Familial clustering of Helicobacter pylori infection: population based study

BMJ 1999;319:537-541 ( 28 August )

Papers

Patrizia Dominici, clinical research project leader, ^a Stefano Bellentani, head, scientific committee, ^b Anna Rita Di Biase, research fellow, ^c Gioconda Saccoccio, research fellow, ^b Aurelia Le Rose, research fellow, ^b Flora Masutti, research fellow, ^b Laura Viola, research fellow, ^c Fiorella Balli, head, gastroenterology unit, ^c Claudio Tiribelli, president, ^b Roberto Grilli, head, unit of clinical policy analysis, ^d Michele Fusillo, clinical research coordinator, ^a Enzo Grossi, medical department director. ^a

^a Medical Department, Bracco SpA, 20134 Milano, Italy, ^b Fondo per lo Studio delle Malattie del Fegato (ONLUS), 34121 Trieste, Italy, ^c Department of Gynaecology, Obstetrics, and Paediatric Sciences, University of Modena and Reggio Emilia, 41100 Modena, Italy, ^d Istituto di Ricerche Farmacologiche Mario Negri, 20157 Milano, Italy

Correspondence to: S Bellentani, Fondo Studi Fegato, Sezione di Modena, 41100 Modena, Italy liversb{at}unimo.it

Objectives: To assess the rate of intrafamilial transmissionof Helicobacter pylori infection in the general population andthe role of a family's socialbackground.
Design: Populationsurvey.
Setting: Campogalliano, a town in northern Italy withabout 5000residents.
Participants: 3289 residents, accounting for 416families.
Main outcome measures: Prevalence of H pylori infection assessedby presence of IgG antibodies to H pylori.
Results: The overall prevalence of H pylori infectionwas 58%. Children belonging to families with both parents infectedhad a significantly higher prevalence of H pylori infection (44%)than children from families with only one (30%) or no parents(21%) infected (P<0.001). Multivariate analyses confirmed thatchildren with both parents positive had double the risk of beinginfected by H pylori than those from families in which both parentswere negative. Family social status was independently relatedto infection in children, with those from blue collar or farmingfamilies showing an increased risk of infection compared withchildren of white collars workers (odds ratio 2.02, 95% confidenceinterval 1.16 to 3.49).
Conclusions: H pylori infection clusters within familiesbelonging to the same population. Social status may also be arisk factor. This suggests either a person to person transmissionor a common source of exposure for H pyloriinfection.

Key messages

The route of transmission of H pylori is still unknown and most studies have been on selected groups
In this population based study the prevalence of H pylori infection in children was related to parents' infection
Children whose fathers were blue collar workers or farmers' families had a significantly increased risk of H pylori infection compared with children of white collar workers.
These findings support person to person transmission of H pylori infection
Further research is needed to assess the role of housing, dietary habits, and other lifestyle factors

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