Materiały źródłowe

• #1 Helicobacter pylori: Epidemiology, pathophysiology, and overview of disease associations – UpToDate

  http://www.uptodate.com/contents/helicobacter-pylori-epidemiology-pathophysiology-and-overview-of-disease-associations/print

  Helicobacter pylori: Epidemiology, pathophysiology, and overview of disease associations […] Helicobacter pylori is the most common chronic bacterial infection in humans and the most common cause of infection-associated cancer. H. pylori is a gram-negative bacterium that appears to have coevolved with humans for nearly 60,000 years since humans first migrated out of Africa. It colonizes the human gastric mucosa and invariably causes gastritis, which may progress to overt gastroduodenal disease depending on the host, microbe, and environmental factors. […] This topic discusses the epidemiology, pathogenesis, and diseases that are associated with H. pylori infection. […] Prevalence — The reported prevalence of H. pylori depends on the testing modality used to diagnose infection. Nonserologic testing methods, such as stool antigen and urea breath testing, indicate active H. pylori infection. By contrast, H. pylori serology detects antibody status and does not differentiate active from former infection (ie, previously treated and eradicated).

• #2 Helicobacter pylori: Epidemiology, pathophysiology, and overview of disease associations – UpToDate

  http://www.uptodate.com/contents/helicobacter-pylori-epidemiology-pathophysiology-and-overview-of-disease-associations/print

  Global prevalence – Approximately 40 to 60 percent of the global population is currently or has previously been infected with H. pylori. Prevalence among and within countries varies. Pooled data from systematic reviews demonstrate that H. pylori prevalence is highest in the eastern Mediterranean (56.1 percent, 95% CI 37.3-74.9) and in Africa (53.3 percent, 95% CI 42.4-64.2) and lowest in the western Pacific (37.9 percent, 95% CI 33.8-42.1) and the Americas (32.8 percent, 95% CI 19.3-46.4 percent).

• #3 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20230428/Study-offers-a-comprehensive-updated-epidemiology-of-H-pylori-infection.aspx

  A research team led by Professor Leung Wai-keung from Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong (HKUMed) and the Baylor College of Medicine of the United States found that Helicobacter pylori (H. pylori) infection around the world has been steadily declining over the past four decades, thus offering a comprehensive, updated epidemiology of H. pylori infection. […] The study found that the global prevalence of H. pylori infection has been declining from 58.2% in the decade of 1980-1990 to 43.1% in the period of 2011-2022. On average, there was a decline of about 0.39-0.83% per year in the prevalence of H. pylori infection in the world. […] Our latest estimation shows that more than 40% of the adult population in the world is still infected with H. pylori, this could still pose a major burden on the health care system, especially on the morbidity and mortality related to peptic ulcer disease and gastric cancer.

• #4 Global Prevalence of H. pylori Infection Has Been Steadily Declining for Over 40 Years | Technology Networks

  https://www.technologynetworks.com/immunology/news/global-prevalence-of-h-pylori-infection-has-been-steadily-declining-for-over-40-years-372580

  A research team led by Professor Leung Wai-keung from Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong (HKUMed) and the Baylor College of Medicine of the United States found that Helicobacter pylori (H. pylori) infection around the world has been steadily declining over the past four decades, thus offering a comprehensive, updated epidemiology of H. pylori infection. […] The study found that the global prevalence of H. pylori infection has been declining from 58.2% in the decade of 1980-1990 to 43.1% in the period of 2011-2022. […] Our latest estimation shows that more than 40% of the adult population in the world is still infected with H. pylori, this could still pose a major burden on the health care system, especially on the morbidity and mortality related to peptic ulcer disease and gastric cancer.

• #5 Helicobacter pylori: Epidemiology, pathophysiology, and overview of disease associations – UpToDate

  http://www.uptodate.com/contents/helicobacter-pylori-epidemiology-pathophysiology-and-overview-of-disease-associations/print

  Global prevalence – Approximately 40 to 60 percent of the global population is currently or has previously been infected with H. pylori. Prevalence among and within countries varies. Pooled data from systematic reviews demonstrate that H. pylori prevalence is highest in the eastern Mediterranean (56.1 percent, 95% CI 37.3-74.9) and in Africa (53.3 percent, 95% CI 42.4-64.2) and lowest in the western Pacific (37.9 percent, 95% CI 33.8-42.1) and the Americas (32.8 percent, 95% CI 19.3-46.4 percent).

• #6 Antimicrobial Resistance Incidence and Risk Factors among Helicobacter pylori–Infected Persons, United States – Volume 10, Number 6—June 2004 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/10/6/03-0744_article

  Helicobacter pylori is the primary cause of peptic ulcer disease and an etiologic agent in the development of gastric cancer. H. pylori infection is curable with regimens of multiple antimicrobial agents, and antimicrobial resistance is a leading cause of treatment failure. The Helicobacter pylori Antimicrobial Resistance Monitoring Program (HARP) is a prospective, multicenter U.S. network that tracks national prevalence rates of H. pylori antimicrobial resistance. […] The prevalence of Helicobacter pylori infection worldwide is approximately 50%, as high as 80%-90% in developing countries, and 35%-40% in the United States. […] The annual incidence of H. pylori infection is 4%-15% in developing countries, compared with approximately 0.5% in industrialized countries. Documented risk factors include low socioeconomic status, overcrowding, poor sanitation or hygiene, and living in a developing country.

• #7 Helicobacter Pylori Infection: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/176938-overview

  Helicobacter pylori is a ubiquitous organism that is present in about 50% of the global population. […] H pylori infection occurs more frequently in developing countries than in industrialized countries. […] H pylori is a ubiquitous organism. At least 50% of all people are infected, but an exact determination is not available, mostly because precise data are not available from developing countries. […] The frequency of H pylori infection may be linked to race and low socioeconomic status. White persons account for 29% of cases, and Hispanic persons account for 60% of cases. […] The pathogenetic role of H pylori may differ depending on the geography and race. White persons are infected with H pylori less frequently than persons of other racial groups. The prevalence rate is approximately 20% in white persons, 54% in African American persons, and 60% in Hispanic persons. […] H pylori infection may be acquired at any age. According to some epidemiologic studies, this infection is acquired most frequently during childhood. Children and females have a higher incidence of reinfection (5%-8%) than adult males.

• #8 H. Pylori: Prevalence and Incidence | Zuckerman College of Public Health

  https://publichealth.arizona.edu/outreach/health-literacy-awareness/hpylori/prevalence-incidence

  H. pylori prevalence and incidence differs by geography and race. Prevalence refers to the total number of people that have a disease at a given time, while incidence refers to new infections of a disease. In general, H. pylori prevalence is higher in developing countries and declining in the United States. Incidence of new infections in developing countries is 3 to 10 percent of the population each year compared to 0.5 percent in developed countries. […] In the United States, H. pylori prevalence is higher in Hispanics, African Americans, and the elderly. H. pylori prevalence is 60 percent in Hispanics, 54 percent in African Americans, and 20 percent in whites. […] In the United States, the estimated prevalence is 20 percent for people younger than 30 years and 50 percent for those older than 60 years.

• #9 Worldwide Prevalence and Risk Factors of Helicobacter pylori Infection in Children

  https://www.mdpi.com/2227-9067/9/9/1359

  Worldwide Prevalence and Risk Factors of Helicobacter pylori Infection in Children […] 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.

• #10 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  Although such studies may suggest that in some cases transmission may occur between spouses, one cannot rule out the possibility that carriage of the same strain by spouses may have occurred due to a child infected by one parent subsequently infecting the second parent. Indeed, evidence that children may facilitate the spread of H. pylori has come from several studies, some showing that the number of children in a family is associated with an increased risk of infection in adult family members. […] Numerous studies conducted throughout the world have shown low socioeconomic status to be associated with an increased prevalence of H. pylori infection. In particular, the socioeconomic status of a subject during childhood is considered to be an important determinant of the development of H. pylori infection. The role of socioeconomic status per se is particularly clear if one examines the prevalence of H. pylori infection in poorer racial groups living in developed countries. For example, in a study examining the relationship between socioeconomic status in childhood and the prevalence of H. pylori in African-American and Hispanic populations resident in the United States, Malaty et al. found the prevalence of H. pylori infection to be inversely related to social class during childhood, the prevalence of infection in the lowest social class (85%) being significantly higher than that in the highest social class (11%). The importance of socioeconomic status in childhood has been further demonstrated in an elegant study of monozygotic twins reared apart and discordant for their H. pylori status. In this study, Malaty and colleagues showed that the twins infected with H. pylori had been raised in homes under poorer socioeconomic conditions than those of their unaffected co-twins.

• #11 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  Socioeconomic status is, however, a broad criterion and encompasses factors such as level of hygiene, sanitation, density of living, and educational opportunities, some or all of which have been reported to influence the level of infection within a population. […] Low levels of sanitation have been associated with an increased prevalence of H. pylori infection. In particular, the absence of running water in the childhood home has been shown to be a significant risk factor for H. pylori infection. Interestingly, Irish soldiers exposed to poor living conditions and sanitation for 6 months showed no significant change in prevalence of H. pylori infection, a finding that further supports the view that acquisition of infection primarily occurs in childhood. […] In both developed and developing countries high density of living has been consistently related to an increased prevalence of H. pylori infection. The importance of overcrowding in the acquisition of H. pylori is further accentuated by the finding that sharing a bed in childhood is associated with an increased prevalence of H. pylori infection.

• #12 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  Educational level, also a surrogate marker of socioeconomic status, has been shown in both developed and developing countries to be an important determinant of H. pylori prevalence. For example, in a large seroepidemiological study that examined the prevalence of H. pylori infection in 3,194 asymptomatic subjects living in 17 different populations, Forman et al. showed an inverse relationship to exist between the prevalence of H. pylori infection and educational level, 34% of subjects with a tertiary education being found to be infected compared with 47% of those with a secondary education and 63% of those with only a primary school education. […] The influence of living conditions on the prevalence of H. pylori infection is clearly illustrated in countries where socioeconomic conditions have significantly improved over the last few decades. For example, in Japan the fall in prevalence of H. pylori infection in subjects less than 40 years of age has been related to the significant improvement of the Japanese economy, and hence living conditions, following the Second World War. A similar trend has been noted in Korea, another country that has recently undergone substantial improvements in its standard of living.

• #13 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  To date, there have been few studies that have examined the role of genetic predisposition in relation to H. pylori infection. In an attempt to examine the importance of genetic factors on the acquisition of H. pylori infection, Malaty et al. compared the seroprevalence of H. pylori infection in 100 monozygotic and 169 dizygotic twins reared together and reared apart. The results of this study showed the correlation coefficient for the relative importance of genetic predisposition on acquisition of H. pylori infection to be approximately 0.66, with the remaining variance being accounted for by shared rearing environmental factors and non-shared environmental factors. As a result of this study, Malaty et al. concluded that genetic effects influenced the acquisition of H. pylori infection due to greater similarities within monozygotic twin pairs and that sharing of the same rearing environment also contributed to the familial tendency for acquiring H. pylori infection.

• #14 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  It is probably true to say that the most studied and certainly the most controversial area of H. pylori epidemiological research today is the route of transmission of H. pylori. Given the location of H. pylori infection and the basic need of this bacterium for gastric-type mucosa for in vivo proliferation, ingestion appears to be the most likely means of acquiring H. pylori. However, whether H. pylori reaches the oral cavity via the gastro-oral, oral-oral, or fecal-oral route remains open for conjecture. One of the major difficulties in attempting to culture H. pylori from feces or the oral cavity is the presence in these sites of the autochthonous microbiota. These bacteria tend to grow much more rapidly than H. pylori and hence, even if H. pylori is present, they will often mask its presence.

• #15 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  The presence of H. pylori in the gastric juice of up to 58% of patients infected with H. pylori raises the possibility that refluxed gastric juice may represent a vehicle of transmission for this organism. Indeed, direct contact with gastric secretions has been implicated in the higher prevalence of H. pylori infection reported in gastroenterologists and in the reported epidemics of Helicobacter gastritis following gastric intubation experiments. […] The possibility that the gastro-oral route may be an important route of transmission of H. pylori in childhood has been postulated by a number of researchers. For example, an early report postulated that the most likely route of transmission of H. pylori was via stomach secretions or vomitus. Although at that time there was no evidence to support this view, vomiting and regurgitation of gastric material into the mouth are fairly common in childhood and may represent an important route of transmission.

• #16 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  Evidence to support the view that gastro-oral transmission via contaminated vomitus may represent an important mode of transmitting H. pylori, especially in children, has recently been published by Leung et al. In this study, four children presenting with gastroenteritis-associated vomiting were shown serologically to be infected with H. pylori. In one of these children H. pylori was isolated from the vomitus and from two others H. pylori DNA was detected in vomitus by PCR. Interestingly, an 18-month-old girl, negative by serology for H. pylori but in whom H. pylori DNA was detected in vomitus 6 months later, showed seroconversion for H. pylori. Support for the view that vomitus may be an important vehicle in the spread of H. pylori has come from a recent study by Parsonnet et al. In this study, H. pylori was cultured from the vomitus of 100% of adult subjects who had been given an emetic to induce vomiting. Interestingly, air sampled in an area 0.3 meter away from these subjects during vomiting grew H. pylori in 6 of 16 (37.5%) instances, but air samples collected 1.2 meters away from subjects failed to yield H. pylori.

• #17 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  Indirect evidence of the importance of vomiting in the transmission of H. pylori has also recently been shown by Luzza et al. In this study, vomiting siblings and siblings of 100 vomiting index children were screened by means of the [13C]urea breath test for H. pylori. A high rate of active H. pylori infection was shown to be present in both vomiting siblings (60%) and siblings of H. pylori-infected vomiting index children, with a history of vomiting in siblings being shown to be positively associated with active H. pylori infection in index children. […] Attempts to culture H. pylori from the oral cavity have proved in many cases to be fruitless. There have, however, been a limited number of studies where H. pylori has been isolated from dental plaque and saliva. In an early study Krajden et al. isolated H. pylori from the dental plaque of 1 of 29 patients whose stomach biopsies were shown to be positive for H. pylori. Comparison of the strains isolated from the stomach and dental plaque of this patient with restriction endonuclease analysis subsequently showed one of three strains isolated from dental plaque to be indistinguishable from that isolated from the stomach. Cellini et al. also reported the isolation of H. pylori from the dental plaque of 1 of 20 H. pylori-positive endoscopy patients. In this case, comparison of the protein patterns as well as the restriction endonuclease pattern of H. pylori isolated from the stomach biopsy and from dental plaque again showed these to be identical. The isolation of low numbers of H. pylori from the saliva of one of nine H. pylori-positive subjects has been reported by Ferguson et al. Again this group showed, using restriction fragment length polymorphism, that the H. pylori strain isolated from saliva was identical to that in gastric tissue. In contrast to the low detection rate in the above studies, Desai et al. found H. pylori to be present in the dental plaque of 98% of Indian dyspeptic patients; however, in this study, identification of H. pylori was based solely on the urease test. Given the presence of other urease-positive organisms in the mouth, it is possible that the identification of isolates as H. pylori in this study may have been false. The possibility of falsely identifying normal flora from the oral cavity as H. pylori has been reported by Namavar et al., who showed that organisms isolated from the tongue and palate of one patient and considered to be phenotypically identical to H. pylori were in fact negative by an H. pylori-specific PCR. In an important study recently published by Parsonnet et al., H. pylori was successfully cultured from the saliva of three subjects. Following the induction of vomiting in these subjects with an emetic, Parsonnet and colleagues were able to culture H. pylori from nine (56%) subjects.

• #18 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  Failure to consistently isolate H. pylori from reservoirs other than humans suggests that direct person-to-person contact is the most likely mode of transmission. The finding of an increased prevalence of H. pylori infection in institutionalized subjects supports this view and suggests that close personal contact is important for the spread of H. pylori. The importance of close contact is further emphasized by the finding that the prevalence of H. pylori infection is significantly increased in family members of children infected with H. pylori as compared with that in family members of children not infected with H. pylori. Such findings have led to the view that transmission of H. pylori occurs mainly within the family setting. The relative risk of a child becoming infected with H. pylori has been reported to be approximately eight times greater if the mother is infected and approximately four times greater if the father is infected.

• #19 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  The key role of infected mothers in the transmission of H. pylori within families has recently been confirmed by Malaty et al., who monitored longitudinal changes in H. pylori status in 46 Japanese families with children and 48 Japanese couples without children. This study showed that the relative risk of children with H. pylori-positive mothers acquiring infection was 5.3 times that of children whose mothers were H. pylori negative. Confirming the importance of adult-child transmission, seroconversion only occurred among children living with H. pylori-positive mothers over the period of the study. The finding in a number of studies of identical strains of H. pylori within family members further supports intrafamilial transmission. […] Although the majority of studies support interfamilial transmission, a case-control study conducted in Bangladeshi families has reported the prevalence of infection in parents of H. pylori-positive children to be the same as that in H. pylori-negative children. This finding may indicate that in some countries the source of H. pylori infection may lie outside the family.

• #20 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  Family composition has also been shown to influence the transmission of H. pylori, the relative risk of infection being shown to increase according to the number of siblings within the household, the odds ratios for one, two, three, and four to five siblings being reported by Goodman et al. to be 1.4, 2.3, 2.6, and 4.3, respectively. This study also showed that transmission of infection occurred most readily among siblings who were close in age, transmission being most frequently from older to younger siblings. A similar finding has been reported by Rothenbacher et al. […] Whether transmission occurs between spouses remains controversial. Although a number of early seroprevalence studies found no evidence to support such transmission, a recent study of 110 employees of a health insurance company and their partners showed a strong association between partners’ infection status and infection, the risk of infection increasing with the number of years that the spouses had lived together. Further evidence that could support transmission between spouses is the finding that a significant number of couples are infected with the same strain of H. pylori. For example, Georgopoulos et al., using ribotyping to compare strains, found 8 of 18 couples to carry an identical strain of H. pylori, the remaining 10 couples in the study being colonized with different strains. In contrast, Suzuki et al., who used PCR-restriction fragment length polymorphism electrophoretic patterns of amplified ureB to compare strains of H. pylori from 21 asymptomatic couples infected with H. pylori, found only 1 couple to harbor identical strains.

• #21 H. Pylori: Prevalence and Incidence | Zuckerman College of Public Health

  https://publichealth.arizona.edu/outreach/health-literacy-awareness/hpylori/prevalence-incidence

  H. pylori prevalence and incidence differs by geography and race. Prevalence refers to the total number of people that have a disease at a given time, while incidence refers to new infections of a disease. In general, H. pylori prevalence is higher in developing countries and declining in the United States. Incidence of new infections in developing countries is 3 to 10 percent of the population each year compared to 0.5 percent in developed countries. […] In the United States, H. pylori prevalence is higher in Hispanics, African Americans, and the elderly. H. pylori prevalence is 60 percent in Hispanics, 54 percent in African Americans, and 20 percent in whites. […] In the United States, the estimated prevalence is 20 percent for people younger than 30 years and 50 percent for those older than 60 years.

• #22 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  Natural acquisition of H. pylori infection occurs, for the most part, in childhood. Once established within the gastric mucosa, the bacterium persists for life. Studies in children suggest, however, that in the early years of life prior to the establishment of infection, transient infection with H. pylori may be common. This is evidenced both by prevalence studies and a number of follow-up studies that have monitored H. pylori prevalence in the same children over a number of years. One of the first studies to suggest that loss of infection may occur in children was by Klein et al., who showed that 6-month-old Peruvian children monitored for their H. pylori status at 6-month intervals over a 2-year period had an overall probability of acquiring H. pylori of between 0.28 and 0.38, and a probability of clearing the infection of between 0.22 and 0.45 in a given 6-month period. Similar findings have been reported by Granstrom et al., who monitored the prevalence of H. pylori infection in 294 Swedish children at the ages of 6, 8, 10, and 18 months and 2, 4, and 11 years. This study showed that while at 2 years 10% of children were H. pylori positive, by 11 years of age only 3% of children remained seropositive. Although the above studies clearly demonstrate loss of H. pylori infection in children, unfortunately neither study controlled for antibiotic usage, a factor that clearly may affect H. pylori status. Consumption of antibiotics was, however, taken into consideration in a 2-year follow-up study of 48 H. pylori-positive Italian children in whom H. pylori status was monitored by the [13C]urea breath test at 6-month intervals over a 2-year period. In this study, 40 of the children were shown to remain persistently positive for H. pylori despite the fact that 10 had been treated for concomitant infections with a short course of antibiotics. The remaining eight children were found to be negative for H. pylori after 2 years and, of these, two had been given antibiotics for concomitant infections.

• #23 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  Natural acquisition of H. pylori infection occurs, for the most part, in childhood. Once established within the gastric mucosa, the bacterium persists for life. Studies in children suggest, however, that in the early years of life prior to the establishment of infection, transient infection with H. pylori may be common. This is evidenced both by prevalence studies and a number of follow-up studies that have monitored H. pylori prevalence in the same children over a number of years. One of the first studies to suggest that loss of infection may occur in children was by Klein et al., who showed that 6-month-old Peruvian children monitored for their H. pylori status at 6-month intervals over a 2-year period had an overall probability of acquiring H. pylori of between 0.28 and 0.38, and a probability of clearing the infection of between 0.22 and 0.45 in a given 6-month period. Similar findings have been reported by Granstrom et al., who monitored the prevalence of H. pylori infection in 294 Swedish children at the ages of 6, 8, 10, and 18 months and 2, 4, and 11 years. This study showed that while at 2 years 10% of children were H. pylori positive, by 11 years of age only 3% of children remained seropositive. Although the above studies clearly demonstrate loss of H. pylori infection in children, unfortunately neither study controlled for antibiotic usage, a factor that clearly may affect H. pylori status. Consumption of antibiotics was, however, taken into consideration in a 2-year follow-up study of 48 H. pylori-positive Italian children in whom H. pylori status was monitored by the [13C]urea breath test at 6-month intervals over a 2-year period. In this study, 40 of the children were shown to remain persistently positive for H. pylori despite the fact that 10 had been treated for concomitant infections with a short course of antibiotics. The remaining eight children were found to be negative for H. pylori after 2 years and, of these, two had been given antibiotics for concomitant infections.

• #24 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  Further indirect evidence for spontaneous clearance of infection in children has come from a recent seroprevalence study of 365 primary school children aged 4 to 7 years from a low-income United States-Mexico border community. This study showed a sequential falloff in H. pylori prevalence from 36% in 4-year-olds to 24% in 5-year-olds, to 20% in 6-year-olds to 14% in 7-year-olds. The authors of the study concluded that the downward trend in prevalence observed in these children suggests that transient infection might be common in young children. […] A number of studies have proposed that acquisition of H. pylori occurs via a common environmental source. In particular, animals and water have been implicated as potential sources of infection. […] The possibility that H. pylori may be a zoonosis first arose following the publication of two seroepidemiological studies that showed that the prevalence of H. pylori infection in abattoir and meat workers was significantly increased as compared with that in subjects not involved in handling animals or animal products. These findings have subsequently been questioned, and it is now suggested that the increased prevalence in these workers may have resulted from cross-reactivity between H. pylori and antibodies to other gastrointestinal organisms such as Campylobacter jejuni. Although it has been shown that both germ-free and specific pathogen-free pigs can be experimentally colonized with H. pylori, attempts to identify H. pylori in abattoir pigs with both serological and cultural techniques have failed. Dore et al. have reported a positive association between the prevalence of H. pylori in Sardinian shepherds and contact with sheep and sheepdogs. In this study, 98% of shepherds were shown to be infected with H. pylori, a prevalence significantly higher than that in their family members who did not have regular contact with sheep and blood donors. These authors concluded that „the cycle of H. pylori infection might, in certain circumstances, include phases in the environment, animals (sheep or dogs) and human beings.” The subsequent recovery of H. pylori from sheep’s milk led Dore et al. to suggest that sheep may be the ancestral host of H. pylori.

• #25 Epidemiology and diagnosis of Helicobacter pylori infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1121445/

  The stool antigen test a simple sandwich ELISA is used to detect the presence of Hpylori antigens shed in the faeces. Studies have reported sensitivities and specificities similar to those of the 13C-urea breath test (90%), and the technique has the potential to be developed as a near patient test. The main advantage of the test, however, is in large scale epidemiological studies of acquisition of Hpylori in children.

• #26 Helicobacter pylori: Epidemiology, pathophysiology, and overview of disease associations – UpToDate

  http://www.uptodate.com/contents/helicobacter-pylori-epidemiology-pathophysiology-and-overview-of-disease-associations/print

  Helicobacter pylori: Epidemiology, pathophysiology, and overview of disease associations […] Helicobacter pylori is the most common chronic bacterial infection in humans and the most common cause of infection-associated cancer. H. pylori is a gram-negative bacterium that appears to have coevolved with humans for nearly 60,000 years since humans first migrated out of Africa. It colonizes the human gastric mucosa and invariably causes gastritis, which may progress to overt gastroduodenal disease depending on the host, microbe, and environmental factors. […] This topic discusses the epidemiology, pathogenesis, and diseases that are associated with H. pylori infection. […] Prevalence — The reported prevalence of H. pylori depends on the testing modality used to diagnose infection. Nonserologic testing methods, such as stool antigen and urea breath testing, indicate active H. pylori infection. By contrast, H. pylori serology detects antibody status and does not differentiate active from former infection (ie, previously treated and eradicated).

• #27 Helicobacter pylori: Infectious substances pathogen safety data sheet – Canada.ca

  https://www.canada.ca/en/public-health/services/laboratory-biosafety-biosecurity/pathogen-safety-data-sheets-risk-assessment/helicobacter-pylori.html

  H. pylori infection can be detected using the 13C urea breath test, which is a non-invasive test based on detection of urease activity in the stomach. H. pylori can also be detected using a stool antigen test. More invasive testing involves endoscopy with gastric biopsy followed by culture and/or PCR.

• #28

  https://link.springer.com/article/10.1007/s00420-018-1315-6

  The aim of this systematic review was to describe the prevalence of Helicobacter pylori infection in specific occupational groups and to compare them with the general population. […] A total of 98 studies addressing the prevalence of H. pylori infection in occupational groups were included in the systematic review. Overall, health professionals showed a significantly higher prevalence of H. pylori infection than the general population, especially among those working at gastrointestinal units. Similar results were found in subjects involved in agricultural, forestry and fishery, as well as in sewage workers, miners, and workers at institutions for the intellectually disabled, although differences were less pronounced. […] Our results show an occupational risk of H. pylori infection supporting the role of oral-oral, fecal-oral, and zoonotic transmission. Studies comparing specific occupational groups with adequate comparators may contribute to better identify groups at higher risk of infection. The recognition of this infection as an occupational disease would result in early detection and treatment, as well as prevention and control of its transmission in workplaces.

• #29 Epidemiology and diagnosis of Helicobacter pylori infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1121445/

  Helicobacter pylori is a small, curved, highly motile, Gram negative bacillus that colonises only the mucus layer of the human stomach. Since its discovery in 1984, it has been recognised as the principal cause of peptic ulcer disease and as the main risk factor for the development of gastric cancer. However, most infected people (70%) are asymptomatic. […] Hpylori is one of the commonest bacterial pathogens in humans. The prevalence of infection varies but is falling in most developed countries. Seropositivity increases with age and low socioeconomic status. Retrospective seroepidemiological studies have shown a cohort effect consistent with the hypothesis that infection is mainly acquired in early childhood. Until recently, however, it has been difficult to assess accurately the incidence (or route) of infection because of the inaccuracy and cost of detecting (non-invasively) Hpylori in young children. Primary acquisition in adults, or reinfection after successful eradication, does occur but is less common, with an annual incidence of 0.3-0.7% in developed countries and 6-14% in developing countries.

• #30 Helicobacter Pylori (H. pylori) – ISID

  https://isid.org/guide/pathogens/hpylori/

  Several studies have shown that endoscopes and biopsy forceps readily become contaminated after endoscopic examination of H. pylori-positive patients. […] H. pylori has been found, in vitro, to be sensitive to high level chemical disinfectants within 15 to 30 seconds, but a strict minimum of 10 min immersion is recommended. […] Despite current regimens for pylori infection, there is a consensus that an effective vaccine is needed to limit the severity of this infection.

• #31 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20230428/Study-offers-a-comprehensive-updated-epidemiology-of-H-pylori-infection.aspx

  A research team led by Professor Leung Wai-keung from Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong (HKUMed) and the Baylor College of Medicine of the United States found that Helicobacter pylori (H. pylori) infection around the world has been steadily declining over the past four decades, thus offering a comprehensive, updated epidemiology of H. pylori infection. […] The study found that the global prevalence of H. pylori infection has been declining from 58.2% in the decade of 1980-1990 to 43.1% in the period of 2011-2022. On average, there was a decline of about 0.39-0.83% per year in the prevalence of H. pylori infection in the world. […] Our latest estimation shows that more than 40% of the adult population in the world is still infected with H. pylori, this could still pose a major burden on the health care system, especially on the morbidity and mortality related to peptic ulcer disease and gastric cancer.

• #32 Helicobacter pylori – Wikipedia

  https://en.wikipedia.org/wiki/Helicobacter_pylori

  In 2023, it was estimated that about two-thirds of the world’s population were infected with H. pylori infection, being more common in developing countries. H. pylori infection is more prevalent in South America, Sub-Saharan Africa, and the Middle East. The global prevalence declined markedly in the decade following 2010, with a particular reduction in Africa. […] The age when someone acquires this bacterium seems to influence the pathologic outcome of the infection. People infected at an early age are likely to develop more intense inflammation that may be followed by atrophic gastritis with a higher subsequent risk of gastric ulcer, gastric cancer, or both. Acquisition at an older age brings different gastric changes more likely to lead to duodenal ulcer. […] Infections are usually acquired in early childhood in all countries. However, the infection rate of children in developing nations is higher than in industrialized nations, probably due to poor sanitary conditions, perhaps combined with lower antibiotics usage for unrelated pathologies. In developed nations, it is currently uncommon to find infected children, but the percentage of infected people increases with age. The higher prevalence among the elderly reflects higher infection rates incurred in childhood.

• #33 Helicobacter pylori – Wikipedia

  https://en.wikipedia.org/wiki/Helicobacter_pylori

  The lower rate of infection in the West is largely attributed to higher hygiene standards and widespread use of antibiotics. Despite high rates of infection in certain areas of the world, the overall frequency of H. pylori infection is declining. However, antibiotic resistance is appearing in H. pylori; many metronidazole- and clarithromycin-resistant strains are found in most parts of the world.

• #34 Epidemiology and diagnosis of Helicobacter pylori infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1121445/

  Helicobacter pylori is a small, curved, highly motile, Gram negative bacillus that colonises only the mucus layer of the human stomach. Since its discovery in 1984, it has been recognised as the principal cause of peptic ulcer disease and as the main risk factor for the development of gastric cancer. However, most infected people (70%) are asymptomatic. […] Hpylori is one of the commonest bacterial pathogens in humans. The prevalence of infection varies but is falling in most developed countries. Seropositivity increases with age and low socioeconomic status. Retrospective seroepidemiological studies have shown a cohort effect consistent with the hypothesis that infection is mainly acquired in early childhood. Until recently, however, it has been difficult to assess accurately the incidence (or route) of infection because of the inaccuracy and cost of detecting (non-invasively) Hpylori in young children. Primary acquisition in adults, or reinfection after successful eradication, does occur but is less common, with an annual incidence of 0.3-0.7% in developed countries and 6-14% in developing countries.

• #35 Changing trends in the prevalence of H. pylori infection in Japan (1908–2003): a systematic review and meta-regression analysis of 170,752 individuals | Scientific Reports

  https://www.nature.com/articles/s41598-017-15490-7

  Changing trends in the prevalence of H. pylori infection in the general population over time are thought to be the main driving force behind the declining gastric cancer mortality in Japan. […] The prevalence of H. pylori infection confirmed a clear birth cohort pattern: the predicted prevalence (%, 95% CI) was 60.9 (56.3-65.4), 65.9 (63.9-67.9), 67.4 (66.0-68.7), 64.1 (63.1-65.1), 59.1 (58.2-60.0), 49.1 (49.0-49.2), 34.9 (34.0-35.8), 24.6 (23.5-25.8), 15.6 (14.0-17.3), and 6.6 (4.8-8.9) among those who were born in the year 1910, 1920, 1930, 1940, 1950, 1960, 1970, 1980, 1990, and 2000, respectively. […] The present study demonstrated a clear birth-cohort pattern of H. pylori infection in the Japanese population. […] The decreased prevalence of H. pylori infection in successive generations should be weighed in future gastric cancer control programs.

• #36 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  Educational level, also a surrogate marker of socioeconomic status, has been shown in both developed and developing countries to be an important determinant of H. pylori prevalence. For example, in a large seroepidemiological study that examined the prevalence of H. pylori infection in 3,194 asymptomatic subjects living in 17 different populations, Forman et al. showed an inverse relationship to exist between the prevalence of H. pylori infection and educational level, 34% of subjects with a tertiary education being found to be infected compared with 47% of those with a secondary education and 63% of those with only a primary school education. […] The influence of living conditions on the prevalence of H. pylori infection is clearly illustrated in countries where socioeconomic conditions have significantly improved over the last few decades. For example, in Japan the fall in prevalence of H. pylori infection in subjects less than 40 years of age has been related to the significant improvement of the Japanese economy, and hence living conditions, following the Second World War. A similar trend has been noted in Korea, another country that has recently undergone substantial improvements in its standard of living.

• #37 Changing trends in the prevalence of H. pylori infection in Japan (1908–2003): a systematic review and meta-regression analysis of 170,752 individuals | Scientific Reports

  https://www.nature.com/articles/s41598-017-15490-7

  Changing trends in the prevalence of H. pylori infection in the general population over time are thought to be the main driving force behind the declining gastric cancer mortality in Japan. […] The prevalence of H. pylori infection confirmed a clear birth cohort pattern: the predicted prevalence (%, 95% CI) was 60.9 (56.3-65.4), 65.9 (63.9-67.9), 67.4 (66.0-68.7), 64.1 (63.1-65.1), 59.1 (58.2-60.0), 49.1 (49.0-49.2), 34.9 (34.0-35.8), 24.6 (23.5-25.8), 15.6 (14.0-17.3), and 6.6 (4.8-8.9) among those who were born in the year 1910, 1920, 1930, 1940, 1950, 1960, 1970, 1980, 1990, and 2000, respectively. […] The present study demonstrated a clear birth-cohort pattern of H. pylori infection in the Japanese population. […] The decreased prevalence of H. pylori infection in successive generations should be weighed in future gastric cancer control programs.

• #38 Epidemiology and diagnosis of Helicobacter pylori infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1121445/

  How Hpylori is usually acquired and its route of transmission are unknown. Since humans are the only known reservoir of infection, it is likely that in developed countries Hpylori is picked up from siblings, other children, or parents, predominantly via the gastro-oral route. In developing countries faecal-oral transmission may also occur. Various risk factors are associated with Hpylori infection, but the extent to which these are simply markers of childhood socioeconomic deprivation is unclear. Hpylori infection is an occupational hazard for gastroenterologists and is associated with performing endoscopy. […] About 15% of infected individuals will develop peptic ulcer (duodenal or gastric) or gastric cancer as a long term consequence of infection. The outcome of infection depends mainly on the severity and topography of histological gastritis, which may be determined by the age at which infection is acquired. Infection in infancy is thought to lead to pangastritis, whereas acquisition in later childhood may lead to a predominantly antral gastritis only.

• #39 Epidemiology of Helicobacter pylori and CagA-Positive Infections and Global Variations in Gastric Cancer

  https://www.mdpi.com/2072-6651/10/4/163

  Gastric cancer is a major health burden and is the fifth most common malignancy and the third most common cause of death from cancer worldwide. […] There is increasing evidence from epidemiological studies of the association of H. pylori infection and specific virulence factors with gastric cancer. […] A combination of the high prevalence of H. pylori infection and the subsequent high OR for the association with gastric cancer results in a high attributable risk. […] These estimates indicate that H. pylori infection should be considered the primary risk factor for gastric cancer, and it has been proposed that infection might be considered “a (close to) necessary cause of non-cardia gastric cancer.” […] The strong evidence for the carcinogenicity of chronic H. pylori infection suggests a clear path to preventing gastric cancer cases through eradication of the infection.

• #40 Epidemiology and diagnosis of Helicobacter pylori infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1121445/

  How Hpylori is usually acquired and its route of transmission are unknown. Since humans are the only known reservoir of infection, it is likely that in developed countries Hpylori is picked up from siblings, other children, or parents, predominantly via the gastro-oral route. In developing countries faecal-oral transmission may also occur. Various risk factors are associated with Hpylori infection, but the extent to which these are simply markers of childhood socioeconomic deprivation is unclear. Hpylori infection is an occupational hazard for gastroenterologists and is associated with performing endoscopy. […] About 15% of infected individuals will develop peptic ulcer (duodenal or gastric) or gastric cancer as a long term consequence of infection. The outcome of infection depends mainly on the severity and topography of histological gastritis, which may be determined by the age at which infection is acquired. Infection in infancy is thought to lead to pangastritis, whereas acquisition in later childhood may lead to a predominantly antral gastritis only.

• #41 Epidemiology of Helicobacter pylori and CagA-Positive Infections and Global Variations in Gastric Cancer

  https://www.mdpi.com/2072-6651/10/4/163

  Gastric cancer is a major health burden and is the fifth most common malignancy and the third most common cause of death from cancer worldwide. […] There is increasing evidence from epidemiological studies of the association of H. pylori infection and specific virulence factors with gastric cancer. […] A combination of the high prevalence of H. pylori infection and the subsequent high OR for the association with gastric cancer results in a high attributable risk. […] These estimates indicate that H. pylori infection should be considered the primary risk factor for gastric cancer, and it has been proposed that infection might be considered “a (close to) necessary cause of non-cardia gastric cancer.” […] The strong evidence for the carcinogenicity of chronic H. pylori infection suggests a clear path to preventing gastric cancer cases through eradication of the infection.

• #42 Epidemiology of Helicobacter pylori and CagA-Positive Infections and Global Variations in Gastric Cancer

  https://www.mdpi.com/2072-6651/10/4/163

  Population-based search-and-treat H. pylori programmes have, therefore, been proposed as a means to prevent gastric cancer. […] The introduction in regions of high gastric cancer incidence of population-based H. pylori screening and treatment programmes, with a scientifically valid assessment of programme processes, feasibility, effectiveness and possible adverse consequences would affect the incidence of H. pylori-induced gastric cancer.

• #43 Antimicrobial Resistance Incidence and Risk Factors among Helicobacter pylori–Infected Persons, United States – Volume 10, Number 6—June 2004 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/10/6/03-0744_article

  The emergence of antimicrobial resistance in H. pylori represents a serious public health challenge because of the prevalence of infection and incidence of severe sequelae. […] HARP is the only multicenter network providing ongoing prospective antimicrobial resistance and associated risk factor data for H. pylori in North America. […] Given the limited population-based surveillance data on H. pylori resistance, HARP offers the best available data on H. pylori resistance in the United States. The accuracy and usefulness of this prospective, multicenter network can be enhanced in a number of ways. Increasing the number of HARP sites will improve geographic and demographic representation. […] In summary, we have shown that antimicrobial resistance in clinical H. pylori isolates is extensive, that it varies from year to year, and that resistant isolates are more common among blacks. Ongoing, prospective surveillance of H. pylori resistance is essential to assure that appropriate data are available to guide the choice of therapy, particularly in high-risk populations.

• #44 Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus | Gut

  https://gut.bmj.com/content/69/12/2093

  Urea breath test or H. pylori stool antigen test are the preferred tests for mass screening, but a locally validated serology test may be considered. […] In H. pylori infected individuals, endoscopy is additionally recommended for those with a higher risk for gastric cancer. […] Population-wide screening and eradication of H. pylori infection should be integrated or included in the national healthcare priorities to optimise the resources. […] There is a trend of increasing resistance rates to clarithromycin and levofloxacin worldwide. […] Reliable locally effective regimens based on the principles of antibiotic stewardship are recommended.

• #45 Epidemiology and antibiotic resistance profile of Helicobacter pylori infection in Cameroon: a systematic review with meta-analysis | medRxiv

  https://www.medrxiv.org/content/10.1101/2021.01.13.21249766v1.full-text

  Objectives Although global epidemiology of Helicobacter pylori (HP) infection is well characterized, country-specific figure is more accurate for context-specific tailored interventions. The aim was to determine the prevalence, factors associated with infection, antibiotic resistance profile, and genotypes of HP in Cameroon. […] This study depicted a high prevalence of HP infection and a worrying resistance profile to first-line antibiotics. […] The prevalence of H. pylori infection we found in this study is in the range of estimates reported from other countries of Africa (46.8-87.7%) as well as for other regions of the world (44.3%, 95% CI: 40.9-47.7). […] H. pylori was resistant to most of antibiotics at 50% level or more. […] In Cameroon, first line treatment for H. pylori include two main strategies: concomitant quadruple therapy (proton pump inhibitor + amoxicillin + metronidazole + clarithromycin for 14 days) and sequential quadruple therapy (proton pump inhibitor + amoxicillin for 5 days, followed by proton pump inhibitor + metronidazole + clarithromycin for 5 days).

• #46 Epidemiology and antibiotic resistance profile of Helicobacter pylori infection in Cameroon: a systematic review with meta-analysis | medRxiv

  https://www.medrxiv.org/content/10.1101/2021.01.13.21249766v1.full-text

  H. pylori was resistant to amoxicillin (85.6-97.1%), metronidazole (93.2-97.9%), and clarithromycin (13.6-44.7%). Only clarithromycin had profile resistance 50%. Therefore, all treatment initiation against H. pylori should be guided by the antibiotic resistance profile. […] This study also highlights a worrying resistance profile to first-line antibiotics.

• #47 Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus | Gut

  https://gut.bmj.com/content/69/12/2093

  Urea breath test or H. pylori stool antigen test are the preferred tests for mass screening, but a locally validated serology test may be considered. […] In H. pylori infected individuals, endoscopy is additionally recommended for those with a higher risk for gastric cancer. […] Population-wide screening and eradication of H. pylori infection should be integrated or included in the national healthcare priorities to optimise the resources. […] There is a trend of increasing resistance rates to clarithromycin and levofloxacin worldwide. […] Reliable locally effective regimens based on the principles of antibiotic stewardship are recommended.

• #48 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  Attempts to detect H. pylori DNA in feces by PCR have resulted in variable outcomes. Whereas some studies have reported the detection of H. pylori DNA in the feces of 25 to 90% of subjects known to be infected with H. pylori, others have reported less than 10% of H. pylori-positive subjects to have H. pylori DNA in their feces. Although detection of H. pylori DNA in feces may add to the evidence supporting the fecal-oral route of transmission, it is again essential to remember that the finding of H. pylori DNA does not necessarily mean that viable H. pylori is present in the feces. […] Given the association between H. pylori and peptic ulcer disease, gastric cancer, and B-cell MALT lymphoma, there is an urgent need for the development of intervention strategies to prevent the spread of this bacterium. Although development of a vaccine against H. pylori is progressing well, it is highly likely that it will be 5 to 10 years before such a vaccine becomes available. Given the increasing levels of resistance to current antimicrobial therapies used against H. pylori and the high cost of such an approach, mass programs to treat H. pylori-infected individuals is clearly out of the question. […] In many other diseases with an infectious etiology, public health measures based on epidemiological data have been extremely successful in preventing the spread of pathogenic agents. Before such measures can be implemented, clarification of the route of transmission of H. pylori will be essential.

• #49 Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus | Gut

  https://gut.bmj.com/content/69/12/2093

  Objective A global consensus meeting was held to review current evidence and knowledge gaps and propose collaborative studies on population-wide screening and eradication of Helicobacter pylori for prevention of gastric cancer (GC). […] At an individual level, eradication of H. pylori reduces the risk of GC in asymptomatic subjects and is recommended unless there are competing considerations. […] H. pylori eradication in patients with early GC after curative endoscopic resection reduces the risk of metachronous cancer and calls for a re-examination on the hypothesis of the point of no return. […] At the general population level, the strategy of screen-and-treat for H. pylori infection is most cost-effective in young adults in regions with a high incidence of GC and is recommended preferably before the development of atrophic gastritis and intestinal metaplasia.

• #50 Helicobacter Pylori (H. pylori) – ISID

  https://isid.org/guide/pathogens/hpylori/

  Helicobacter pylori (H. pylori) is the most prevalent chronic bacterial infection in humans, colonizing the stomach of about half the worlds population. […] pylori infection is the most common cause of chronic gastritis. […] pylori is commonly acquired in childhood, and in under-resourced countries the prevalence of H. pylori infection is as high as 50% by the age of 5 years. […] The rate of acquisition is higher in developing countries. In industrialized countries, the prevalence of pylori is declining especially in children, but lower socioeconomic status and poor household hygiene practices are key factors leading to a higher prevalence of colonization. […] A meta-analysis including 15 studies demonstrated an increased risk of pylori infection among gastroenterology personnel. […] A recent successful vaccine field trial has been reported in Chinese children.

• #51 Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus | Gut

  https://gut.bmj.com/content/69/12/2093

  Objective A global consensus meeting was held to review current evidence and knowledge gaps and propose collaborative studies on population-wide screening and eradication of Helicobacter pylori for prevention of gastric cancer (GC). […] At an individual level, eradication of H. pylori reduces the risk of GC in asymptomatic subjects and is recommended unless there are competing considerations. […] H. pylori eradication in patients with early GC after curative endoscopic resection reduces the risk of metachronous cancer and calls for a re-examination on the hypothesis of the point of no return. […] At the general population level, the strategy of screen-and-treat for H. pylori infection is most cost-effective in young adults in regions with a high incidence of GC and is recommended preferably before the development of atrophic gastritis and intestinal metaplasia.

• #52 Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus | Gut

  https://gut.bmj.com/content/69/12/2093

  Objective A global consensus meeting was held to review current evidence and knowledge gaps and propose collaborative studies on population-wide screening and eradication of Helicobacter pylori for prevention of gastric cancer (GC). […] At an individual level, eradication of H. pylori reduces the risk of GC in asymptomatic subjects and is recommended unless there are competing considerations. […] H. pylori eradication in patients with early GC after curative endoscopic resection reduces the risk of metachronous cancer and calls for a re-examination on the hypothesis of the point of no return. […] At the general population level, the strategy of screen-and-treat for H. pylori infection is most cost-effective in young adults in regions with a high incidence of GC and is recommended preferably before the development of atrophic gastritis and intestinal metaplasia.

• #53 Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus | Gut

  https://gut.bmj.com/content/69/12/2093

  However, such a strategy may still be effective in people aged over 50, and may be integrated or included into national healthcare priorities, such as colorectal cancer screening programmes, to optimise the resources. […] Reliable locally effective regimens based on the principles of antibiotic stewardship are recommended. […] Subjects at higher risk of GC, such as those with advanced gastric atrophy or intestinal metaplasia, should receive surveillance endoscopy after eradication of H. pylori. […] Evidence supports the proposal that eradication therapy should be offered to all individuals infected with H. pylori. […] Mass screening and eradication of H. pylori should be considered in populations at higher risk of GC. […] Despite a recent decline in incidence, gastric cancer remains one of the leading causes of cancer death worldwide.

• #54 Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus | Gut

  https://gut.bmj.com/content/69/12/2093

  Urea breath test or H. pylori stool antigen test are the preferred tests for mass screening, but a locally validated serology test may be considered. […] In H. pylori infected individuals, endoscopy is additionally recommended for those with a higher risk for gastric cancer. […] Population-wide screening and eradication of H. pylori infection should be integrated or included in the national healthcare priorities to optimise the resources. […] There is a trend of increasing resistance rates to clarithromycin and levofloxacin worldwide. […] Reliable locally effective regimens based on the principles of antibiotic stewardship are recommended.

• #55 Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus | Gut

  https://gut.bmj.com/content/69/12/2093

  Urea breath test or H. pylori stool antigen test are the preferred tests for mass screening, but a locally validated serology test may be considered. […] In H. pylori infected individuals, endoscopy is additionally recommended for those with a higher risk for gastric cancer. […] Population-wide screening and eradication of H. pylori infection should be integrated or included in the national healthcare priorities to optimise the resources. […] There is a trend of increasing resistance rates to clarithromycin and levofloxacin worldwide. […] Reliable locally effective regimens based on the principles of antibiotic stewardship are recommended.

• #56 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20230428/Study-offers-a-comprehensive-updated-epidemiology-of-H-pylori-infection.aspx

  A research team led by Professor Leung Wai-keung from Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong (HKUMed) and the Baylor College of Medicine of the United States found that Helicobacter pylori (H. pylori) infection around the world has been steadily declining over the past four decades, thus offering a comprehensive, updated epidemiology of H. pylori infection. […] The study found that the global prevalence of H. pylori infection has been declining from 58.2% in the decade of 1980-1990 to 43.1% in the period of 2011-2022. On average, there was a decline of about 0.39-0.83% per year in the prevalence of H. pylori infection in the world. […] Our latest estimation shows that more than 40% of the adult population in the world is still infected with H. pylori, this could still pose a major burden on the health care system, especially on the morbidity and mortality related to peptic ulcer disease and gastric cancer.

• #57 Global Prevalence of H. pylori Infection Has Been Steadily Declining for Over 40 Years | Technology Networks

  https://www.technologynetworks.com/immunology/news/global-prevalence-of-h-pylori-infection-has-been-steadily-declining-for-over-40-years-372580

  A research team led by Professor Leung Wai-keung from Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong (HKUMed) and the Baylor College of Medicine of the United States found that Helicobacter pylori (H. pylori) infection around the world has been steadily declining over the past four decades, thus offering a comprehensive, updated epidemiology of H. pylori infection. […] The study found that the global prevalence of H. pylori infection has been declining from 58.2% in the decade of 1980-1990 to 43.1% in the period of 2011-2022. […] Our latest estimation shows that more than 40% of the adult population in the world is still infected with H. pylori, this could still pose a major burden on the health care system, especially on the morbidity and mortality related to peptic ulcer disease and gastric cancer.

• #58 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  H. pylori infection is ubiquitous and infects both males and females. Although infection occurs worldwide, there are significant differences in the prevalence of infection both within and between countries. In general, the overall prevalence of H. pylori infection in developed countries is lower than that in developing countries. This difference in prevalence of infection has been attributed to the rate of acquisition of H. pylori in childhood. For example, in a study conducted in southern China, the overall prevalence of H. pylori infection in Chinese subjects was shown to be significantly higher than that in Australians (44.2 versus 21%). Examination of the data for age-related prevalence showed that this difference related to the rate of acquisition of H. pylori under the age of 10 years; the prevalence of infection in Australian children is 4% in comparison with 27% in Chinese children. Over the age of 10 years, however, the rate of acquisition of infection in both countries was similar (approximately 1% per annum). Epidemiological data from other developed and developing countries support this finding, with the prevalence of H. pylori infection in children under 10 years resident in developed countries being approximately 0 to 5% compared with 13 to 60% in children resident in developing countries. Over this age an increase in prevalence in the order of 0.5 to 2% per annum is commonly observed. It has been proposed that the increasing prevalence of H. pylori from younger to older subjects reflects the passage through the population of distinct cohorts. That is, all persons are infected in childhood and the decreased levels of H. pylori infection associated with younger age groups, particularly in developed countries, are due to gradual improvements in medical care, sanitation, and/or living conditions. In contrast to this view, a number of studies have argued that there is a continuous risk of acquisition of H. pylori of approximately 1% per year in adulthood. Clarification of this issue will require large cohort studies that monitor the H. pylori status of approximately 1,000 subjects over a 5-year period. Given an acquisition rate of 0.5 to 2% per annum, at the end of this period it would be expected that 25 to 100 subjects would have seroconverted.

• #59 Epidemiology and diagnosis of Helicobacter pylori infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1121445/

  Helicobacter pylori is a small, curved, highly motile, Gram negative bacillus that colonises only the mucus layer of the human stomach. Since its discovery in 1984, it has been recognised as the principal cause of peptic ulcer disease and as the main risk factor for the development of gastric cancer. However, most infected people (70%) are asymptomatic. […] Hpylori is one of the commonest bacterial pathogens in humans. The prevalence of infection varies but is falling in most developed countries. Seropositivity increases with age and low socioeconomic status. Retrospective seroepidemiological studies have shown a cohort effect consistent with the hypothesis that infection is mainly acquired in early childhood. Until recently, however, it has been difficult to assess accurately the incidence (or route) of infection because of the inaccuracy and cost of detecting (non-invasively) Hpylori in young children. Primary acquisition in adults, or reinfection after successful eradication, does occur but is less common, with an annual incidence of 0.3-0.7% in developed countries and 6-14% in developing countries.

• #60 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  Although such studies may suggest that in some cases transmission may occur between spouses, one cannot rule out the possibility that carriage of the same strain by spouses may have occurred due to a child infected by one parent subsequently infecting the second parent. Indeed, evidence that children may facilitate the spread of H. pylori has come from several studies, some showing that the number of children in a family is associated with an increased risk of infection in adult family members. […] Numerous studies conducted throughout the world have shown low socioeconomic status to be associated with an increased prevalence of H. pylori infection. In particular, the socioeconomic status of a subject during childhood is considered to be an important determinant of the development of H. pylori infection. The role of socioeconomic status per se is particularly clear if one examines the prevalence of H. pylori infection in poorer racial groups living in developed countries. For example, in a study examining the relationship between socioeconomic status in childhood and the prevalence of H. pylori in African-American and Hispanic populations resident in the United States, Malaty et al. found the prevalence of H. pylori infection to be inversely related to social class during childhood, the prevalence of infection in the lowest social class (85%) being significantly higher than that in the highest social class (11%). The importance of socioeconomic status in childhood has been further demonstrated in an elegant study of monozygotic twins reared apart and discordant for their H. pylori status. In this study, Malaty and colleagues showed that the twins infected with H. pylori had been raised in homes under poorer socioeconomic conditions than those of their unaffected co-twins.

• #61 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  Failure to consistently isolate H. pylori from reservoirs other than humans suggests that direct person-to-person contact is the most likely mode of transmission. The finding of an increased prevalence of H. pylori infection in institutionalized subjects supports this view and suggests that close personal contact is important for the spread of H. pylori. The importance of close contact is further emphasized by the finding that the prevalence of H. pylori infection is significantly increased in family members of children infected with H. pylori as compared with that in family members of children not infected with H. pylori. Such findings have led to the view that transmission of H. pylori occurs mainly within the family setting. The relative risk of a child becoming infected with H. pylori has been reported to be approximately eight times greater if the mother is infected and approximately four times greater if the father is infected.

• #62 Epidemiology and diagnosis of Helicobacter pylori infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1121445/

  How Hpylori is usually acquired and its route of transmission are unknown. Since humans are the only known reservoir of infection, it is likely that in developed countries Hpylori is picked up from siblings, other children, or parents, predominantly via the gastro-oral route. In developing countries faecal-oral transmission may also occur. Various risk factors are associated with Hpylori infection, but the extent to which these are simply markers of childhood socioeconomic deprivation is unclear. Hpylori infection is an occupational hazard for gastroenterologists and is associated with performing endoscopy. […] About 15% of infected individuals will develop peptic ulcer (duodenal or gastric) or gastric cancer as a long term consequence of infection. The outcome of infection depends mainly on the severity and topography of histological gastritis, which may be determined by the age at which infection is acquired. Infection in infancy is thought to lead to pangastritis, whereas acquisition in later childhood may lead to a predominantly antral gastritis only.

• #63 Epidemiology of Helicobacter pylori and CagA-Positive Infections and Global Variations in Gastric Cancer

  https://www.mdpi.com/2072-6651/10/4/163

  Gastric cancer is a major health burden and is the fifth most common malignancy and the third most common cause of death from cancer worldwide. […] There is increasing evidence from epidemiological studies of the association of H. pylori infection and specific virulence factors with gastric cancer. […] A combination of the high prevalence of H. pylori infection and the subsequent high OR for the association with gastric cancer results in a high attributable risk. […] These estimates indicate that H. pylori infection should be considered the primary risk factor for gastric cancer, and it has been proposed that infection might be considered “a (close to) necessary cause of non-cardia gastric cancer.” […] The strong evidence for the carcinogenicity of chronic H. pylori infection suggests a clear path to preventing gastric cancer cases through eradication of the infection.

• #64 Epidemiology of Infection – Helicobacter pylori – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2421/

  Attempts to detect H. pylori DNA in feces by PCR have resulted in variable outcomes. Whereas some studies have reported the detection of H. pylori DNA in the feces of 25 to 90% of subjects known to be infected with H. pylori, others have reported less than 10% of H. pylori-positive subjects to have H. pylori DNA in their feces. Although detection of H. pylori DNA in feces may add to the evidence supporting the fecal-oral route of transmission, it is again essential to remember that the finding of H. pylori DNA does not necessarily mean that viable H. pylori is present in the feces. […] Given the association between H. pylori and peptic ulcer disease, gastric cancer, and B-cell MALT lymphoma, there is an urgent need for the development of intervention strategies to prevent the spread of this bacterium. Although development of a vaccine against H. pylori is progressing well, it is highly likely that it will be 5 to 10 years before such a vaccine becomes available. Given the increasing levels of resistance to current antimicrobial therapies used against H. pylori and the high cost of such an approach, mass programs to treat H. pylori-infected individuals is clearly out of the question. […] In many other diseases with an infectious etiology, public health measures based on epidemiological data have been extremely successful in preventing the spread of pathogenic agents. Before such measures can be implemented, clarification of the route of transmission of H. pylori will be essential.

• #65 Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus | Gut

  https://gut.bmj.com/content/69/12/2093

  Objective A global consensus meeting was held to review current evidence and knowledge gaps and propose collaborative studies on population-wide screening and eradication of Helicobacter pylori for prevention of gastric cancer (GC). […] At an individual level, eradication of H. pylori reduces the risk of GC in asymptomatic subjects and is recommended unless there are competing considerations. […] H. pylori eradication in patients with early GC after curative endoscopic resection reduces the risk of metachronous cancer and calls for a re-examination on the hypothesis of the point of no return. […] At the general population level, the strategy of screen-and-treat for H. pylori infection is most cost-effective in young adults in regions with a high incidence of GC and is recommended preferably before the development of atrophic gastritis and intestinal metaplasia.

• #66 Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus | Gut

  https://gut.bmj.com/content/69/12/2093

  Urea breath test or H. pylori stool antigen test are the preferred tests for mass screening, but a locally validated serology test may be considered. […] In H. pylori infected individuals, endoscopy is additionally recommended for those with a higher risk for gastric cancer. […] Population-wide screening and eradication of H. pylori infection should be integrated or included in the national healthcare priorities to optimise the resources. […] There is a trend of increasing resistance rates to clarithromycin and levofloxacin worldwide. […] Reliable locally effective regimens based on the principles of antibiotic stewardship are recommended.

• #67 Antimicrobial Resistance Incidence and Risk Factors among Helicobacter pylori–Infected Persons, United States – Volume 10, Number 6—June 2004 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/10/6/03-0744_article

  The emergence of antimicrobial resistance in H. pylori represents a serious public health challenge because of the prevalence of infection and incidence of severe sequelae. […] HARP is the only multicenter network providing ongoing prospective antimicrobial resistance and associated risk factor data for H. pylori in North America. […] Given the limited population-based surveillance data on H. pylori resistance, HARP offers the best available data on H. pylori resistance in the United States. The accuracy and usefulness of this prospective, multicenter network can be enhanced in a number of ways. Increasing the number of HARP sites will improve geographic and demographic representation. […] In summary, we have shown that antimicrobial resistance in clinical H. pylori isolates is extensive, that it varies from year to year, and that resistant isolates are more common among blacks. Ongoing, prospective surveillance of H. pylori resistance is essential to assure that appropriate data are available to guide the choice of therapy, particularly in high-risk populations.

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