Elsevier

The Lancet

Volume 359, Issue 9310, 16 March 2002, Pages 931-935
The Lancet

Articles
Age at acquisition of Helicobacter pylori infection: a follow-up study from infancy to adulthood

https://doi.org/10.1016/S0140-6736(02)08025-XGet rights and content

Summary

Background

Helicobacter pylori infection is common worldwide, but the time of acquisition is unclear. We investigated this issue in a cohort of children selected retrospectively from a population followed up for 21 years.

Methods

We monitored 224 children (99 black, 125 white; 110 male, 114 female) from 1975-76 (ages 1-3 years) to 1995-96. H pylori status was assessed by presence of serum IgG antibodies.

Findings

18 (8.0%) children at age 1-3 years had H pylori antibodies (13% black vs 4% white children, p=0.008). By age 18-23 years, the prevalence of the infection was 24.5% (43% black vs 8% white participants, p<0-0001). Of the 206 children not infected at baseline, 40 (19%) became infected by age 21–23. The crude incidence rate per year was 1.4% for the whole cohort, ranging from 2.1% at 4–5 years and 1.5% at age 7-9 years to 0.3% at 21–23 years. The seroconversion rate was higher among black than among white children (relative risk 3.3, 95% CI 1.8-6.2, p=0.001). The median age for seroconversion was 7.5 years for both races. Nine of the 58 seropositive children cleared the infection during follow-up. The rate of seroreversion per year was 1.1%; it was highest among children at age 4–5 years (2.2% vs 0.2% at ages 18-19).

Interpretation

Most newly acquired H pylori infections happened before age 10 years. Treatment and preventive strategies should be aimed at children in this age-group.

Introduction

Gastritis, gastric ulcer, duodenal ulcer, gastric carcinoma, and primary gastric B-cell lymphoma are all aetiologically associated with Helicobacter pylori infection.1, 2, 3 Childhood is the time of high risk for H pylori acquisition,4, 5, 6 but the peak age of acquisition is still unclear and could differ among populations. An understanding of the epidemiology of H pylori infection in childhood is required to elucidate fully its natural history.

H pylori infection of the gastric mucosa leads to local and systemic immune responses. Measurement of serum IgG antibodies by ELISA is a reliable, inexpensive, and non-invasive way to detect the infection and is useful in epidemiological studies.7, 8 The prevalence of H pylori in a community depends on the rate of acquisition and the rate of loss of the infection. The seroconversion rate is an indicator of the rate of acquisition of the infection, and the seroreversion rate reflects loss of infection. Seroconversion and seroreversion rates are important factors for definition of the best time for therapeutic or immunising interventions.

The epidemiology and risk factors associated with H pylori infection have been intensively investigated.9, 10, 11, 12 Studies from the USA have reported ethnic differences in the age-specific prevalence of H pylori infection in children, with black and hispanic children having the highest rates of acquisition.13, 14 Most of the epidemiological studies have been cross-sectional, and thus could not gauge the rates of acquisition and loss of the infection.

In this study, we examined the age at which the rate of acquisition of the infection was highest and the effects of race and sex on the acquisition of H pylori infection. We studied a representative sample of a longitudinal cohort of infants monitored up to age 21 years as part of the Bogalusa heart study, which provided a unique opportunity to examine H pylori status from infancy to adulthood in a well-defined biracial community.

Section snippets

Study population

The Bogalusa heart study is being done in the community of Bogalusa, LA, USA. This epidemiological study aimed to examine risk factors for cardiovascular disease from birth through to adulthood. The population is well defined and biracial (35% black, 65% white), with a homogeneous lower middle socioeconomic class. A mixed epidemiological design has included cross-sectional surveys, 3-5 years apart, and longitudinal surveys to obtain detailed observations on more than 12 000 people from birth to

Results

The cohort consisted of 224 children, of whom 99 (44%) were black and 125 were white; 110 (49%) were male and 114 (51%) female. The frequency of seropositivity for H pylori increased from 8.0% (18/224) at ages 1–3 to 24.5% (35/143) at ages 18-23 (p= 0.002). The serum samples from the 18 young children who were seropositive at study entry were also tested by the immunoblot assay and there was 100% concordance.

The frequency of seropositivity differed significantly between black and white children

Discussion

Our results indicate that the highest rates of acquisition of the infection were before age 10 years. The frequency of seropositivity differed significantly between black and white children, as seen in cross-sectional studies.13, 14 Socioeconomic status correlates with variation in the prevalence of H pylori infection between races and ethnic groups.9, 10, 13, 16 In the Bogalusa community, the risk of acquiring a new infection was five times greater among black than white children and the

References (29)

  • HM Malaty et al.

    Helicobacter pylori acquisition in childhood: a 12-year follow-up cohort study in a bi-racial community.

    Clin Infect Dis

    (1999)
  • SK Chong et al.

    Helicobacter pylori infection in recurrent abdominal pain in childhood: comparison of diagnostic tests and therapy.

    Pediatrics

    (1995)
  • BH Teh et al.

    Seroprevalence and associated risk factors of Helicobacter pylori infection in Taiwan.

    Anticancer Res

    (1994)
  • F Megraud et al.

    Seroepidemiology of Cpylori infection in various populations.

    J Clin Microbiol

    (1989)
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