The All-Age Prevalence of Helicobacter pylori Infection and Potential Transmission Routes. A Population-Based Study.

BACKGROUND AND AIMS: Previous research on H. pylori epidemiology has mostly focused on adult populations. We have aimed to study H. pylori prevalence in all age groups including children and adolescents and to identify potential routes of transmission. METHODS: Subjects from all age groups (children 0-11 years, adolescents 12-17 years and adults ≥18 years of age), recruited from both an urban and a rural community in Northern Norway, were invited to provide stool samples for the diagnosis of H. pylori antigen and to fill in a questionnaire (adult and adolescents only) on gastrointestinal symptoms, lifestyle factors and biometric data. RESULTS: A total of 1 624 (35.3%) of the invited subjects, including 173 (39.3%) of the children, 46 (19.2%) of the adolescents, and 1 416 (36.1%) of the adults, responded to the invitation. H. pylori infection was nearly undetectable (0.6%) among the children, whereas the prevalence increased from 20% in adolescents toward a peak of 45% in the highest age group. Univariate analyses of possible risk factors of H. pylori infection showed significant associations to private well water, the use of outhouse toilet, and having farm animals in childhood, but the associations waned in multivariate analyses. CONCLUSIONS: In our populations, with apparent high hygienic standards, the transmission of H. pylori infection may start not only in childhood, but also in adolescence, where potential transmission routes may be outdoor toilet use, private well water, and farm animals.

Managing dyspepsia in the young adult patient: effects of different tests for Helicobacter pylori in a "test-and-scope" approach.

AIM: To evaluate how different methods for the detection of Helicobacter pylori influence on a "test, score and scope" decision approach in young dyspeptic patients. RESULTS: Complete data from 341 patients (52.2% males) were analyzed. One hundred and ten (32%) were H. pylori-positive by definition. The rapid serology test was true-positive in 64 patients, false-positive in 8, and false-negative in 46. For the EIA IgG serology test, the corresponding results were 99 true-positive, 7 false-positive, and 11 false-negative. If the H. pylori fecal test or urea breath test had been applied, 108 (98%) and 107 (97%) positives would have been correctly detected, respectively, as well as 14 and 7 false positives. Models using test data in a setting of decreasing H. pylori prevalence show that test properties have increasing significance. CONCLUSIONS: In a selection strategy for young dyspeptics based on the detection of H. pylori, the choice of test should be made with caution. H. pylori fecal test would probably give the best basis for such selection.

Prevalence, comorbidity, and risk factors for functional bowel symptoms: a population-based survey in Northern Norway.

OBJECTIVE: To assess the occurrence of functional bowel (FB) symptoms in Northern Norway, and to describe gender differences, comorbidity, and association to risk factors, including Helicobacter pylori infection. MATERIALS AND METHODS: Adult subjects (18-85 years) from the communities Bodø and Sørreisa were invited to complete a questionnaire on gastrointestinal symptoms, and to provide stool samples for assessment of H. pylori. RESULTS: Of 3927 invited subjects, 1731 (44.1%) responded to the questionnaire and 1416 (36.0%) provided stool samples. Functional bowel symptoms were found in 25%, somewhat more frequent in females (28.6%). Symptom pattern differed between genders only with regard to constipation. Presence of FB symptoms was significantly associated with gastroesophageal reflux symptoms, headache, dizziness, palpitations, sleep disturbances, and musculoskeletal symptoms. Psychometric traits were also more prevalent: feeling of low coping ability, feeling depressed, feeling of time pressure, and a low self-evaluation of health. In a multivariate regression model, factors that influenced the reporting FB symptoms were male gender (OR 0.71, 95% CI (0.52; 0.96)), age 50-69 years or ≥70 years (OR 0.49 (0.30; 0.80) and 0.40 (0.21; 0.79)), obesity (OR 1.61 (1.05; 2.47)), NSAID use (OR 2.50 (1.63; 3.83)), and previous abdominal surgery (OR 1.54 (1.05; 2.26)). The presence of H. pylori was not associated with FB symptoms. CONCLUSIONS: Functional bowel symptoms are prevalent, but our findings may be prone to self-selection bias. FB symptoms carry a significant burden of comorbidity. Female gender and low age are known risk factors for FB symptoms, whereas NSAID use as a risk factor deserves further clarification.

Do young dyspeptic patients consider upper gastro-intestinal endoscopy useful?

BACKGROUND/AIMS: Carefully planned strategies for selecting patients to upper gastro-intestinal (GI) endoscopy may reduce the number of procedures. However, the impact of the examination and the potential value of being reassured by a negative endoscopy has yet to be evaluated. METHODOLOGY: 280 young dyspeptic patients were classified to have either peptic ulcer disease, non ulcer dyspepsia (NUD), gastro esophageal reflux disease (GERD) with or without erosive esophagitis after upper gastro-intestinal endoscopy. At one year follow-up, the patients evaluated their symptoms and were asked what they considered the main reason for improvement, if any, when given six alternatives. RESULTS: 242 returned the one year follow-up questionnaire. 82% of the peptic ulcer group reported symptom improvement and the eradication therapy as the main reason for it. In the NUD group 63% had improved, weighting change in life-style and diet as the main reasons. Only 16% reported the reassurance by a negative endoscopy as important for improvement. The two GERD groups scored similar and recorded acid reducing medication as the far most important reason for improvement. CONCLUSIONS: Young dyspeptic patients, patients with peptic ulcer disease seems to be the only group where endoscopy has significant value for choosing the optimal therapeutic option. Neither the reassurance by a negative endoscopy in the NUD group nor the detection of esophagitis in patients with GERD is of importance to subjective improvement.

The impact of body mass index and Helicobacter pylori infection on gastro-oesophageal reflux symptoms: a population-based study in Northern Norway.

OBJECTIVE: Increased body mass index (BMI) has been proposed as a risk factor for gastro-oesophageal reflux symptoms. The aim of this study was to evaluate the effect of BMI and Helicobacter pylori on reflux symptoms in an adult population. MATERIAL AND METHODS: For this cross-sectional, population-based study from Bodø and Sørreisa communities in Northern Norway, a total of 3927 adults were invited to complete a questionnaire on gastrointestinal symptoms and to provide stool samples for the assessment of H. pylori. Reflux symptoms were considered present when a reflux syndrome score was > or =2 according to the Gastrointestinal Symptom Rating Scale (GSRS). RESULTS: The response rate was 44.2%, and 44.7% of the respondents were male. Age-adjusted prevalences were: for overweight, 35.6% (95% CI (32.4%; 38.8%)); for obesity, 10.0% (8.4%; 11.6%); for H. pylori: 21.2% (19.1%; 23.9%) and for reflux symptoms: 21.7% (19.5%; 23.9%). In the logistic regression analyses, H. pylori and smoking were not risk factors for reflux symptoms, whereas male gender (OR 4.78 (95%CI (1.88; 12.1)), age (1.01 (1.00; 1.03)) and overweight (1.51 (1.14; 2.00)) were. When stratified by gender, overweight and age were independent risk factors for reflux symptoms in females only, whereas H. pylori infection was protective against such symptoms in men. Models including these parameters could only explain 3% of the variations in reflux symptoms. CONCLUSIONS: BMI is an independent risk factor for gastro-oesophageal reflux symptoms among healthy female adults, but contributes only to a minor part of the variation in these symptoms. H. pylori is protective against reflux symptoms in men.

"Test, score and scope": a selection strategy for safe reduction of upper gastrointestinal endoscopies in young dyspeptic patients referred from primary care.

OBJECTIVE: To test the ability of pre-endoscopic clinical evaluation to predict clinically relevant findings of upper gastrointestinal endoscopy. MATERIAL AND METHODS: Patients (341) who had been referred to upper gastrointestinal endoscopy for further evaluation of dyspeptic symptoms were included in this prospective, single-blinded study. Prior to endoscopy, the patients underwent a standardized clinical evaluation consisting of 1) a symptom questionnaire, 2) serological testing for Helicobacter pylori antibody and 3) determination of blood hemoglobin. Based upon this evaluation, patients were assigned to one of three defined risk groups. Group A comprised patients with known risk factors for diseases that would require further therapeutic or diagnostic management. Patients in groups B and C had no such risk factors. Patients in group C had heartburn or regurgitation as a predominant symptom, whereas patients in group B did not. The prevalence of clinically relevant findings upon upper endoscopy was then compared for these three groups. RESULTS: The prevalence of clinically relevant endoscopic findings in risk groups A, B and C were 20.1, 2.4 and 1.6%, respectively (p<0.01 for both A versus B and A versus C). Furthermore, 89% of those with clinically relevant endoscopic findings belonged to group A, which comprised a total of 45% of the patients studied. In groups B and C, the prevalence of disease was similar to the area-specific prevalence in the general population without dyspeptic symptoms. CONCLUSIONS: By using a simple standardized questionnaire, H. pylori serology and a hemoglobin reading in the evaluation of dyspeptic patients under 45 years of age, the need for endoscopy can be reduced by 55%.