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Does lifestyle matter? H. pylori infection is not associated with lifestyle factors in the Bristol helicobacter project
AGAA725
April 2000
3941
3943
ACQUISITION AND LOSS OF HELICOBACTER PYLORI INFECTION: A 47 PERSON- YEARS FOLLOW-UP IN A COHORT OF CHILDREN: THE HOUSTON DAY-CARE-CENTER STUDY. Hoda M. Malaty, Nancy D. Logan, David Y. Graham, Siddharta G. Reddy, VAMC and Baylor Coli of Medicine, Houston. TX. Background: Because H. pylori infection is mainly acquired during childhood, the risk for acquiring or clearing the organism is best evaluated in children. The l3C_ urea breath test (UBT) is a highly sensitive and specific test for Hp active infection. Aim: To determine the rate of acquisition and loss of Hp infection among asymptomatic children attending day care centers. Methods:We performed a prospective study of children attending 10 licensed day care centers from different locations in Houston, Texas. Demographic information, socioeco nomic factors including parent(s) educational level, place of residence, living conditions, history of upper GI symptoms, and taking antibiotics treatment were evaluated. Hp status was determined by l3C-UBT. Results: We entered 166 children Black and Hispanic children between the ages of2-12 years; 74 boys and 92 girls. At baseline, the prevalence of Hp infection was 21% (35/ 131) with no difference between boys and girls 24% vs. 19%, respectively (p = O.4). Fifty three children were followed for a duration of 47 person-years (mean II months). At entry 11/53 (21%) had active H. py lori infection detected by UBT. One of the 42 (2.4%) uninfected children at the study entry became infected after 47 person-years of follow-up. Nine (82%) of the infected children remained infected and 2 (18%) became uninfected during the follow-up period. The overall incidence rate for infection was 2%Iyear and for loss of infection was 4%/year . Of interest, the child who acquired the infection was 3 years old and both children who lost the infection were 7 years old of whom one did not receive any antibiotic treatment within the study period. Conclusion: Acquisition and spontaneous loss of Hp infection occur more frequently among young children. These findings have a strong impact on the outcome of treatment of the infection in young asymptomatic children.
THE INTER·RELATIONSHIP BETWEEN GASTROESOPHA· GEAL REFLUX DISEASE (GE RD) & H. PYLORI : CHICKEN OR EGG ? Darren Morton, Kama D. Bardhan, Rotherham Gen Hosp, Rotherham, United Kingdom. INTRODUCTION The inter-relationship between GERD and H. pylori (HP) remains controversial. The widely differing views include infection is coincidental, predisposes to GERD or even protects against its development. AIM We tested the hypothesis that HP infection in GERD is coincidental. METHODS HP seroprevalence in GERD patients (erosive oesophagitis or heartburn but with normal oesophagus at endoscopy) attending clinic in 1998-99, was compared with healthy blood donors (controls) in our region (Morton et al. Gastroenterology 1998;114: G0964), matched for age and socioeco nomic (SE) status, which are understood to affect HP prevalence. For comparison our patients with DU and GU were also screened. HP IgG ELISA was performed on venous blood samples from all subjects (Bio-Stat, UK). SE status was assessed by use of the Jarma n index (BMJ 1984;289:1587-92). RESULTS We examined (n; mean age): DU 416(57y); GU 48(67y); GERD 332(55y); blood donors 2950 (42y), patients & control subjects. HP seropositivity rates were: DU 93%; GU 83%; GERD 60%; Donors 29%. HP seroprevalence (table %(n»in GERD was significantly higher than in control subjects matched for age and SE status. CONCLUSIONS Infection rates in DU & GU was approximately 3-fold higher than in donors. HP seroprevalence in GERD was 2-fold greater than donor controls, & consistently so in all socioeconomic groups & across all ages. This suggests the higher prevalence may not be coincidental. Our finding raises the possibility that HP infection may be linked in some way with the predisposition, development or perpetuation of reflux disease.
3942 HEUCOBACTER PYLORI INFECTION. IS COW MILK A VEHI· CLE FOR TRANSMISSION? Carlos Martin de Argila, Isabel Garcia Arata, Daniel Boixeda, Rafael Canton, Luis De Rafael, Felix Hernandez Ranz, Antonio Garcia Plaza, Ramon y Cajal Hosp, Madrid, Spain. Background : Despite extensive advances in other fields of H.pylori infection, the exact mode of transmission of this microorganism remains unknown. Given the high prevalence of this infection in the general population (particularly in countries with low socio-eco nomical development ) it seems plausible that this organism might spread via a widely distributed vehicle in our daily lifestyle. On the other hand, in the last decades, H.pylo ri prevalence has markedly declined in countries with high socioeconomical developmen t. Objectives: To examine whether H.pylori infection might be transmitted from cow milk. as the consume of this dairy product is widely extended among most human cultures, by investigating the presence of H.pylori in pasteurized (widely consumed by countries with high socio-economical standards) and non-pasteurized (consumed by populations with low level of socio-economi cal standards) cow milk. Material s and methods: Five non-pasteurized milk samples collected from different cows and farms and four commercial ultra-high-temperature-treated samples were analyzed. In order to standarize the method and to know whether H.pylori can be detected in these samples, the PCR method was performed in DNA obtained from 0.1 ml of pellet and from 0.1 ml supemadant obtained after 10 min centrifugation of 50 ml samples; before and after, DNA of H.pylori or a small amount of a grown colony were added to the 50 ml sample. DNA was extracted following a previously described method consisting in SDS lysis, CTAB (cetyl trimety ammonium bromide) precipitation, and phenol-chlorophorm extraction. Final DNA was resuspended in 0.06 ml sterile distilled water and was used for ureA gene of H.pylori detection following the conditions previously described (Wang et al, EICMID 1993). PeR products were checked in a 2% agarose gel electrophoresis and stained with ethidium bromide. Results: All samples in which DNA or bacteria had been added were positive, while controls without added H.pylori and the remainin g nine milk samples were negative. Conclusions: These results do not support the presence of H.pylori in non-pasteurized and pasteurized cow milk. Therefore, cow milk does not seem to be a major mode of transmission of this infection. The consume of pasteurized cow milk is not necessarily a major determinant of the decline observed in the prevalence of H.pylori infection in countries with high socio-economical standards. Further studies are required to elucidate the principal transmission mode of H.pylori infection.
SOCIOECONOMICGROUP
GERD Oonol'1 Xl pvalue AGE GROUP (yrs) GERD Oonol'1 Xl Pvalue
Deprived
Intenned!ate
Affluent
59%(38164) 29%(189/656) <0.0001
63%(911144) 35%(41811186) <0.0001 41-60 55%(851154) 32'10 (516/1623) <0.0001
57% (71/124) 24% (26111108) <0.0001 >60 72"/0 (89/122) 41 '10 (87/215) <0.0001
<40 46%(26156) 22%(249/1 112) <00001
3944 DOES LIFESTYLE MATTER? H. PYLORI INFECTION IS NOT ASSOCIATED WITH LIFESTYLE FACTORS IN THE BRISTOL HELICOBACTER PROJECT. Liam 1. Murray, Athene J. Lane, Ian M. Harvey, Matthias Egger, Jenny L. Donovan, Prakash Nair, Richard F. Harvey, The Queen' s Univ of Belfast, Belfast, United Kingdom; Univ of Bristol, Bristol, United Kingdom ; Univ of East Anglia, Norwich. United Kingdom; Peterborough District Hosp, Peterborough , United Kingdom; Frenchay Hosp, Bristol , United Kingdom. Purpose: Our aim was to examine the relationships between smoking, alcohol and coffee consumpt ion and active H. pylori (HP) infection in a large cross-sectional study. Methods: 25,821 subjects aged 20-59 were invited to participate from 7 primary care centers in SW England in a community based Helicobacter eradication RCT. 10,537 underwent a 13C_ urea breath test and completed a questionnaire regarding smoking, alcohol and coffee consumption. 1.620 suhjects tested positively and 1,620 negative subjects were randomly selected for analysis. Results: Adjustment was made for age, sex, ethnicity, measures of childhood and adulthood socioeconomic status and for the other tabulated variables. Tests for trends or heterogeneity in the adjusted risk of infection across the categories were not statistically significant. Conclusion: Smoking, alcohol or coffee consumption are not risk factors for active HP infection. Number Smoking
Alcohol
Coffee
Never Ever Current « 201d) Current (~ 20/dl None < 10 un~slweek 10-19 unitslweek ~ 20unitslweek None <5cups/day > 5cups/day
' Reference category
1635 691 423 281 491 1381 583 449 595 1622 818
Odds ratio for H. pylori infection Crode Adjusted 1.00' 1.08(0.90. 1.28) 1.00(0.80. 1.23) 1.11(0.87. 1.43) 1.00' 0.73 (0.59. 0.90) 0.93 (0.73. 1.18) 0.80 (0.61, 1.02) 1.00' 0.86 (0.71, 1.03) 0.89(0.72. 1.10)
1.00' 0.94 (0.78. 1.14) 101(080. 1.28) 1.05 (0.79. 1.40) 1.00' 0.87(0.70. 1.08) 1.06 (0.81 , 1.38) 0.82(0.62, 1.10) 1.00' 0.87(0.61 . 1.10) 0.95(0.75.1.19)
April 2000
3941
3943
ACQUISITION AND LOSS OF HELICOBACTER PYLORI INFECTION: A 47 PERSON- YEARS FOLLOW-UP IN A COHORT OF CHILDREN: THE HOUSTON DAY-CARE-CENTER STUDY. Hoda M. Malaty, Nancy D. Logan, David Y. Graham, Siddharta G. Reddy, VAMC and Baylor Coli of Medicine, Houston. TX. Background: Because H. pylori infection is mainly acquired during childhood, the risk for acquiring or clearing the organism is best evaluated in children. The l3C_ urea breath test (UBT) is a highly sensitive and specific test for Hp active infection. Aim: To determine the rate of acquisition and loss of Hp infection among asymptomatic children attending day care centers. Methods:We performed a prospective study of children attending 10 licensed day care centers from different locations in Houston, Texas. Demographic information, socioeco nomic factors including parent(s) educational level, place of residence, living conditions, history of upper GI symptoms, and taking antibiotics treatment were evaluated. Hp status was determined by l3C-UBT. Results: We entered 166 children Black and Hispanic children between the ages of2-12 years; 74 boys and 92 girls. At baseline, the prevalence of Hp infection was 21% (35/ 131) with no difference between boys and girls 24% vs. 19%, respectively (p = O.4). Fifty three children were followed for a duration of 47 person-years (mean II months). At entry 11/53 (21%) had active H. py lori infection detected by UBT. One of the 42 (2.4%) uninfected children at the study entry became infected after 47 person-years of follow-up. Nine (82%) of the infected children remained infected and 2 (18%) became uninfected during the follow-up period. The overall incidence rate for infection was 2%Iyear and for loss of infection was 4%/year . Of interest, the child who acquired the infection was 3 years old and both children who lost the infection were 7 years old of whom one did not receive any antibiotic treatment within the study period. Conclusion: Acquisition and spontaneous loss of Hp infection occur more frequently among young children. These findings have a strong impact on the outcome of treatment of the infection in young asymptomatic children.
THE INTER·RELATIONSHIP BETWEEN GASTROESOPHA· GEAL REFLUX DISEASE (GE RD) & H. PYLORI : CHICKEN OR EGG ? Darren Morton, Kama D. Bardhan, Rotherham Gen Hosp, Rotherham, United Kingdom. INTRODUCTION The inter-relationship between GERD and H. pylori (HP) remains controversial. The widely differing views include infection is coincidental, predisposes to GERD or even protects against its development. AIM We tested the hypothesis that HP infection in GERD is coincidental. METHODS HP seroprevalence in GERD patients (erosive oesophagitis or heartburn but with normal oesophagus at endoscopy) attending clinic in 1998-99, was compared with healthy blood donors (controls) in our region (Morton et al. Gastroenterology 1998;114: G0964), matched for age and socioeco nomic (SE) status, which are understood to affect HP prevalence. For comparison our patients with DU and GU were also screened. HP IgG ELISA was performed on venous blood samples from all subjects (Bio-Stat, UK). SE status was assessed by use of the Jarma n index (BMJ 1984;289:1587-92). RESULTS We examined (n; mean age): DU 416(57y); GU 48(67y); GERD 332(55y); blood donors 2950 (42y), patients & control subjects. HP seropositivity rates were: DU 93%; GU 83%; GERD 60%; Donors 29%. HP seroprevalence (table %(n»in GERD was significantly higher than in control subjects matched for age and SE status. CONCLUSIONS Infection rates in DU & GU was approximately 3-fold higher than in donors. HP seroprevalence in GERD was 2-fold greater than donor controls, & consistently so in all socioeconomic groups & across all ages. This suggests the higher prevalence may not be coincidental. Our finding raises the possibility that HP infection may be linked in some way with the predisposition, development or perpetuation of reflux disease.
3942 HEUCOBACTER PYLORI INFECTION. IS COW MILK A VEHI· CLE FOR TRANSMISSION? Carlos Martin de Argila, Isabel Garcia Arata, Daniel Boixeda, Rafael Canton, Luis De Rafael, Felix Hernandez Ranz, Antonio Garcia Plaza, Ramon y Cajal Hosp, Madrid, Spain. Background : Despite extensive advances in other fields of H.pylori infection, the exact mode of transmission of this microorganism remains unknown. Given the high prevalence of this infection in the general population (particularly in countries with low socio-eco nomical development ) it seems plausible that this organism might spread via a widely distributed vehicle in our daily lifestyle. On the other hand, in the last decades, H.pylo ri prevalence has markedly declined in countries with high socioeconomical developmen t. Objectives: To examine whether H.pylori infection might be transmitted from cow milk. as the consume of this dairy product is widely extended among most human cultures, by investigating the presence of H.pylori in pasteurized (widely consumed by countries with high socio-economical standards) and non-pasteurized (consumed by populations with low level of socio-economi cal standards) cow milk. Material s and methods: Five non-pasteurized milk samples collected from different cows and farms and four commercial ultra-high-temperature-treated samples were analyzed. In order to standarize the method and to know whether H.pylori can be detected in these samples, the PCR method was performed in DNA obtained from 0.1 ml of pellet and from 0.1 ml supemadant obtained after 10 min centrifugation of 50 ml samples; before and after, DNA of H.pylori or a small amount of a grown colony were added to the 50 ml sample. DNA was extracted following a previously described method consisting in SDS lysis, CTAB (cetyl trimety ammonium bromide) precipitation, and phenol-chlorophorm extraction. Final DNA was resuspended in 0.06 ml sterile distilled water and was used for ureA gene of H.pylori detection following the conditions previously described (Wang et al, EICMID 1993). PeR products were checked in a 2% agarose gel electrophoresis and stained with ethidium bromide. Results: All samples in which DNA or bacteria had been added were positive, while controls without added H.pylori and the remainin g nine milk samples were negative. Conclusions: These results do not support the presence of H.pylori in non-pasteurized and pasteurized cow milk. Therefore, cow milk does not seem to be a major mode of transmission of this infection. The consume of pasteurized cow milk is not necessarily a major determinant of the decline observed in the prevalence of H.pylori infection in countries with high socio-economical standards. Further studies are required to elucidate the principal transmission mode of H.pylori infection.
SOCIOECONOMICGROUP
GERD Oonol'1 Xl pvalue AGE GROUP (yrs) GERD Oonol'1 Xl Pvalue
Deprived
Intenned!ate
Affluent
59%(38164) 29%(189/656) <0.0001
63%(911144) 35%(41811186) <0.0001 41-60 55%(851154) 32'10 (516/1623) <0.0001
57% (71/124) 24% (26111108) <0.0001 >60 72"/0 (89/122) 41 '10 (87/215) <0.0001
<40 46%(26156) 22%(249/1 112) <00001
3944 DOES LIFESTYLE MATTER? H. PYLORI INFECTION IS NOT ASSOCIATED WITH LIFESTYLE FACTORS IN THE BRISTOL HELICOBACTER PROJECT. Liam 1. Murray, Athene J. Lane, Ian M. Harvey, Matthias Egger, Jenny L. Donovan, Prakash Nair, Richard F. Harvey, The Queen' s Univ of Belfast, Belfast, United Kingdom; Univ of Bristol, Bristol, United Kingdom ; Univ of East Anglia, Norwich. United Kingdom; Peterborough District Hosp, Peterborough , United Kingdom; Frenchay Hosp, Bristol , United Kingdom. Purpose: Our aim was to examine the relationships between smoking, alcohol and coffee consumpt ion and active H. pylori (HP) infection in a large cross-sectional study. Methods: 25,821 subjects aged 20-59 were invited to participate from 7 primary care centers in SW England in a community based Helicobacter eradication RCT. 10,537 underwent a 13C_ urea breath test and completed a questionnaire regarding smoking, alcohol and coffee consumption. 1.620 suhjects tested positively and 1,620 negative subjects were randomly selected for analysis. Results: Adjustment was made for age, sex, ethnicity, measures of childhood and adulthood socioeconomic status and for the other tabulated variables. Tests for trends or heterogeneity in the adjusted risk of infection across the categories were not statistically significant. Conclusion: Smoking, alcohol or coffee consumption are not risk factors for active HP infection. Number Smoking
Alcohol
Coffee
Never Ever Current « 201d) Current (~ 20/dl None < 10 un~slweek 10-19 unitslweek ~ 20unitslweek None <5cups/day > 5cups/day
' Reference category
1635 691 423 281 491 1381 583 449 595 1622 818
Odds ratio for H. pylori infection Crode Adjusted 1.00' 1.08(0.90. 1.28) 1.00(0.80. 1.23) 1.11(0.87. 1.43) 1.00' 0.73 (0.59. 0.90) 0.93 (0.73. 1.18) 0.80 (0.61, 1.02) 1.00' 0.86 (0.71, 1.03) 0.89(0.72. 1.10)
1.00' 0.94 (0.78. 1.14) 101(080. 1.28) 1.05 (0.79. 1.40) 1.00' 0.87(0.70. 1.08) 1.06 (0.81 , 1.38) 0.82(0.62, 1.10) 1.00' 0.87(0.61 . 1.10) 0.95(0.75.1.19)