Clinical Review ABC of the upper gastrointestinal tract

Epidemiology and diagnosis of Helicobacter pylori infection

BMJ 2001; 323 doi: (Published 20 October 2001) Cite this as: BMJ 2001;323:920
  1. Robert P H Logan,
  2. Marjorie M Walker

    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. We therefore need to discover how infection is acquired, why ulcers or cancer occur in so few of those infected, and how this subgroup can be identified and treated.

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    Coloured scanning electron micrograph of H pylori on surface of gastric cell

    Epidemiology of H pylori infection

    H pylori 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) H pylori 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.

    Prevalence of H pylori infection by age in developing and developed countries

    How H pylori 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 H pylori 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 H pylori infection, but the extent to which these are simply markers of childhood socioeconomic deprivation is unclear. H pylori infection …

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