Prevalence of peptic ulcer in Helicobacter pylori positive blood donors.

Vaira, Dino; Miglioli, M.; Mulè, Paolo; Holton, John; Menegatti, Marcello; Vergura, M; Biasco, Guido; Conte, Roberto; Logan, R. P. H.; Leggett, Barbara A.

doi:10.1136/gut.35.3.309

Cited by 83 publications

(43 citation statements)

References 16 publications

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“…Other studies conducted among blood donors in developed countries have usually not revealed a decline in H. pylori seroprevalence similar to the one observed by us (5,7,15,20,26,(33)(34)(35)(36). A closer inspection of the previous data, however, unveils lower-than-expected seroprevalence rates above the age of 50 in several studies, (5,34,36), but few of them included subjects who were older than 60.…”

Section: Discussionsupporting

confidence: 69%

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Unexpected Decrease with Age of Helicobacter pylori Seroprevalence among Swedish Blood Donors

Sörberg¹,

Nyrén²,

Granström

2003

J Clin Microbiol

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Blood donors are often used as proxies for the general population in studies of Helicobacter pylori epidemiology. Our aim was to test if the age-specific seroprevalence rates among blood donors match with the corresponding rates in a random population sample. This descriptive study was based on sera obtained from 3,502 blood donors representing all Swedish counties and cities. An age-stratified random population sample of 1,030 from Stockholm County served as comparison. Sera were analyzed by an in-house enzyme-linked immunosorbent assay for H. pylori immunoglobulin G antibodies. In the population sample, we found the expected increase with age in the seroprevalence of H. pylori infection. This was true also among young blood donors, while the prevalence-by-age curve showed a deflection downward among blood donors who are > 50 years of age. In this age group, the probability of being seropositive was reduced by 73% (95% confidence interval [CI], 63 to 81%) relative to the population sample. Overall, the adjusted odds ratio for H. pylori seropositivity among blood donors was decreased by 43% (95% CI, 28 to 55%). Thus, it appears that blood donors who are H. pylori seropositive selectively disappear from the blood donor cohort. We speculate that H. pyloriseropositive blood donors may tolerate repeated bleedings less well than do noninfected individuals and/or that the general well-being among those who are infected may be somewhat impaired. Our unexpected observation indicates that blood donors may be less suitable as proxies for the general population in analytic studies of H. pylori infection and that the underlying cause needs further study.Helicobacter pylori is accepted as a principal cause of nonautoimmune chronic gastritis (10). Moreover, eradication of H. pylori prevents recurrence of peptic ulcers (14), and evidence for a causal role in gastric cancer is accumulating (11,17,30).H. pylori infections are mainly acquired in early childhood (13). In developing countries, the seroprevalence of the infection is higher than in developed countries, where it rises gradually with age (12,23). This latter phenomenon is considered to reflect a birth cohort effect. Hence, the higher infection prevalence in older individuals represents higher childhood infection rates in these birth cohorts rather than acquisition during adult life (1, 9).In European epidemiological studies, blood donors are often used to represent the general population since all European countries have unpaid donors (34, 36). The appropriateness of this assumption has not been rigorously tested for H. pylori seroprevalence.We took advantage of a large nationwide sample of blood donors, drawn for the purpose of investigating the seroprevalence of Borrelia burgdorferi infection in different parts of Sweden (28), to study also the age-specific seroprevalence of H. pylori infection, presuming that the blood donors were representative for the general population. We then compared the seroprevalence pattern among blood donors with that in a population contr...

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Section: Discussionsupporting

confidence: 69%

“…In European epidemiological studies, blood donors are often used to represent the general population since all European countries have unpaid donors (34,36). The appropriateness of this assumption has not been rigorously tested for H. pylori seroprevalence.…”

mentioning

confidence: 99%

Unexpected Decrease with Age of Helicobacter pylori Seroprevalence among Swedish Blood Donors

Sörberg¹,

Nyrén²,

Granström

2003

J Clin Microbiol

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“…The difference between the two studies rested on a comparison of asymptomatic subjects (healthy volunteers) and PU patients (3), while the present findings were based on a controlled study with consecutive patients with dyspeptic symptoms (patients with NUD and patients with PU). However, in another study with asymptomatic subjects, Vaira et al (21) showed that of 128 of 1,010 asymptomatic blood donors who were seropositive and who had consented to endoscopy, 121 had chronic active gastritis. Among these 121 patients, 25 had PU, 21 had erosive duodenitis, and 2 had gastric cancer.…”

Section: Discussionmentioning

confidence: 98%

Metronidazole-Resistant Helicobacter pylori Is More Prevalent in Patients with Nonulcer Dyspepsia than in Peptic Ulcer Patients in a Multiethnic Asian Population

Lui¹,

Yeoh

Ho³

2003

J Clin Microbiol

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The trend of increasing prevalence of antibiotic resistance among Helicobacter pylori strains has been suggested as a cause of the failure of treatment of H. pylori infections. In this study, 120 of 211 antral biopsy specimens from patients with dyspeptic symptoms were found to harbor H. pylori. The isolates from the 120 specimens were tested by the agar dilution method, and 38 (31.7%) were found to be metronidazole resistant. Among the 211 subjects, 81 of 115 (70.4%) patients with peptic ulcer (PU) were infected with H. pylori, whereas 39 of 96 (40.6%) patients with nonulcer dyspepsia (NUD) were infected with H. pylori. Interestingly, significantly more NUD patients than PU patients harbored metronidazole-resistant H. pylori ( Helicobacter pylori is a gram-negative spiral microorganism that is closely associated with gastritis and peptic ulcer (PU) diseases. It was noted that a substantial number of subjects with nonulcer dyspepsia (NUD) also harbor the bacterium. The triple therapy used to treat H. pylori infection, consisting of bismuth subsalicylate and two antibiotics, usually metronidazole and tetracycline or amoxicillin, has been found to result in an eradication rate of approximately 90% (18). However, the effect of this treatment was found to be compromised when the patient harbors H. pylori isolates that are drug resistant (15,16,19). The prevalence of resistance to metronidazole has increased or remained steady over the past few years in several countries, including Singapore (3, 4, 6).The disk diffusion test is routinely used to determine sensitivities to antibiotics, as it is economical and easy to perform (17). However, the agar dilution method, although tedious to perform, is still the reference method for the testing of antibiotic susceptibility (13). This method not only determines the antibiotic susceptibility but also the MICs for the bacteria. The commercially available E-test is a method that combines the advantages of the disk diffusion and agar dilution methods, as it is easy to use and also provides the MICs for the bacteria tested (5). However, the E-test is a commercial kit and for routine use is more costly than the agar dilution method, and studies have shown discrepancies in the results obtained by the two methods (1,14).In this study, we examined the relevance of metronidazole resistance in patients with PU and NUD, while the agar dilution method was used to determine the MICs for the H. pylori isolates. MATERIALS AND METHODSProcessing of biopsy specimens. A total of 211 consecutive patients with dyspeptic symptoms were included in this study. Of these, 115 patients had PU, while 96 patients had NUD. PUs include duodenal or gastric ulcers, or both, while NUD is defined as dyspeptic symptoms but a lack of endoscopic evidence of an ulcer (27). The ages of the patients ranged from 17 to 86 years, with an average age of 45.7 years. Of the 211 patients, 133 were males and 78 were females. The study included 175 Chinese, 14 Malays, 14 Indians, and 8 patients of other ethnicities. Informed...

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“…The availability of commercial kits using puri®ed antigens represents a real advancement in terms of sensitivity and speci®city. 2 H. pylori infection is mostly asymptomatic 2,3 because the organism tends to have a symbiotic relationship with the host. However, patients with dyspeptic symptoms are very often infected with H. pylori although it is SUMMARY Aim: To assess the seroprevalence of Helicobacter pylori infection in a large series of patients with upper gastrointestinal symptoms referred for their ®rst upper gastrointestinal endoscopy, and to evaluate any association with disease.…”

Section: Introductionmentioning

confidence: 99%

A serologic survey of Helicobacter pylori infection in 3281 Italian patients endoscoped for upper gastrointestinal symptoms

Palli¹,

Vaira²,

Menegatti³

et al. 1997

Aliment Pharmacol Ther

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Aim:To assess the seroprevalence of Helicobacter pylori infection in a large series of patients with upper gastrointestinal symptoms referred for their first upper gastrointestinal endoscopy, and to evaluate any association with disease. Methods: A large survey of 3281 dyspeptic patients undergoing their first endoscopic examination was undertaken, involving 93 centres in Italy. A blood sample was taken from each participant, for measuring IgG antibodies against H. pylori using a commercially available kit, and two biopsies of the antral gastric mucosa were obtained for evaluating a Giemsa‐stained specimen. Results: Endoscopic macroscopic diagnoses included normal mucosa (25.3%), gastroduodenitis (51.6%), gastric and duodenal ulcers (3.7 and 14.9%, respectively) and other conditions, including gastric cancer (0.8%). Overall, the seroprevalence result was 71.3% with a strong positive association with increasing age and male sex and a negative one with educational level. According to endoscopic diagnoses, the association with H. pylori seropositivity was highest for duodenal and gastric ulcer (multivariate odds ratio: 6.1 and 2.2) and lowest for carcinoma. The comparison between the results of serology and the single Giemsa‐stained specimen showed good reliability of H. pylori IgG, particularly in a subgroup (n = 2056) for which the interpretation was performed by a single dedicated pathologist: sensitivity and specificity were 92 and 78%, respectively. Conclusion: Commercial IgG serology is a reliable tool for the assessment of H. pylori infection in large‐scale multicentre surveys. A very high seroprevalence among dyspeptic patients was confirmed, particularly in the presence of peptic disease. Factors associated with the infection were very similar to those usually reported in the general population, but male patients showed a significantly higher prevalence.

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Prevalence of peptic ulcer in Helicobacter pylori positive blood donors.

Cited by 83 publications

References 16 publications

Unexpected Decrease with Age of Helicobacter pylori Seroprevalence among Swedish Blood Donors

Unexpected Decrease with Age of Helicobacter pylori Seroprevalence among Swedish Blood Donors

Metronidazole-Resistant Helicobacter pylori Is More Prevalent in Patients with Nonulcer Dyspepsia than in Peptic Ulcer Patients in a Multiethnic Asian Population

A serologic survey of Helicobacter pylori infection in 3281 Italian patients endoscoped for upper gastrointestinal symptoms

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