Chinese Consensus Report on Family-Based Helicobacter pylori Infection Control and Management (2021 Edition)

OBJECTIVE

Helicobacter pylori infection is mostly a family-based infectious disease. To facilitate its prevention and management, a national consensus meeting was held to review current evidence and propose strategies for population-wide and family-based H. pylori infection control and management to reduce the related disease burden.

METHODS

Fifty-seven experts from 41 major universities and institutions in 20 provinces/regions of mainland China were invited to review evidence and modify statements using Delphi process and grading of recommendations assessment, development and evaluation system. The consensus level was defined as ≥80% for agreement on the proposed statements.

RESULTS

Experts discussed and modified the original 23 statements on family-based H. pylori infection transmission, control and management, and reached consensus on 16 statements. The final report consists of three parts: (1) H. pylori infection and transmission among family members, (2) prevention and management of H. pylori infection in children and elderly people within households, and (3) strategies for prevention and management of H. pylori infection for family members. In addition to the 'test-and-treat' and 'screen-and-treat' strategies, this consensus also introduced a novel third 'family-based H. pylori infection control and management' strategy to prevent its intrafamilial transmission and development of related diseases.

CONCLUSION

H. pylori is transmissible from person to person, and among family members. A family-based H. pylori prevention and eradication strategy would be a suitable approach to prevent its intra-familial transmission and related diseases. The notion and practice would be beneficial not only for Chinese residents but also valuable as a reference for other highly infected areas.

Prevalence and risk factors of Helicobacter pylori infection in military personnel: a systematic review and meta-analysis

BACKGROUND AND AIMS

Helicobacter pylori infection is prevalent and recognized as a major cause of gastrointestinal diseases in the world. Previous studies on the prevalence of H. pylori infection in military personnel have shown some conflicting results. This study aimed to estimate the pooled prevalence of H. pylori infection and evaluate its risk factors in military personnel.

METHODS

The PubMed, EMBASE, and Cochrane Library databases were searched. We pooled the prevalence of H. pylori infection in military personnel using a random-effect model. Metaregression analysis was used to explore the sources of heterogeneity. Pooled proportion of H. pylori infection with 95% confidence interval (CI) was calculated.

RESULTS

Sixteen studies were included. Meta-analysis showed that the overall prevalence of H. pylori infection was 32% (95% CI = 31-33) in military personnel. There was a significant heterogeneity. Metaregression analysis showed that study region (P = 0.0004) and publication year (P = 0.023) were the potential sources of heterogeneity. In the subgroup analysis by study region, the highest prevalence was found in Asia (50.2%; 95% CI = 49-51.4). In the subgroup analysis by diagnostic methods for H. pylori, the highest prevalence was found when urea breath test was employed (47.9%; 95% CI = 46.5-49.3). The most common risk factor for H. pylori infection was familial aggregation, followed by living environment and age.

CONCLUSION

H. pylori infection is common in military personnel. In future, we may require appropriate population screening for H. pylori infection by multiple diagnostic tests and increase the knowledge and awareness of the bacterial transmission among military personnel.

Helicobacter pylori knowledge and perception among multi-ethnic Asians

BACKGROUND

Helicobacter pylori (HP) infection is endemic and causes peptic ulcer disease and gastric cancer. There is a lack of data related to awareness of the general public about HP and associated health risks. The objective of this study was to investigate the awareness and public perceptions about HP and the attitudes towards screening.

METHODS

This cross-sectional study included a structured 19-item questionnaire targeting members of the general public at a restructured acute hospital in Singapore.

RESULTS

Out of 504 participants, 152 (30.2%) were aware of HP. Higher education was associated with HP awareness (p < 0.001, OR 7.4, 95% CI 1.6-32.6). A third, 175 (34.7%) of the respondents identified the stomach as the primary site of infection. 131 (26.0%) respondents identified the fecal-oral route as a mode of transmission. 178 (35.3%) respondents were aware of available screening modalities, with around half of them willing to be screened with blood (n = 256, 50.8%) or breath tests (n = 265, 52.6%). 430 (85.3%) participants were keen to learn more about HP, and this was associated with age (p < 0.05, OR 3.9, 95% CI 2.1-7.1).

CONCLUSION

Awareness about HP infection is low, and acceptance of screening tests is high. Educational efforts are needed to improve awareness.

Global whole family based-Helicobacter pylori eradication strategy to prevent its related diseases and gastric cancer

Helicobacter pylori (H. pylori) infects approximately 50% of the world population. The multiple gastrointestinal and extra-gastrointestinal diseases caused by H. pylori infection pose a major healthcare threat to families and societies; it is also a heavy economic and healthcare burden for countries that having high infection rates. Eradication of H. pylori is recommended for all infected individuals. Traditionally, “test and treat” and "screen and treat" strategies are available for various infected populations. However, clinical practice has noticed that these strategies have some shortfalls and may need refinement, mostly due to the fact that they are not easily manageable, and are affected by patient compliance, selection of treatment population and cost-benefit estimations. Furthermore, it is difficult to control infections from the source, therefore, development of additional, compensative strategies are encouraged to solve the above problems and facilitate bacteria eradication. H. pylori infection is a family-based disease, but few studies have been performed in a whole family-based approach to curb its intra-familial transmission and the development of related diseases. In this work, a third, novel whole family-based H. pylori eradication strategy is introduced. This approach screens, identifies, treats and follows up on all H. pylori-infected individuals in entire families to control H. pylori infection among family members, and reduce its long-term complications. This strategy is high-risk population-oriented, and able to reduce H. pylori spread among family members. It also has good patient-family compliance and, importantly, is practical for both high and low H. pylori-infected communities. Future efforts in these areas will be critical to initiate and establish healthcare policies and management strategies to reduce H. pylori-induced disease burden for society.

Pathogenesis and clinical management of Helicobacter pylori gastric infection

Helicobacter pylori (H. pylori) is a gram-negative bacterium that infects approximately 4.4 billion individuals worldwide. However, its prevalence varies among different geographic areas, and is influenced by several factors. The infection can be acquired by means of oral-oral or fecal-oral transmission, and the pathogen possesses various mechanisms that improve its capacity of mobility, adherence and manipulation of the gastric microenvironment, making possible the colonization of an organ with a highly acidic lumen. In addition, H. pylori presents a large variety of virulence factors that improve its pathogenicity, of which we highlight cytotoxin associated antigen A, vacuolating cytotoxin, duodenal ulcer promoting gene A protein, outer inflammatory protein and gamma-glutamyl transpeptidase. The host immune system, mainly by means of a Th1-polarized response, also plays a crucial role in the infection course. Although most H. pylori-positive individuals remain asymptomatic, the infection predisposes the development of various clinical conditions as peptic ulcers, gastric adenocarcinomas and mucosa-associated lymphoid tissue lymphomas. Invasive and non-invasive diagnostic methods, each of them with their related advantages and limitations, have been applied in H. pylori detection. Moreover, bacterial resistance to antimicrobial therapy is a major challenge in the treatment of this infection, and new therapy alternatives are being tested to improve H. pylori eradication. Last but not least, the development of effective vaccines against H. pylori infection have been the aim of several research studies.

Helicobacter pylori: A foodborne pathogen?

Helicobacter pylori (H. pylori) is an organism that is widespread in the human population and is sometimes responsible for some of the most common chronic clinical disorders of the upper gastrointestinal tract in humans, such as chronic-active gastritis, duodenal and gastric ulcer disease, low-grade B-cell mucosa associated lymphoid tissue lymphoma of the stomach, and gastric adenocarcinoma, which is the third leading cause of cancer death worldwide. The routes of infection have not yet been firmly established, and different routes of transmission have been suggested, although the most commonly accepted hypothesis is that infection takes place through the faecal-oral route and that contaminated water and foods might play an important role in transmission of the microorganism to humans. Furthermore, several authors have considered H. pylori to be a foodborne pathogen because of some of its microbiological and epidemiological characteristics. H. pylori has been detected in drinking water, seawater, vegetables and foods of animal origin. H. pylori survives in complex foodstuffs such as milk, vegetables and ready-to-eat foods. This review article presents an overview of the present knowledge on the microbiological aspects in terms of phenotypic characteristics and growth requirements of H. pylori, focusing on the potential role that foodstuffs and water may play in the transmission of the pathogen to humans and the methods successfully used for the detection of this microorganism in foodstuffs and water.

Relating Phage Genomes to Helicobacter pylori Population Structure: General Steps Using Whole-Genome Sequencing Data

The review uses the Helicobacter pylori, the gastric bacterium that colonizes the human stomach, to address how to obtain information from bacterial genomes about prophage biology. In a time of continuous growing number of genomes available, this review provides tools to explore genomes for prophage presence, or other mobile genetic elements and virulence factors. The review starts by covering the genetic diversity of H. pylori and then moves to the biologic basis and the bioinformatics approaches used for studding the H. pylori phage biology from their genomes and how this is related with the bacterial population structure. Aspects concerning H. pylori prophage biology, evolution and phylogeography are discussed.

Treatment of Helicobacter pylori with dielectric barrier discharge plasma causes UV induced damage to genomic DNA leading to cell death

Gastrointestinal endoscopy is an important tool for the indentification and treatment of disorders of the gastrointestinal tract. However, nosocomial infections of Helicobacter pylori have been linked to the use of contaminated endoscopes. Disinfectants such as glutaraldehyde, ortho-phthalaldehyde and peracetic acid are generally used in the reprocesssing of endoscopes, but these chemicals are hazardous to human health. Thus, safer reprocessing and disinfecion methods are needed. In this study, we applied a dielectric barrier discharge (DBD) plasma torch for inactivation of H. pylori to investigate a potential new methodology to disinfect endoscopes. Suspensions of H. pylori in 10% glycerol were subjected to the DBD plasma torch, which reduced the viable cell count to undetectable levels after 2 min of treatment. Furthermore, urease activity of H. pylori was eliminated after 2 min-plasma treatment, while plasma-treatment reduced the intact DNA of H. pylori in a time-dependent manner. Next, we examined several potential bactericidal factors produced by the DBD plasma torch. Two min-plasma treatment resulted in a small temperature rise (4 °C), ultraviolet radiation (UV) generation, and the production of hydrogen peroxide. H. pylori samples were then exposed to equivalent levels of each of these factors in turn. Our results showed that treatment with heat and hydrogen peroxide at the levels produced after 2-min of plasma treatment did not efficiently inactivate H. pylori, whereas exposure to UV had a significant bactericidal effect. Taken together, UV generated by the plasma torch may be crucial for efficient inactivation of H. pylori by damaging the bacterial DNA.

Helicobacter pylori infection in family members of patients with gastroduodenal symptoms. A cross-sectional analytical study

BACKGROUND

Primary Helicobacter pylori (H. pylori) infection is acquired predominantly in childhood in the family setting. We aimed to investigate the presence of intrafamilial concurrent H. pylori infection.

DESIGN AND SETTING

Cross-sectional analytical study with a control group, conducted in a tertiary care hospital.

METHODS

Fifty adult patients with gastroduodenal symptoms who underwent gastroscopy (index parents), their spouses and their children were enrolled in the study. Blood samples were collected from all of the study subjects to test for immunoglobulin G (IgG) antibody response. H. pylori antigen was investigated in the stool specimens of children only.

RESULTS

The participants were divided into two groups: Group 1 consisted of the 40 patients in whom H. pylori infection was demonstrated via endoscopy, their spouses and their children. Group 2 included the remaining 10 patients who underwent endoscopy revealing negative results for H. pylori, their spouses and their children. IgG antibodies were present in all of the index parents, 95% of their spouses and 93% of their children in group 1; 13 of the children (9%) were also positive for H. pylori stool antigen (HpSA). However, IgG antibodies were present in only 2 of the 10 index parents in group 2. One of their spouses and one of their children had a positive antibody response. All of their children had negative stool antigen test results.

CONCLUSION

H. pylori infections exhibit intrafamilial clustering. Parental infection, age ≥ years and having three or more siblings are the major risk factors for H. pylori infection in children.

Are the view of Helicobacter pylori colonized in the oral cavity an illusion?

Urea breath test (UBT), as a leading preferred non-invasive diagnostic technology, but may not be able to detect oral H. pylori. With negative results of UBT, the patient may have an oral infection. On the basis of the fact of success, eradication rate may increase by 21% in the 95% Cl range after the elimination of oral H. pylori, the author believes oral H. pylori does exist and the oral cavity is the second colonized site aside its primary site of the stomach. H. pylori migrated out of Africa along with its human host circa 60 000 years ago; they are not lives in stomach only. In this review article, evidence established in recent years studies with use more appropriate technology had been listed and discussed. The author considers the oral cavity is a black hole for H. pylori infection that significant effective on gastroenterology and another medical field. The role of the oral cavity as the source of H. pylori infection is so controvert in past years. It seems like a human being having a second-time face to discover H. pylori in the history.

Helicobacter typhlonius was detected in the sex organs of three mouse strains but did not transmit vertically

Helicobacter typhlonius, one of the most recently identified members of this rapidly expanding genus of bacteria, was detected by polymerase chain reaction (PCR) in an animal facility and studied for tissue distribution in sentinel mice ( Helicobacter-free, barrier maintained). Immunodeficient athymic nude- nu ( nu/nu), Helicobacter-sensitive C3H/HeJ and Helicobacter-resistant C57BL/6J mouse strains were used to study whether Helicobacter species could spread to the sex organs and be transmitted vertically. Sentinel mice of these three strains became infected at different times after first exposure and Helicobacter was detected by PCR for a brief period in the sex organs. The potential for PCR-positive tissues from the ovary, uterus, testis and epididymis to transmit infection was investigated via in vitro fertilization (IVF), embryo transfer (ET) or ovary transplantation in immunodeficient athymic nude- nu mice and did not result in contamination of the recipient females.

Helicobacter pylori colonization of the oral cavity: A milestone discovery

Over the past several years, the severity of Helicobacter pylori (H. pylori) infections has not significantly diminished. After successful eradication, the annual H. pylori recurrence rate is approximately 13% due to oral H. pylori infection. Established clinical diagnostic techniques do not identify an oral etiologic basis of H. pylori prior to gastric infection. There has been disagreement as to whether oral infection of H. pylori exists or not, with no definite conclusion. In medical practice, negative results with the urea breath test suggest that the stomach infection of H. pylori is cured in these patients. In fact, patients can present negative urea breath test results and yet exhibit H. pylori infection due to oral infection. The present paper provides evidence that H. pylori oral infection is nonetheless present, and the oral cavity represents a secondary site for H. pylori colonization.

[Qualitative analysis of water quality deterioration and infection by Helicobacter pylori in a community with high risk of stomach cancer (Cauca, Colombia)]

This study looks at aspects of the environmental health of the rural population in Timbío (Cauca, Columbia) in relation to the deterioration of water quality. The information was obtained through participatory research methods exploring the management and use of water, the sources of pollution and the perception of water quality and its relation to Helicobacter pylori infection. The results are part of the qualitative analysis of a first research phase characterizing water and sanitation problems and their relation to emerging infectious diseases as well as possible solutions, which was carried out between November 2013 and August 2014. The results of this research are discussed from an ecosystemic approach to human health, recognizing the complexity of environmental conflicts related to water resources and their impacts on the health of populations. Through the methodology used, it is possible to detect and visualize the most urgent problems as well as frequent causes of contamination of water resources so as to propose solutions within a joint agenda of multiple social actors.

Helicobacter cinaedi bacteremia with cellulitis after ABO-incompatible living-donor liver transplantation: Case report

Helicobacter cinaedi (H. cinaedi), a Gram-negative spiral-shaped bacterium, is an enterohepatic non-Helicobacter pylori Helicobacter species. We report the first case of H. cinaedi bacteremia with cellulitis after liver transplantation. A 48-year-old male, who had been a dog breeder for 15 years, underwent ABO-incompatible living-donor liver transplantation for hepatitis C virus-induced decompensated cirrhosis using an anti-hepatitis B core antibody-positive graft. The patient was preoperatively administered rituximab and underwent plasma exchange twice to overcome blood type incompatibility. After discharge, he had been doing well with immunosuppression therapy comprising cyclosporine, mycophenolate mofetil, and steroid according to the ABO-incompatible protocol of our institution. However, 7 mo after transplantation, he was admitted to our hospital with a diagnosis of recurrent cellulitis on the left lower extremity, and H. cinaedi was detected by both blood culture and polymerase chain reaction analysis. Antibiotics improved his symptoms, and he was discharged at day 30 after admission. Clinicians should be more aware of H. cinaedi in immunocompromised patients, such as ABO-incompatible transplant recipients.

[Prevalence and routes of transmission of pyloric Helicobacter infection. II. Transmission infection from an external source (literature review)]

AIM OF THE STUDY

On the available reports to assess the possibility of the infection with pyloric Helicobacter (H.pylori) from external sources--via contaminated food and water. BASIC CONCEPTS: H. pylori was established to be unable to multiply in dairy and other products, but under favorable conditions, can survive in the limited time. There are obtained epidemiological data about the feedback between the prevalence of H. pylori infection in the region and the availability of safe water. There was recorded ability of bacteria to survive for a short time in water in bacillary virulent form. In different water sources in different countries there was found H. pylori coccal form.

CONCLUSION

H. pylori ability to survive in the commonly used product supports the hypothesis that contaminated food (tank-human) may serve as a conductor of infection. The literature data testify to the possibility and importance of the waterway for H. pylori infection transmission that changes the approaches to prophylaxis and the prevention of associated with it diseases.

Helicobacter heilmannii sensu lato: An overview of the infection in humans

Helicobacter heilmannii sensu lato (H. heilmannii s.l.) is a group of gastric non-Helicobacter pylori Helicobacter species that are morphologically indistinguishable from each other. H. heilmannii s.l. infect the stomach of several animals and may have zoonotic potential. Although the prevalence of these infections in humans is low, they are associated with gastric pathology, including mucosa-associated lymphoid tissue lymphoma, making them a significant health issue. Here, the taxonomy, epidemiology, microbiology, diagnosis, and treatment of these infections will be reviewed. The gastric pathology associated with H. heilmannii s.l. infections in humans will also be addressed. Finally, the features of the complete bacterial genomes available and studies on species-specific pathogenesis will be reviewed. The understanding of the mechanisms that underlie gastric disease development mediated by the different bacterial species that constitute H. heilmannii s.l. is essential for developing strategies for prevention and treatment of these infections.

Prevention of Helicobacter pylori infection in childhood

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.

[Prevalence and transmission pathways of the pyloric Helicobacter infection. Transmission from person to person (literature review)]

The purpose of review: analysis of the available in the literature data about the possible kinds and pathways of transmission of pyloric Helicobacter infection from person to person. Knowledge of these data is necessary for its prevention. Subjects--available literature, mainly English-language articles. There were separated two modes of transmission of Helicobacter pylori: vertical--the spread of infection from older to younger and horizontal--by contact between persons outside of the family. Basis statements. There is abundant evidence confirming the gastro-oral, oral-oral and fecal-oral transmission of H. pylori. To prevent the transmission of infection from person to person and the development of related diseases an essential measure is elibiotics.

Vacuoles of Candida yeast as a specialized niche for Helicobacter pylori

Helicobacter pylori (H. pylori) are resistant to hostile gastric environments and antibiotic therapy, reflecting the possibility that they are protected by an ecological niche, such as inside the vacuoles of human epithelial and immune cells. Candida yeast may also provide such an alternative niche, as fluorescently labeled H. pylori were observed as fast-moving and viable bacterium-like bodies inside the vacuoles of gastric, oral, vaginal and foodborne Candida yeasts. In addition, H. pylori-specific genes and proteins were detected in samples extracted from these yeasts. The H. pylori present within these yeasts produce peroxiredoxin and thiol peroxidase, providing the ability to detoxify oxygen metabolites formed in immune cells. Furthermore, these bacteria produce urease and VacA, two virulence determinants of H. pylori that influence phago-lysosome fusion and bacterial survival in macrophages. Microscopic observations of H. pylori cells in new generations of yeasts along with amplification of H. pylori-specific genes from consecutive generations indicate that new yeasts can inherit the intracellular H. pylori as part of their vacuolar content. Accordingly, it is proposed that yeast vacuoles serve as a sophisticated niche that protects H. pylori against the environmental stresses and provides essential nutrients, including ergosterol, for its growth and multiplication. This intracellular establishment inside the yeast vacuole likely occurred long ago, leading to the adaptation of H. pylori to persist in phagocytic cells. The presence of these bacteria within yeasts, including foodborne yeasts, along with the vertical transmission of yeasts from mother to neonate, provide explanations for the persistence and propagation of H. pylori in the human population. This Topic Highlight reviews and discusses recent evidence regarding the evolutionary adaptation of H. pylori to thrive in host cell vacuoles.

History of Helicobacter pylori, duodenal ulcer, gastric ulcer and gastric cancer

Helicobacter pylori (H. pylori) infection underlies gastric ulcer disease, gastric cancer and duodenal ulcer disease. The disease expression reflects the pattern and extent of gastritis/gastric atrophy (i.e., duodenal ulcer with non-atrophic and gastric ulcer and gastric cancer with atrophic gastritis). Gastric and duodenal ulcers and gastric cancer have been known for thousands of years. Ulcers are generally non-fatal and until the 20^th century were difficult to diagnose. However, the presence and pattern of gastritis in past civilizations can be deduced based on the diseases present. It has been suggested that gastric ulcer and duodenal ulcer both arose or became more frequent in Europe in the 19^th century. Here, we show that gastric cancer and gastric ulcer were present throughout the 17^th to 19^th centuries consistent with atrophic gastritis being the predominant pattern, as it proved to be when it could be examined directly in the late 19^th century. The environment before the 20^th century favored acquisition of H. pylori infection and atrophic gastritis (e.g., poor sanitation and standards of living, seasonal diets poor in fresh fruits and vegetables, especially in winter, vitamin deficiencies, and frequent febrile infections in childhood). The latter part of the 19^th century saw improvements in standards of living, sanitation, and diets with a corresponding decrease in rate of development of atrophic gastritis allowing duodenal ulcers to become more prominent. In the early 20^th century physician’s believed they could diagnose ulcers clinically and that the diagnosis required hospitalization for “surgical disease” or for “Sippy” diets. We show that while H. pylori remained common and virulent in Europe and the United States, environmental changes resulted in changes of the pattern of gastritis producing a change in the manifestations of H. pylori infections and subsequently to a rapid decline in transmission and a rapid decline in all H. pylori-related diseases.

Seroprevalence of Helicobacter pylori infection in Polish children and adults depending on socioeconomic status and living conditions

PURPOSE

Helicobacter pylori (H. pylori) is one of the causes of gastritis, peptic ulcer disease, gastric cancer and MALT-lymphoma. The frequency of H. pylori infection is different in various regions of the world and dependent on age, socioeconomic and hygiene status. The objective of this study was to assess seroprevalence and the associated socioeconomic and sociodemographic characteristics influencing H. pylori infection in children and adults in Polish population.

MATERIAL/METHODS

In multicenter epidemiological studies, H. pylori infection occurrence was assessed in Poland in the years 2002 and 2003. The seroprevalence of H. pylori infection diagnosis was based on IgG anti-H. pylori antibodies concentration above 24 UI/ml, which was measured using ELISA test. The study included 6565 subjects: 3307 adults (50.37%) and 3258 children (49.63%).

RESULTS

Positive result was observed in 3827 subjects (58.29%), i.e. 1043 children (32.01%) and 2784 adults (84.19%). H. pylori infection prevalence was greater in children of poor economic status, who were born in a rural area, lived in crowded houses with no running tap water and with toilet outside the house, and who did not observe hygiene rules. In adults, the factors predisposing to higher probability of being H. pylori infected included: being born in a rural area, having low family income and elementary education, smoking tobacco, drinking high proof alcohols as well as not observing of hygiene rules.

CONCLUSIONS

Improvement of socioeconomic status, sanitary and hygienic conditions and the education of the society might decrease H. pylori infection prevalence in children and in adults.

[Epidemiology of Helicobacter pylori infection and gastric cancer]

The incidence of H. pylori infection is steadily declining in developed countries, with a prevalence reduced in younger patients (less than 20 % but remaining still high (over 50 %) in the elderly population. The incidence is stable in developing countries, with a prevalence of 70-80%. Adenocarcinoma is the main type of gastric malignancy. The mechanisms of carcinogenesis and risk factors differ depending on the location proximal (cardia) or distal and the histological type "intestinal" or "diffuse". With approximately 6500 new cases per year and a 80% mortality in France, gastric cancer is relatively frequent and severe. The current dominant etiologic role of H. pylori infection explains the epidemiological changes of recent decades: the decline due to reduced incidence of distal cancers of "intestinal" type whereas "diffuse" and proximal cancer are increasing, the average age of onset of 70 years with a male preponderance associated with the high prevalence of distal intestinal type. The cardia cancer occurs earlier and has a worst prognosis. The main risk factors are chronic gastritis induced by H. pylori, smoking, salty and smoked food, a family history of gastric cancer, Lynch syndrome and hereditary diffuse gastric cancer.

Helicobacter pylori and pregnancy-related disorders

Helicobacter pylori (H. pylori) infection is investigated in gastric diseases even during pregnancy. In particular, this Gram-negative bacterium seems to be associated with hyperemesis gravidarum, a severe form of nausea and vomiting during pregnancy. During the last decade, the relationship among H. pylori and several extra-gastric diseases strongly emerged in literature. The correlation among H. pylori infection and pregnancy-related disorders was mainly focused on iron deficiency anemia, thrombocytopenia, fetal malformations, miscarriage, pre-eclampsia and fetal growth restriction. H. pylori infection may have a role in the pathogenesis of various pregnancy-related disorders through different mechanisms: depletion of micronutrients (iron and vitamin B₁₂) in maternal anemia and fetal neural tube defects; local or systemic induction of pro-inflammatory cytokines release and oxidative stress in gastrointestinal disorders and pre-eclampsia; cross-reaction between specific anti-H. pylori antibodies and antigens localized in placental tissue and endothelial cells (pre-eclampsia, fetal growth restriction, miscarriage). Since H. pylori infection is most likely acquired before pregnancy, it is widely believed that hormonal and immunological changes occurring during pregnancy could activate latent H. pylori with a negative impact not only on maternal health (nutritional deficiency, organ injury, death), but also on the fetus (insufficient growth, malformation, death) and sometime consequences can be observed later in life. Another important issue addressed by investigators was to determine whether it is possible to transmit H. pylori infection from mother to child and whether maternal anti-H. pylori antibodies could prevent infant’s infection. Studies on novel diagnostic and therapeutic methods for H. pylori are no less important, since these are particularly sensitive topics in pregnancy conditions. It could be interesting to study the possible correlation between H. pylori infection and other pregnancy-related diseases of unknown etiology, such as gestational diabetes mellitus, obstetric cholestasis and spontaneous preterm delivery. Since H. pylori infection is treatable, the demonstration of its causative role in pregnancy-related disorders will have important social-economic implications.

Helicobacter pylori infection: diagnosis and treatment

Helicobacter pylori is one of the most common infections worldwide. Eradication of this important pathogen would lead to virtual elimination of the second most common cancer worldwide - gastric cancer. A variety of accurate diagnostic tests are available but current therapeutic regimens are generally unsatisfactory, with failure rates of between 20 and 40%. Difficulty in curing the infection has led to a three-step approach: diagnosis, therapy and confirmation of cure. Better studies, including head-to-head comparison of different drugs, drug formulations, dosing intervals, dosing in relation to meals, and duration of therapy are needed. The high rates of reinfection and the lack of improvements in standards of living in developing countries makes the development of a vaccine a high priority.

Helicobacter pylori genomic microevolution during naturally occurring transmission between adults

The human gastric pathogen Helicobacter pylori is usually acquired during childhood and, in the absence of treatment, chronic infection persists through most of the host's life. However, the frequency and importance of H. pylori transmission between adults is underestimated. Here we sequenced the complete genomes of H. pylori strains that were transmitted between spouses and analysed the genomic changes. Similar to H. pylori from chronic infection, a significantly high proportion of the determined 31 SNPs and 10 recombinant DNA fragments affected genes of the hop family of outer membrane proteins, some of which are known to be adhesins. In addition, changes in a fucosyltransferase gene modified the LPS component of the bacterial cell surface, suggesting strong diversifying selection. In contrast, virulence factor genes were not affected by the genomic changes. We propose a model of the genomic changes that are associated with the transmission and adaptation of H. pylori to a new human host.

Helicobacter and salmonella persistent infection strategies

Some host-adapted bacterial pathogens are capable of causing persistent infections in humans. For example, Helicobacter pylori inhabits the human gastric mucosa and persistence can be lifelong. Salmonella enterica serovar Typhi causes systemic infections that involve colonization of the reticuloendothelial system and some individuals become lifelong carriers. In this review, I compare and contrast the different lifestyles of Helicobacter and Salmonella within the host and the strategies they have evolved to persist in mammalian hosts. Persistently infected carriers serve as the reservoirs for these pathogens, and the carrier state is an essential feature that is required for survival of the bacteria within a restricted host population. Therefore, investigating the chronic carrier state should provide insight into bacterial survival strategies, as well as new therapeutic approaches for treatments.

[Transmission route of H. pylori]

The incidence of Helicobacter pylori (H. pylori) infection is rapidly decreased in Japan. H. pylori infection is mainly acquired in the first 2 years life and the risk of infection declines rapidly after 5 years of age. Person-to-person transmission in the family appears to be the predominant and in the population with low prevalence, several studies showed the infected mother is likely to be the main source of the infection. H. pylori can be detected from vomitus, saliva and cathartic stools and the possibility of source of infection. Waterborne infection is unlikely in the developed countries.

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.

Epidemiological ins and outs of helicobacter pylori: a review

Helicobacter pylori infection is now recognised as a worldwide problem. It is the most common cause of chronic gastritis, and is strongly linked to peptic ulcer disease and gastric cancer. A comprehensive understanding of epidemiological ins and outs of H. pylori infection is very important in solving the patho-physiological enigma and might help in leading towards better management and prognosis of infection. This article presents a review of the literature on the epidemiology of H. pylori infection from 2006 to 2011. The authors used Medical Subject Heading (MeSH) terms 'Helicobacter' with 'epidemiology,' 'transmission' or 'risk factor' to search PubMed database. All relevant studies identified were included. Despite extensive medical advancement, many questions on Helicobacter pylori epidemiology still remain unanswered. Further studies are, therefore, required to gain a better understanding of the transmission pathway of this notorious pathogen.

Helicobacter pylori persistence in children: distinguishing inadequate treatment, resistant organisms, and reinfection

Helicobacter pylori is a worldwide infection that causes chronic gastritis, duodenal ulcers, and malignancy. Transmission of Helicobacter pylori within a family appears to be the predominant mode of contamination. Recurrence of the infection is frequently seen following treatment. Lack of eradication due to either inadequate treatment or resistant bacteria vs. reinfection have been explanations for detection of H. pylori following treatment. In this article we will discuss the concepts of inadequate treatment vs. resistant infection and reinfection as causes of persistent H. pylori infection.

[Helicobacter pylori: routes of transmission of infection (a review of literature)]

The paper reviews the data characterizing the routes of transmission of Helicobacter pylori. Particular emphasis is laid on the water transmission route that has not been long considered to be important despite strong epidemiological evidence that allows it to be regarded as one of the most important routes of transmission of this infection. It describes the most favorable conditions for this microorganism to survive in the water systems, including plumbing, and a possible survival mechanism via biofilm formation and zooplankton symbiosis. The pathogen is able to bind to autochronous microorganisms in the biofilms and to generate itself the latter. It is not inconceivable that this microbe can persist and even multiply within protozoa. Due to the improved analytical studies, there are additional possibilities to detect new pathogenic microorganisms that have not been historically regarded as pollutants. These microorganisms are of interest to community hygiene specialists. The preferred routes of urban and rural transmission of the pathogen may be different, which should be taken into account when elaborating preventive measures.

PCR assay targeting virulence genes of Helicobacter pylori isolated from drinking water and clinical samples in Lahore metropolitan, Pakistan

Helicobacter pylorus is considered for chronic gastritis, gastric ulcers and adenocarcinoma and its high infection rate is observed in overcrowded and lower socioeconomic groups in developing countries. This study was designed to identify the role of drinking water in the transmission and prevalence of H. pylori (HP). Selective HP medium was developed for enrichment and presumptive identification of H. pylori by urease, catalase and species specific 16S rRNA tests. The virulence genes (vacA 's' and 'm' regions and cagA) of H. pylori in 90 out of 225 H. pylori positive drinking water samples were present (40%). Ten out of 18 biopsies (55.55%) and 15 out of 50 vomiting fluids of gastric disease patients (30%) were also positive for virulence genes. Anti-H. pylori antibodies were also detected in 31 out of 50 patients' sera. The presence of virulence genes was also directly confirmed by hybridization studies using non-radioactive DNA probes of 16S rRNA, vacA and cagA genes. The presence of H. pylori in water is due to poor sanitary conditions, improper waste disposal and lack of public health education. PCR-based analysis and colony hybridization can be used for detection of H. pylori in clinical and environmental samples.

Detection of Helicobacter pylori in saliva and esophagus

The route of Helicobacter pylori transmission remains unclear and the currently suggested route is person-to-person transfer by faecal-oral and oral-oral mode. The aim of this study was to verify the presence of H. pylori in esophagus and saliva of humans. Saliva samples, mucosal biopsies from esophagus, gastric antrum and fundus were collected from 19 patients with positive Urea Breath Test (UBT). Gastric biopsies were used for H. pylori colture and antimicrobial susceptibility tests whereas saliva samples were collected to detect H. pylori with a Nested-PCR targeting 16S rRNA gene as well as esophagus biopsies which were also investigated with immunohistochemical staining. Helicobacter pylori was isolated in 18 patients both in gastric antrum and fundus. The molecular analysis, confirmed by comparative sequences evaluation, gave positive results in all saliva and esophageal samples whereas the immunohistochemistry revealed the presence of H. pylori in 15.8% (3/19) of the esophagus samples. Our data suggest that saliva and esophagus may be considered reservoirs for H. pylori in humans and emphasize the need to use more susceptible techniques for H. pylori detection, in particular in over-crowded sites. Identification of the transmission route of H. pylori is crucial in developing an effective plan of surveillance by finding new means of disease management.

Isolation and identification of Helicobacter pylori from drinking water in Basra governorate, Iraq

The mode of the transmission of Helicobacterpylori infection remains poorly understood. A total of 198 samples of drinking water from 22 districts of Basra governorate were collected during the period October 2006 to July 2007. The concentration of residual chlorine was measured and the numbers of total and faecal coliforms were counted. On modified Columbia urea agar, 469 bacterial cultures were obtained, of which 173 isolates were identified. Only 14 isolates were Helicobacter spp., of which 10 were H. pylori (2.0% of the total isolates). These isolates were tested for antibiotic susceptibility as well as ability to tolerate chlorine at 0.5 mg/L. To our knowledge, this is the first report of the occurrence of H. pylori in treated municipal drinking water.

A rigorous small area modelling-study for the Helicobacter pylori epidemiology

This paper presents an investigation into spatial risk differences over small distances for the Helicobacter pylori infection in the city of Leipzig, Germany and two rural districts. A model, using Bayesian inference, was developed that adjusts the risk for individual-specific factors, and for spatial or individual over-dispersion, respectively. Additionally, the model takes into account conditional spatial autocorrelation. We found a significant positive association to the H. pylori infection risk for: "more than three children live in the household" (OR=2.4, p=0.001), "more persons live per sq.m than average" (OR=1.4, p=0.03), "home situated at main road" (OR=1.4, p=0.04) and "using well water" (OR=2.3, p=0.05). A protective effect was identified for "travelled to low prevalence region" (OR=0.4, p<0.0001) and "born in Germany" (OR=0.2, p<0.0001). Three administrative areas with significantly increased spatial risk were identified: one in the rural district and two in the city of Leipzig. The model explained 24.9% of the total deviance. Contrary to expectations, the largest part of deviance of the data was not explained by the identified significant risk factors, but by individual-specific heterogeneities. We conclude that further - so far not discussed - factors influence the risk and the spatial variation of the H.pylori infection. Furthermore, from the results we speculate about a possible impact of long-time air pollution and surface water.

[Is the mother a risk factor for transmission of Helicobacter pylori infection in children between the ages of 6 months and 5 years in Côte d'Ivoire?]

OBJECTIVES

The goals of this study were to determine the prevalence of H. pylori antibodies in children, to establish the relationship between child and mother serostatus, and to identify potential risk factors for contamination.

MATERIAL AND METHODS

A cross-sectional study was conducted over a 3-month period. All children between 6 months and 5 years of age examined in the Pediatrics Department of the University Hospital Center in Yopougon, Côte d'Ivoire were included after obtaining informed consent from their mothers. Testing for H. pylori antibodies using Pylorix (Acon) was performed in both children and mothers. Based on test results, children were divided into two groups, i.e. case group with H. pylori antibodies and control group without H. pylori antibodies. Case and control groups were compared according to the H. pylori status of their mother and several potential lifestyle and environmental factors.

RESULTS

A total of 101 children and 101 mothers were included. The prevalence of H. pylori antibodies was 40.6% in mothers and 24.8% in children. The mean age of children (53% male) was 22.8 +/- 15.6 months (median, 18 months). The mean age of the mothers was 29.6 +/- 5.5 years (range, 19 to 46 years; median, 29 years). Most mothers, i.e., 78.2%, lived in two-parent households but 19% lived in single-parent settings (community or shacks). The number of persons living in the same house ranged from 2 to 20 people (mean, 7.2 +/- 3.8; median, 6 people). Mean monthly household income was 226,188 +/- 161,425 FCFA (range: 30,000 - 750,000 FCFA). In the case group, 80% of children had mothers infected with H. pylori. In the control group, 73.7% of children had non-infected mothers (OR = 11.2, p < 0.001). Median income was less than 150 000 FCA in 76% of families with seropositive children in comparison to 46.1% of families with seronegative children (p = 0.009).

CONCLUSION

This study confirms the early occurrence of H. pylori infection in children. Findings also showed that poor socio-economic condition was a risk factor for infection but the greatest risk factor was living with a mother infected with H. pylori.

Helicobacter pylori infection in mother and infant pairs in Anatolia

BACKGROUND/AIMS

The aim of this prospective study was to determine the seroprevalence rates of Helicobacter pylori in mother and infant pairs and to discuss the possible fecal-oral transmission route of Helicobacter pylori infection in the early years of life.

METHODS

Forty-eight mother-child pairs were followed for 12 months. Helicobacter pylori IgG and hepatitis A virus (HAV) IgG levels were measured in maternal sera, infant sera and breast-milk samples at birth and in breast-milk samples and infant sera at follow-up visits.

RESULTS

At birth, the rate of Helicobacter pylori positivity was 81.25% in breast-milk and 95.8% in maternal and infant sera. Although there was a decrease in seropositivity in both baby sera and breast-milk at the age of nine months, an increase was observed in the 12th month. Hepatitis A virus IgG was measured to show whether Helicobacter pylori and hepatitis A virus use the same transmission routes. Hepatitis A was positive in all infants' sera, in 95.8% of mothers' sera, and in 68.75% of breast-milk samples. Seropositivity rates in infants whose mothers were seropositive for Helicobacter pylori and hepatitis A virus decreased gradually. There was an increase after the 9th month of life.

CONCLUSIONS

Helicobacter pylori seroprevalence rates are high in Anatolia. It is possible that the decrease in breastfeeding with increased introduction of supplemental foods may lead to an increased risk of exposure to Helicobacter pylori.

The association of drinking water quality and sewage disposal with Helicobacter pylori incidence in infants: the potential role of water-borne transmission

The mode of transmission of Helicobacter pylori, a bacterium causing gastric cancer and peptic ulcer disease, is unknown although waterborne transmission is a likely pathway. This study investigated the hypothesis that access to treated water and a sanitary sewerage system reduces the H. pylori incidence rate, using data from 472 participants in a cohort study that followed children in Juarez, Mexico, and El Paso, Texas, from April 1998, with caretaker interviews and the urea breath test for detecting H. pylori infection at target intervals of six months from birth through 24 months of age. The unadjusted hazard ratio comparing bottled/vending machine water to a municipal water supply was 0.71 (95% confidence interval (CI): 0.50, 1.01) and comparing a municipal sewer connection to a septic tank or cesspool, 0.85 (95% CI: 0.60, 1.20). After adjustment for maternal education and country, the hazard ratios decreased slightly to 0.70 (95% confidence interval: 0.49, 1.00) and 0.77 (95% confidence interval: 0.50, 1.21), respectively. These results provide moderate support for potential waterborne transmission of H. pylori.

Gastric tubes as vectors of Helicobacter pylori transmission

Peptic ulcer was a rare disease before 1850. The prevalence of peptic ulcer increased gradually in persons born between 1870 and 1900. A similar decay in opposite direction of the prevalence occurred after the 1960-1970s. Although the pathogenesis of peptic ulcer is readily explained by the Helicobacter pylori infection, the bacterium occurred many thousands years ago and followed the migrations of human populations; consequently, its presence does not explain the increase in peptic ulcer prevalence. Gastric tubes for secretory testing were introduced from 1871 and their use was extended gradually in the then growing departments of gastroenterology, becoming a very popular, though unpleasant method. There is circumstantial evidence from the pre-H. pylori era that gastric/enteral infections could be transmitted though contaminated gastric tubes/electrodes. The author's hypothesis is based on the temporary overlap of the increased peptic ulcer prevalence and the extensive use of gastric secretory testing. The use of contaminated gastric tubes in sick persons harbouring pathogenic strains of the bacterium could have led to the transmission of the infection by gastro-oral route to the patients' ward-mates and on, to their family members: years later, new ulcer or dyspeptic patients may have come from such groups. The current decay in peptic ulcer prevalence could be due to the decreased use of secretory testing and implementation of rigorous disinfection rules.

[Epidemiology of H. pylori infection and exploration of its infection route]

To build up a preventive strategy for H. pylori related diseases including gastric cancer, infection ages and routes are important. Recently, several studies have explored them. In advanced countries, most infections occur under five years of age. Mother to child in some studies and sibling to sibling in others were dominant infection routes. As infection ages and routes depend on countries, studies in Japan are indispensable. Infection in kindergartens, nursery and elementary schools as well as in families should be explored. Based on the findings, a strategy preventing infection to children should be build up to prevention H. pylori related diseases.

[Helicobacter pylori infection in childhood]

Helicobacter pylori (H. pylori) infection is mainly acquired in the first 2 or 3 years and the risk of infection declines rapidly after 5 years of age. In developing countries, acquisition age of the infection is probably lower than in developed countries. In Japan, main transmission route is intrafamilial and mother to children infection is most important. But in developing countries, some reports suggest that extrafamilial infection is more important. The famous paper revealed that H. pylori can be cultivated from vomitus, saliva and cathartic stools and the possibility of source of H. pylori infection. Bed sharing, large number of family members, delayed weaning from a feeding bottle, regurgitated gastric juice in the mother's mouth are reported as risk factors of the infection.

[Epidemiological study on status of Helicobacter pylori in children and teenagers in Wuwei city, Gansu province]

OBJECTIVE

To investigate the prevalence of Helicobacter pylori (Hp) infection among children aged 3 to 18 years old of Wuwei city, Gansu province.

METHODS

The study was based upon a personal questionnaire and a determination of Hp antigen using the Hp stool antigen test (HpSA) method. A total of 938 subjects and 96 families were selected in Wuwei city. Eighty children and teenagers with a definite positive Hp stool antigen test were examined by serum Western blotting method.

RESULTS

The prevalence of Hp was 72.3% (678/938) with no age difference. Prevalence of Hp infection was correlated with type of dwelling, occupation of parents, drinking water source, kindergarten attendance, consumption of raw vegetables, a poor oral hygiene and breast feeding etc. According to the multivariate analysis, drinking water source, kindergarten attendance and consumption of raw vegetables were most strongly associated with prevalence of Hp in children and adolescents. The infection rate of parents whose children were infected with Hp was higher than that of those whose children were not infected [82.3% (121/147) vs 47.4% (18/38), chi(2) = 19.736, P < 0.05]. The antibody responses of 57 samples (71.3%) from 80 children were of type I Hp and 23 samples (28.7%) type II.

CONCLUSIONS

Hp infective rate is high in Wuwei city. The data support maternal-child and sibling-sibling transmission as the primary transmission routes of Hp. The results of serological analysis confirm that the majority of Wuwei Hp infection is of type I.

Transmission of Helicobacter pylori and the role of water and biofilms

Documented evidence relating to the survival of Helicobacter pylori outside the gastric niche is extremely limited. To date the primary transmission routes of H. pylori have yet to be confirmed and when this is achieved preventive infection control measures can be implemented to reduce and ultimately prevent human infection from this pathogen. There is mounting evidence which suggests that the prevalence of H. pylori infection has a strong correlation with access to clean water, suggesting a transmission route to the host. However, there are no established culture methods for the detection of viable H. pylori in the environment, in particular drinking water supplies, preventing the development of true epidemiological and risk assessments. The aim of this review is to highlight the available data to date that suggests drinking water and possible survival in biofilms as a probable transmission mode for H. pylori.

Epidemiology of Helicobacter pylori infection in Malaysia--observations in a multiracial Asian population

Observations of racial differences in the prevalence of Helicobacter pylori in Malaysia have been intriguing. The Indians and Chinese consistently have a higher prevalence compared to the Malays. The racial cohort theory has been proposed to explain these differences where transmission and perpetuation of infection takes place within a racial group rather than between races, races being separate owing to the low rate of interracial marriages. Studies have demonstrated distinctive bacterial strains between races. Phylogenetic studies have shown that H. pylori isolates amongst Chinese and Indians are distinctive while Malays have Indian and other strains suggesting a more recent acquisition of the bacterium from Indians. H. pylori is recognized as the major causative factor in peptic ulcer disease and gastric cancer. Despite the high prevalence of H. pylori, Indians have a relatively low prevalence of peptic ulcer disease and a low incidence of gastric cancer. This paradox with regards to gastric cancer has been termed the "Indian enigma". Bacterial strain differences between races may be putative but this observation may also indicate gastroprotective environmental factors or a lower genetic susceptibility to develop cancer in the Indians.

Evaluation of eating habits in dyspeptic patients with or without Helicobacter pylori infection

BACKGROUND

The prevalence of Helicobacter pylori infection varies in different societies and geographical locations. This is attributed to socioeconomic status, life style, family density and other factors. There is also a possibility of an association between eating habits and the prevalence of H. pylori infection.

AIM

In this study, we examine the association between H. pylori infection and particular eating habits such as sharing plates, glasses and spoons.

METHODS

This cross-sectional study was performed via a questionnaire-based evaluation of all patients with dyspepsia who underwent endoscopic assessment. Data including demographic information, endoscopic findings, H. pylori status and sharing of dishes within families were recorded. Individuals with a history of 3-day antibiotic treatment in the past month, or use of proton pump inhibitors in the past two weeks, or regular use of H2-blockers during the past week were excluded. The H. pylori status was determined using the rapid urease test.

RESULTS

Of the 225 participants who had filled in the questionnaire, 204 were eligible; 92 were male (45.1%) and 112 female (54.9%) with 22% younger than 30 years of age, 49% between 30 and 50 years and 29% older than 50. In families where common dishes were used, the prevalence of H. pylori infection was significantly higher. (77% vs. 53%, p = 0.001) Factors such as age, sex, and education proved to be irrelevant.

CONCLUSION

The results suggest a strong link between H. pylori infection and eating habits, thereby raising the possibility that modification of these habits might limit H. pylori infection.

[Helicobacter pylori 25 years after (1983 -2008): epidemiology, microbiology, pathogenics, diagnostics and treatment]

EPIDEMIOLOGY

People have been infected by this bacteria 58,000 years ago. Prevalence of infection varies in different nation. In developing countries infection is acquired in early childhood. The forms of infection are/fecal-oral, oral-oral an gastro oral. In Perú we found same prevalence in the coast, jungle and sierra and described that water is one of the ways of infection.MICROBIOLOGY: Three strains predominant in Spanish, Asiatic and people from India have been identified. DNA has 1.65 million bases. Different factors of virulence, enzymes and toxins have also been described.

PATHOGENESIS

Inflamatory response; neutrophiles, lymphocytes T and B, plasma cells, macrophages.METHODS OF DIAGNOSIS: Invasive and non invasive procedures.

THERAPY

Different treatment schemes are described: 1st, 2nd, 3rd lines, rescue therapies. Secondary reactions, alternative schemes, recurrence, reinfection and experience in Perú are also described.

Helicobacter infection decreases reproductive performance of IL10-deficient mice

Infections with a variety of Helicobacter species have been documented in rodent research facilities, with variable effects on rodent health. Helicobacter typhlonius has been reported to cause enteric disease in immunodeficient and IL10(-/-) mice, whereas H. rodentium has only been reported to cause disease in immunodeficient mice coinfected with other Helicobacter species. The effect of Helicobacter infections on murine reproduction has not been well studied. The reproductive performance of C57BL/6 IL10(-/-) female mice intentionally infected with H. typhlonius, H. rodentium, or both was compared with that of age-matched uninfected controls or similarly infected mice that received antihelicobacter therapy. The presence of Helicobacter organisms in stool and relevant tissues was detected by PCR assays. Helicobacter infection of IL10(-/-) female mice markedly decreased pregnancy rates and pup survival. The number of pups surviving to weaning was greatest in noninfected mice and decreased for H. rodentium > H. typhlonius >> H. rodentium and H. typhlonius coinfected mice. Helicobacter organisms were detected by semiquantitative real-time PCR in the reproductive organs of a subset of infected mice. Treatment of infected mice with a 4-drug regimen consisting of amoxicillin, clarithromycin, metronidazole, and omeprazole increased pregnancy rates, and pup survival and dam fecundity improved. We conclude that infection with H. typhlonius, H. rodentium, or both decreased the reproductive performance of IL10(-/-) mice. In addition, antihelicobacter therapy improved fecundity and enhanced pup survival.