Risk among gastroenterologists of acquiring Helicobacter pylori infection: case-control study

Determinación antigénica de Helicobacter pylori en escolares de un centro educativo comunitario en Honduras

Helicobacter pylori es un colonizador ávido de la mucosa gástrica del ser humano. Las infecciones por H. pylori son usualmente asintomáticas y adquiridas en la niñez por lo cual tienden a progresar hacia cronicidad generando un daño tisular severo; por ello es relevante caracterizar diversos grupos poblacionales y vigilar epidemiológicamente la distribución de casos. Se realizó un proceso educativo de prevención de enfermedades gastrointestinales enlistando 60 niños entre 8 y 12 años en una escuela de la ciudad de Tegucigalpa, Honduras. Previo asentimiento informado, 45 escolares respondieron una encuesta para obtener datos demográficos, clínicos, ambientales y sociales. Asimismo, accedieron a colectar y entregar una muestra fecal. Se realizó un método inmunocromatográfico para determinar coproantígenos de H. pylori y se analizó estadísticamente la asociación entre infección por H. pylori, variables socioeconómicas y clínicas. Se detectaron coproantígenos de H. pylori en 29% de la población escolar estudiada, los cuales no mostraron sintomatología gastrointestinal severa o complicaciones. La prevalencia de infección aumenta con la edad de los escolares. No se encontró ninguna asociación estadística significativa entre la infección y las variables analizadas; no obstante, la prevalencia de portadores asintomáticos entre escolares pone en perspectiva el desarrollo de programas de vigilancia, así como estudios prospectivos con intervalos de seguimiento diagnóstico y clínico para prevenir oportunamente complicaciones tempranas y tardías. Palabras clave: H. pylori, Diagnostico, Epidemiología, Escolares

Bilio-pancreatic endoscopy during COVID-19 pandemic

On 31 December 2019, the WHO China Country Office was informed of cases of pneumonia of unknown etiology detected in Wuhan (Hubei Province of China). In January 2020, a new coronavirus named SARS-CoV2 was isolated and, since that time, SARS-CoV2 related disease (COVID-19) rapidly spread all over the world becoming pandemic in March 2020. The COVID-19 outbreak dramatically affected the public-health and the health-care facilities organization. Bilio-pancreatic endoscopy is considered a high-risk procedure for cross-contamination and, even though it is not directly involved in COVID-19 diagnosis and management, its reorganization is crucial to guarantee high standards of care minimizing the risk of SARS-CoV2 transmission among patients and health-care providers. Bilio-pancreatic endoscopic procedures often require a short physical distance between the endoscopist and the patient for a long period of time, a frequent exchange of devices, the involvement of a large number of personnel, the use of complex endoscopes difficult to reprocess. On this basis, endoscopic units should take precautions with adjusted management of bilio-pancreatic endoscopy. The aim of this article is to discuss the approach to bilio-pancreatic endoscopy in the COVID-19 era with focus on diagnostic algorithms, indications, management of the endoscopic room, proper use of Personal Protective Equipment and correct reprocessing of instrumentation.

Occupation-associated health hazards for the gastroenterologist/endoscopist

Advances in the field of endoscopy have allowed gastroenterologists to obtain detailed imaging of anatomical structures and to treat gastrointestinal diseases with endoscopic therapies. However, these technological developments have exposed endoscopists and staff to hazards such as musculoskeletal injuries, exposure to infectious agents, and ionizing radiation. We aimed to review the occupational hazards for the gastroenterologist and endoscopist. Using PubMed, Medline, Medscape, and Google Scholar, we identified peer-reviewed articles with the keywords “occupational hazards,” “health hazards,” “occupational health hazards,” “endoscopy,” “gastroenterologist,” “infectious agents,” “musculoskeletal injuries,” and “radiation.” Strategies for reducing exposure to infectious agents, radiation, and the risk of musculoskeletal injuries related to gastroenterology include compliance with established standard measures, the use of thyroid shields and radioprotective eyewear, and ergonomic practices. We conclude that educating endoscopic personnel and trainees in these practices, in addition to further research in these areas, will likely lead to the development of more efficient and user-friendly workspaces that are safer for patients and personnel.

Helicobacter pyloriInfection: A Global Occupational Risk for Healthcare Workers?

The occupational risks from Helicobacter pylori, a major cause of gastroduodenal diseases, were reviewed for selected groups of healthcare workers (HCWs). A literature search was performed using Medline/Pubmed, 1983 to June 2003. Additional manual searches were made using reference lists from the selected articles. Current knowledge implies various pathways of agent transmission, favoring person-to-person transmission. The risks are highest for gastroenterologists, some nurses, and employees caring for persons with mental disability. Results for other groups are conflicting.

The occupational risk of Helicobacter pylori infection among gastroenterologists and their assistants

BACKGROUND

Helicobacter pylori is a widely spread bacterium that mainly inhabits the gastric mucosa and can lead to serious illnesses such as peptic ulcer disease, gastric carcinoma and gastric MALT lymphoma. The oral-oral route seems to be the main transmission route. The fact that endoscopes are contaminated after being used to perform a gastroscopy leads one to question whether gastroenterologists and endoscopy nurses and assistants run a higher risk of infection.

METHODS

A systematic search for literature was conducted in the MEDLINE and EMBASE databases and further publications were found in reference lists of relevant articles. Epidemiological studies on the occupational exposure of endoscopy personnel were collected and their quality was assessed. Pooled effect estimates were identified in a meta-analysis.

RESULTS

Of the 24 studies included in the analysis, 15 were considered to be methodologically good. Of these 15 studies, eight single studies showed a statistically significant increased risk of infection for gastroenterologists, and five for their assistants. Meta-analysis across all methodologically good studies found a statistically significant risk of 1.6 (95%CI 1.3-2.0) for doctors. The pooled effect estimates also indicated a statistically significant risk of Helicobacter pylori infection (RR 1.4; 95%CI 1.1-1.8) for assistants too.When studies are stratified by medical and non-medical control groups, statistically significant risks can only be recognised in the comparison with non-medical controls.

CONCLUSIONS

In summary, our results demonstrated an increased risk of Helicobacter pylori infection among gastroenterological personnel. However, the choice of control group is important for making a valid assessment of occupational exposure risks.

A new model for the transmission of Helicobacter pylori: role of environmental reservoirs as gene pools to increase strain diversity

Twenty-five years after the first successful cultivation and isolation of Helicobacter pylori, the scientific community is still struggling to understand the way(s) this bacterium is transmitted among the human population. Here, both epidemiologic and microbiologic evidence addressing this matter is reviewed and explored to conclude that most H. pylori successful colonizations are derived from direct person-to-person contact and that even though exposure of humans to H. pylori from environmental sources is a very common event, in most occasions the host is able to fight off infection. In addition, under a new model developed here, we propose that the near elimination of environmental reservoirs is the main responsible for the lower prevalence observed in the more industrialized countries by acting on two levels: by decreasing the number of direct infections and by diminishing the number of intraspecies recombination events for producing strain variation within H. pylori.

Current issues in endoscope reprocessing and infection control during gastrointestinal endoscopy

The purpose of this article is to review the evidence regarding transmission of infection during gastrointestinal endoscopy, factors important in endoscope reprocessing and infection control, areas to focus on to improve compliance, and recent developments and advances in the field.

Are endoscopy nurses at risk of infection with Helicobacter pylori from their work?

BACKGROUND

In response to studies suggesting risk of occupational transmission of Helicobacter pylori (HP) to endoscopy staff, this cross-sectional study of seroprevalence to HP in gastroscopy nurses working in West of Scotland hospitals (an area of high endemicity of HP infection) was performed to determine if they were at excess risk relative to peers working in surgical specialities but without gastroscopy exposure. The study aimed to fulfil employer's duties to carry out a suitable risk assessment required by health and safety legislation.

METHOD

This cross-sectional study compares the seroprevalence of HP in gastroscopy nurses and comparators drawn from orthopaedic and trauma units in 10 hospitals during 1998. A directly administered questionnaire collated exposure information on occupational and non-occupational risk factors for infection. Venepuncture was performed for latex agglutination test for IgG to HP. Confounding by socio-economic factors was controlled for by multivariate analysis.

RESULTS

Of the 222 participants, 74 were endoscopy staff (84% response) and 148 (59%) were comparators. Of these, 32.4% of gastroscopy and 33% of comparators were seropositive for HP (OR 0.97, P > 0.9, 95% CI 0.5-1.8). No association was found between gastroscopy exposure variables (frequency, years) or exposure to all endoscopy procedures and HP. Significant associations were found for age, childhood deprivation and greater number of siblings.

CONCLUSION

No excess HP infection was found in gastroscopy nurses. Duties imposed by the health and safety legislation appear discharged by normal infection control procedures. Socio-economic factors are key determinants of HP status.

Does hospital work constitute a risk factor for Helicobacter pylori infection?

The aim of this study was to assess whether clinical work constitutes a risk factor for Helicobacter pylori infection among employees in hospitals. The prevalence of H. pylori infection was analysed in 249 individuals employed in a university teaching hospital according to three categories of hospital workers: (A) personnel from gastrointestinal endoscopy units (N=92); (B) personnel from other hospital units with direct patient contact (N=105); and (C) staff from laboratories and other units with no direct patient contact (N=52). Stool samples from each subject were examined with a validated enzyme-linked immunosorbent assay for the presence of H. pylori antigens. A questionnaire inquiring about sociodemographic and occupational characteristics was completed by each participant. The prevalence of H. pylori infection was 37.0% in group A, 35.2% in group B and 19.2% in group C (P<0.05). Among the different healthcare categories, nurses had a significant higher prevalence of H. pylori infection (P<0.01). No significant association was found between the length of employment or exposure to oral and faecal secretions, and H. pylori infection. Hospital work involving direct patient contact seems to constitute a major risk factor for H. pylori infection compared with hospital work not involving direct patient contact.

Seroconversion of Helicobacter pylori in Korean male employees

OBJECTIVE

Helicobacter pylori infections are acquired primarily during childhood, but also occur in adults. As no published estimates are available on the seroconversion rate of H. pylori in the Korean population, the purpose of this study was to evaluate the incidence and prevalence of H. pylori infection in male Korean employees.

MATERIAL AND METHODS

Levels of anti-H. pylori IgG were measured by ELISA, and gastroscopic findings were checked in 588 employees of the Subway Corporation (aged 40-60 years, male) in 1997, 1998, 1999, 2000, and 2003. Questionnaire responses concerning socio-economic state, education level, and type of job were analyzed versus serologic test results.

RESULTS

Out of the 588 subjects, 455 (77.4%) were positive for anti-H. pylori IgG. Multivariate analysis showed that abnormal gastroscopic findings, especially duodenal ulcers, were more frequent in the H. pylori-positive group (17.6) than in the initially H. pylori-negative group (9.0%) (OR: 1.71, 95% CI: 1.07-2.81). Among the multiple questionnaires, only the proportion of white-collar workers was significant; that is, it was lower in the H. pylori-positive group (44/6) than in the initial H. pylori-negative group (57.9%) (OR: 0.62, 95% CI: 0.41-0.92). Seventeen of 133 subjects (12.8%) who were initially seronegative underwent seroconversion during a 6-year follow-up period, a seroconversion rate of 2.13%/annum.

CONCLUSIONS

The seroprevalence of H. pylori infection in this study group was 77.4% and duodenal ulcer was more frequent in H. pylori-positive subjects, thus confirming the relationship between H. pylori infection and duodenal ulcer. Seroconversion of H. pylori infection in the Korean male employees was determined to be 2.13% per year, suggesting that new infections occur continuously even during late adulthood.

Relationship of smoking and coffee and alcohol consumption with seroconversion to Helicobacter pylori: a longitudinal study in hospital workers

BACKGROUND AND AIM

There are few data concerning the relationship between Helicobacter pylori seroconversion, and smoking habits and coffee and alcohol consumption. The aim of the present study was to investigate the relationship between smoking habits, coffee and alcohol consumption, and H. pylori seroconversion.

METHODS

The data used were derived from a sample of 238 subjects (hospital employees) who were initially (on 1994) seronegative to H. pylori. These subjects were tested again 5 years later (1999). Information concerning smoking habits and coffee and alcohol consumption was collected by the use of a special questionnaire, which was completed by the same cohort of subjects in two different periods (1994 and 1999). Logistic regression was used to assess the relationship between H. pylori seroconversion and the aforementioned lifestyle factors.

RESULTS

Neither smoking nor coffee consumption was significantly related to H. pylori seroconversion. Adjusted odds ratio for alcohol drinkers as compared with non-/occasional drinkers was 0.59 (95% confidence interval [CI]: 0.31-1.16, P = 0.13). However, the odds ratio was significantly lower (0.26, 95%CI: 0.07-0.95, P = 0.042) in subjects who reported moderate alcohol consumption at first (1994) examination, as compared with non-/occasional drinkers. Small and heavy drinking were not associated with H. pylori seroconversion.

CONCLUSIONS

There is no significant relation between H. pylori seroconversion and smoking and coffee consumption. The present findings suggest that moderate alcohol consumption might be inversely associated with H. pylori seroconversion.

Seroprevalence of H. pylori infection and symptoms of upper gastrointestinal tract disease in two groups of health-care workers

The purpose of this study was to determine the seroprevalence of Helicobacter pylori and risk factors for infection in gastrointestinal endoscopy personnel and those caring for developmentally disabled individuals. We administered a structured, one-page questionnaire. Helicobacter pylori status was determined serologically. In all, 107 health-care workers participated. Direct patient contact, exposure to gastrointestinal secretions, history of peptic ulcer, and acid-suppressing medicine use were more frequent among those who worked with the developmentally disabled. Seroprevalence of Helicobacter pylori was 24% in endoscopy personnel and 47% among those who cared for the developmentally disabled (P = 0.02). Bed-sharing with a sibling during childhood, working with the developmentally disabled, and direct patient contact were associated with Helicobacter pylori infection; exposure to patients' gastrointestinal secretions was not. We conclude that those caring for developmentally disabled individuals have a higher risk of occupational acquisition of Helicobacter pylori infection than endoscopy personnel.

Recrudescence and reinfection with Helicobacter pylori after eradication therapy in Bangladeshi adults

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.