associated with nitroimidazole-based treatment, occurred in 15 of 105 patients (14%) within the first 3 months, but only 8 of 105 patients tested positive 4 weeks after therapy ended. True reinfection was diagnosed in 11 of 105 patients between 3 and 18 months after therapy. The annual reinfection rate was 13%, based on a total follow-up of 84.7 patient years. Ulcer relapse occurred in 2 of 15 (13%) recrudescence cases and in 6 of 11 (55%) reinfection cases, but also in 4 of 73 (5%) H. pylori-negative patients. CONCLUSIONS In Bangladesh, late recrudescence of H. pylori after eradication therapy occurs within the first 3 months. The reinfection rate is high and might influence cost-benefit analyses for determining diagnostic and therapeutic procedures.
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Affiliation(s)
- P Hildebrand
- Department of Research, University Hospital, Basel, Switzerland
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Goodman KJ, Cockburn M. The role of epidemiology in understanding the health effects of Helicobacter pylori. Epidemiology 2001; 12:266-71. [PMID: 11246592 DOI: 10.1097/00001648-200103000-00023] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Helicobacter pylori infects one-half or more of the world population and causes chronic gastritis, peptic ulcer, and probably gastric cancer as well. The public-health impact of this infection is far from trivial. Chronic gastritis and peptic ulcer disease are common across populations. Gastric cancer rates have declined during this century, but this cancer remains second among causes of cancer deaths worldwide. Much has been learned about biological and clinical aspects of H. pylori, but key epidemiologic questions have not been answered. How infection results in diverse diseases, the precise modes of transmission, and a comprehensive solution to H. pylori as a public-health problem remain elusive. In this paper, we highlight methodologic challenges and outline an agenda for future research. Challenges include improving validation of detection methods and considering the limitations of these methods when interpreting epidemiologic data. The role of cofactors in H. pylori-induced diseases requires extensive exploration. Many intriguing areas of H. pylori research require the skills of epidemiologists. The discovery of an infectious etiology of common chronic diseases presents a promising opportunity for improving public health.
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Affiliation(s)
- K J Goodman
- School of Public Health, University of Texas-Houston Health Science Center, 77225, USA
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Abstract
Prevalence determinations have been performed around the world, and regardless of how exotic a location, H. pylori is found in a substantial proportion of the population. H. pylori remains among the most universal of infections. Understanding of some features of infection has changed. Infection can be gained and lost at rates higher than previously realized. Oral-oral and oral-fecal transmission account for most, if not nearly all, cases of infection. H. pylori infection has declined rapidly in developed countries, which probably has contributed to declines in duodenal ulcer disease and gastric cancer. The full health implications of the potential elimination of infection are unknown.
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Affiliation(s)
- J E Everhart
- Epidemiology and Clinical Trials Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA.
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Abstract
My hypothesis is that infantile hypertrophic pyloric stenosis (IHPS) is caused in some cases by Helicobacter pylori (HP) a bacterium commonly found in the human stomach. IHPS is an idiopathic condition of infancy. It occurs at about 5 weeks of age in 3 per 1000 newborns. Children with IHPS have structurally normal pylori at birth and do not resemble children with congenital anomalies. Some nonspecific evidence (temporal distribution, seasonality, familial clustering, leukocytic infiltrates, and increased risk with bottle feeding) are compatible with an infectious etiology. Some other epidemiologic features of IHPS, such as its strong male predominance, its racial and social class variation, and a possible drop in its incidence, are also features of HP infection. Clinical features of IHPS, such as vomiting, hematemesis, and esophagitis, are also consistent with HP. Finally, children with IHPS appear to be more likely to develop chronic conditions, such as peptic ulcers, now known to be caused by HP.
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Affiliation(s)
- L J Paulozzi
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA.
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Rosenstock S, Jørgensen T, Andersen L, Bonnevie O. Seroconversion and seroreversion in IgG antibodies to Helicobacter pylori: a serology based prospective cohort study. J Epidemiol Community Health 2000; 54:444-50. [PMID: 10818120 PMCID: PMC1731697 DOI: 10.1136/jech.54.6.444] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES To assess the incidence of seroconversion and seroreversion in IgG antibodies to Helicobacter pylori within a 11 year observation period using these events as markers for acquisition and loss of the infection, respectively. DESIGN Population based prospective cohort study. SETTING Northern part of Copenhagen County, Denmark. PARTICIPANTS AND METHODS A random sample of 2527 Danish adults were examined and blood obtained in 1983 and in 1994. Matching pairs of sera were analysed for the presence of IgG and IgM antibodies to H pylori with an in house enzyme linked immunosorbent assay. Participants who were seronegative at study entry and seropositive at follow up and had a fourfold increase in baseline IgG antibody levels were categorised as seroconverters and regarded as having acquired H pylori infection. Participants who were seropositive at study entry and had at least a fourfold decrease in baseline IgG antibody levels at follow up were assumed to have lost the infection (seroreverters). RESULTS The seroprevalence of H pylori infection was 24.7 (95% confidence intervals (95% CI) 23.0, 26.4) % in 1983 and 24.5 (95% CI 22.8, 26. 2) % in 1994. A total of 14 participants seroconverted within the observation period (cumulative 11 year incidence proportion: 1.0 (95% CI 0.5, 1.5) %). Having increased IgM antibody levels at study entry significantly increased the likelihood of IgG seroconversion (relative risk 6.4 (95% CI 2.1, 19.6). Seroreversion was seen in 48 participants (cumulative 11 year incidence proportion: 7.7 (95% CI 5. 6, 9.8) %). CONCLUSIONS Changes in H pylori infection status with time are rare in Danish adults. Few adults become infected with H pylori in Denmark.
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Affiliation(s)
- S Rosenstock
- Copenhagen County Centre of Preventive Medicine, Glostrup University Hospital, Glostrup, Denmark.
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Bazzoli F, Cecchini L, Corvaglia L, Dall'Antonia M, De Giacomo C, Fossi S, Casali LG, Gullini S, Lazzari R, Leggeri G, Lerro P, Valdambrini V, Mandrioli G, Marani M, Martelli P, Miano A, Nicolini G, Oderda G, Pazzi P, Pozzato P, Ricciardiello L, Roda E, Simoni P, Sottili S, Zagari RM. Validation of the 13C-urea breath test for the diagnosis of Helicobacter pylori infection in children: a multicenter study. Am J Gastroenterol 2000; 95:646-50. [PMID: 10710052 DOI: 10.1111/j.1572-0241.2000.01836.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The 13C-urea breath test (13C-UBT) is a safe, noninvasive, and accurate test for the detection of Helicobacter pylori (H. pylori) infection in adults. The aim of this study was to evaluate sensitivity and specificity of 13C-UBT in children using different types of test meal, doses of 13C-urea and breath sampling intervals. As yet, a validated, standardized 13C-UBT protocol for children has not been formulated. METHODS 13C-UBT was performed in 115 children and repeated within 3 days, modifying the test meal or the dose of 13C-urea. H. pylori status was assessed by histology and rapid urease test. 13C-UBT was performed using 100 mg or 50 mg of 13C-urea and a fatty test meal (100 FA; 50 FA), 50 mg of 13C-urea, and a carbohydrate test meal (50 CA). Breath samples were collected every 10 min for 60 min. RESULTS The 13C-UBT in children was highly sensitive and specific with all three protocols used. The best combination of sensitivity (97.92%) and specificity (97.96%) was obtained with Protocol 50 FA at 30 min with a cut-off of 3.5 per mil. CONCLUSIONS The 13C-UBT is an accurate test for the detection of H. pylori infection also in children. Administration of 50 mg of 13C-urea, a fatty test meal, and breath sampling at 30 min appears to be the most convenient protocol.
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Affiliation(s)
- F Bazzoli
- Dipartimento di Medicina Interna e Gastroenterologia, Università di Bologna, Italy
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