FAMILY ASSOCIATIONS & H. PYLORI

Evidence from a nine-year birth cohort study in Japan of transmission pathways of Helicobacter pylori infection.

Malaty HM, Kumagai T, Tanaka E, Ota H, Kiyosawa K, Graham DY, Katsuyama T.

Department of Medicine, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA. Hmalaty@bcm.tmc.edu

We examined the longitudinal changes of Helicobacter pylori infection within 46 families with children and 48 couples without children living in Japan. The study cohort was monitored from 1986 to 1994. H. pylori status was assessed by the presence of anti-H. pylori immunoglobulin G antibodies.

At study entry, H. pylori prevalence in children with positive mothers was 23% versus 5% in children with negative mothers (odds ratio = 5.3; 95% confidence interval = 0.6 to 42.8). Seroconversion (rate of 1.5%/year) was evident only among children living with positive mothers and did not differ among adults living with or without children.

These data strongly support the cluster phenomenon of H. pylori infection among families, the key role of the infected mothers in the transmission within families, and the importance of adult-child transmission and not vice versa

Is Helicobacter pylori involved in the pathogenesis of the gastritis characteristic of pernicious anaemia? Comparison between pernicious anaemia relatives and duodenal ulcer relatives.

Varis O, Valle J, Siurala M

Dept. of Pathology, University of Helsinki, Finland.

The aim of the study was to evaluate whether Helicobacter pylori could be involved in the early stages of the severe corpus atrophy that is characteristic of overt pernicious anaemia and is usually H. pylori-negative.

The behaviour of H. pylori infection and chronic gastritis was studied in 159 first-degree relatives of pernicious anaemia (PA) probands and was compared with that in 137 first-degree relatives of duodenal ulcer (DU) probands. DU is as a rule associated with H. pylori infection. PA relatives showed a markedly higher prevalence of severe corpus atrophy and of parietal cell antibodies than DU relatives. However, the prevalences of H. pylori did not show significant differences between the two groups of relatives. The age-specific prevalences of H. pylori infection increased similarly in both series of relatives up to geriatric age, together with an increase in the mean scores of corpus gastritis.

However, in older age the prevalence of H. pylori in PA relatives showed a marked decrease, in spite of the increase in the mean gastritis score. The present result suggests the possibility that H. pylori is involved in the early PA stages that lead to severe corpus atrophy. The later progress of gastritis seems to be dependent on factors other than H. pylori, most likely 'autoimmune' mechanisms

How come I've got it? (A review of Helicobacter pylori transmission).

Deltenre M, de Koster E

Gastro Enterology, CHU Univ. Brugmann ULB-VUB, Brussels, Belgium.

Numerous epidemiological studies have shown the two main risk factors for Helicobacter pylori acquisition: childhood and low socio-economic level both in developing and developed countries. Nevertheless, in the absence of ubiquitous extra-human reservoir(s), the route(s) for person-to-person transmission remains undetermined.

Very recent data favour the oro-oral route: besides gastric mucosa, mouth might be a sanctuary site and the oro-oral transmission hypothesis seems applicable worldwide. Nevertheless, the gastro-oral route (vomiting, gastro-oesophageal reflux) is still possible and deserves further research.

In developing countries, feco-oral transmission (perhaps through the water supply) might be a significant mechanism of human contamination both for primary infection in children and perhaps, reinfection in adults.

Increased risk of infection with Helicobacter pylori in spouses of infected subjects: observations in a general population sample from the UK.

Stone MA, Taub N, Barnett DB, Mayberry JF

Gastrointestinal Research Unit, Leicester General Hospital, UK.

BACKGROUND/AIMS: To investigate risk factors for infection with Helicobacter pylori in a general population sample who accepted an invitation to be screened. In particular, to determine whether being the spouse of an infected subject is an independent risk factor for infection after adjustment for other risks.

METHODOLOGY: A serological screening test for Helicobacter pylori was offered to 4015 randomly selected subjects registered at a single general practice in Market Harborough, UK. Those invited were also asked to complete a questionnaire if attending for screening; this included information relating to possible risk factors for infection. Results were analyzed in the overall sample of attenders and a subset of married couples, using univariate and multivariate analyses.

RESULTS: Complete results were obtained for 1431 (36%) subjects. Age, childhood social class and household crowding in childhood were independent risk factors after adjustment for other variables. Positive status of spouse was an independent risk factor in a subset of 389 married couples (P = 0.005, Odds Ratio: 2.65, 95% Confidence Interval: 1.34-5.25).

CONCLUSIONS: Our study confirmed the correlation between childhood living conditions and infection with Helicobacter pylori. In the study population, having a Helicobacter pylori-positive spouse was associated with a significant increased risk of being infected.

Familial clustering of Helicobacter pylori infection: population based study.

Dominici P, Bellentani S, Di Biase AR, Saccoccio G, Le Rose A, Masutti F, Viola L, Balli F, Tiribelli C, Grilli R, Fusillo M, Grossi E

Medical Department, Bracco SpA, 20134 Milano, Italy.

OBJECTIVES: To assess the rate of intrafamilial transmission of Helicobacter pylori infection in the general population and the role of a family's social background. DESIGN: Population survey.

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ETTING: Campogalliano, a town in northern Italy with about 5000 residents. PARTICIPANTS: 3289 residents, accounting for 416 families. Main outcome measures: Prevalence of H pylori infection assessed by presence of IgG antibodies to H pylori.

RESULTS: The overall prevalence of H pylori infection was 58%. Children belonging to families with both parents infected had 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 that children with both parents positive had double the risk of being infected by H pylori than those from families in which both parents were negative. Family social status was independently related to infection in children, with those from blue collar or farming families showing an increased risk of infection compared with children of white collars workers (odds ratio 2.02, 95% confidence interval 1.16 to 3.49).

CONCLUSIONS: H pylori infection clusters within families belonging to the same population. Social status may also be a risk factor. This suggests either a person to person transmission or a common source of exposure for H pylori infection.

Heterogeneous Helicobacter pylori isolates from H. pylori-infected couples in Taiwan.

Kuo CH, Poon SK, Su YC, Su R, Chang CS, Wang WC.

Department of Life Science, National Tsing Hua University, Hsinchu, Taiwan, Republic of China.

Helicobacter pylori strain diversity was investigated in 55 H. pylori seropositive couples in Taiwan in biopsy samples from the antrum and corpus. Two DNA typing methods were used to characterize 90 isolates from 25 couples. In only 1 of the 25 couples was the same strain colonized from both partners.

Comparison of isolates from 2 sites in each of 40 patients showed that 9 pairs were distinct but might be related. Peptic ulcer occurred in 77.8% of these 9 patients compared with 29% of 31 patients with the same predominant strain in 2 biopsies (P=.025).

Random amplified polymorphic DNA and sequence analyses of 2 closely related isolates from 1 patient support the hypothesis that development of genetic diversity of H. pylori results from horizontal genetic exchange during long-term colonization of mixed bacterial populations.

Active infection with Helicobacter pylori in healthy couples.

Brenner H, Rothenbacher D, Bode G, Dieudonne P, Adler G

Department of Epidemiology, University of Ulm, Germany.

The mode of spread of Helicobacter pylori infection is subject to ongoing debate. Recent studies among patients with gastrointestinal disorders suggest a potential role of conjugal transmission.

In this study, the clustering of H. pylori infection was assessed among 110 employees of a health insurance company and their partners. Active infection with H. pylori was measured by the 13C-urea breath test. Information on potential confounders was collected by a standardized questionnaire.

Overall, 16 employees (14.5%) and 24 partners (21.8%) were infected. While only 7% (6/86) of employees with an uninfected partner were infected, this applied to 42% (10/24) of employees with an infected partner.

A very strong relation between partners' infection status persisted after control for age and other potential confounders (adjusted odds ratio, 7.0; 95% confidence interval, 1.8-26.7). Furthermore, the risk of infection increased with the number of years lived with an infected partner.

These results support the hypothesis of a major role of spouse-to-spouse transmission of H. pylori infection.

Comparative analysis of the Helicobacter pylori status in patients with gastric MALT-type lymphoma and their respective spouses.

Fischbach W, Jung T, Goebeler-Kolve M, Eck M.

Medizinische Klinik II, Klinikum Aschaffenburg, Akademisches Lehrkrankenhaus, Universitat Wurzburg. wolfgang.fischbach@klinikum-aschaffenburg.de

Helicobacter pylori is of major importance for the development and progression of gastric MALT-type lymphoma. In case of localized low grade lymphoma successfully treated by Helicobacter pylori eradication reinfection by the bacterium may involve the risk of lymphoma reoccurrence.

AIMS: To assess the frequency and type of Helicobacter pylori infection among patients with gastric MALT-type lymphoma and their respective spouses as potential sources of person to person spread of the infection. SUBJECTS: 35 patients with gastric MALT-type lymphoma and their cohabiting spouses.

METHODS: We investigated serum IgG titers in response to the infection by Helicobacter pylori and to its virulence factors CagA and VacA by enzyme linked immunosorbent assay (ELISA) and by Western blot.

RESULTS: Seropositivity of Helicobacter pylori, Cag A and Vac A was found to be 100/89/69% and 97/86/66% in patients and respective partners, respectively. The seroprevalence rates of the latter group by far exceed those of the German population.

CONCLUSION: These data provide evidence for a high Helicobacter pylori infection rate in both patients with gastric MALT-type lymphoma and their respective spouses. Considering the latter as a potential source of reinfection with the risk of lymphoma reoccurrence for the successfully treated patient with gastric MALT-type lymphoma careful follow-up seems highly reasonable to decide on the necessity of a future test-and-treat strategy of this population.

Helicobacter pylori: evidence for spouse-to-spouse transmission.

Singh V, Trikha B, Vaiphei K, Nain CK, Thennarasu K, Singh K.

Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

BACKGROUND: Spouse-to-spouse transmission of Helicobacter pylori infection still remains controversial.

METHODS: We studied the prevalence of H. pylori infection among spouses of H. pylori-positive or -negative individuals and looked for intraspousal transmission. Twenty-five couples were studied. Initially, one individual per couple was selected as the index subject. Spouses of these H. pylori-positive or -negative index individuals underwent screening for H. pylori by serology, the rapid urease test and histology. Those couples in whom only one spouse was positive were followed up and H. pylori status was re-evaluated using the above tests after approximately 1 year in the H. pylori-negative spouse.

RESULTS: Of 25 randomly selected index subjects, 18 were H. pylori positive and seven were negative. There was no significant difference in age, sex, socioeconomic status, presence of dyspeptic symptoms, duration of marriage and number of children in these index subjects. Spouses of H. pylori-infected index subjects had a significantly higher prevalence of H. pylori infection than the spouses of H. pylori-negative index subjects (83.3 vs 28.5%; P < 0.01). Age, sex, socioeconomic status, dyspeptic symptoms, duration of marriage and number of children were not different in H. pylori-positive or -negative spouses of H. pylori-positive index subjects. There were five such couples in whom only one spouse was H. pylori positive initially. At follow up, three of these H. pylori-negative spouses became positive.

These findings suggest person-to-person transmission or common source exposure within couples.

Active infection with Helicobacter pylori in healthy couples.

Brenner H, Rothenbacher D, Bode G, Dieudonne P, Adler G.

Department of Epidemiology, University of Ulm, Germany.

The mode of spread of Helicobacter pylori infection is subject to ongoing debate. Recent studies among patients with gastrointestinal disorders suggest a potential role of conjugal transmission.

In this study, the clustering of H. pylori infection was assessed among 110 employees of a health insurance company and their partners. Active infection with H. pylori was measured by the 13C-urea breath test. Information on potential confounders was collected by a standardized questionnaire. Overall, 16 employees (14.5%) and 24 partners (21.8%) were infected. While only 7% (6/86) of employees with an uninfected partner were infected, this applied to 42% (10/24) of employees with an infected partner.

A very strong relation between partners' infection status persisted after control for age and other potential confounders (adjusted odds ratio, 7.0; 95% confidence interval, 1.8-26.7). Furthermore, the risk of infection increased with the number of years lived with an infected partner. These results support the hypothesis of a major role of spouse-to-spouse transmission of H. pylori infection.

Helicobacter pylori infection in spouses of patients with duodenal ulcers and comparison of ribosomal RNA gene patterns.

Georgopoulos SD, Mentis AF, Spiliadis CA, Tzouvelekis LS, Tzelepi E, Moshopoulos A, Skandalis N.

Department of Gastroenterology, General Hospital of Athens, Greece.

BACKGROUND: In recent studies, familial coinfection with the same Helicobacter pylori strains has been indicated, but more data are necessary to confirm intra-familial spread of the micro-organism. AIMS: The aim of this study was (a) to assess the frequency of H pylori infection in spouses of patients with duodenal ulcers and (b) to investigate the possibility of intraspousal typing of the r espective strains.

PATIENTS: Sixty four patients with duodenal ulcer and their spouses were included in the study. METHODS: The H pylori infection was confirmed after endoscopy by culture and histological examination of biopsy specimens, and CLO test. The isolates were compared on the basis of their rRNA gene patterns (ribopatterns) after digestion of chromosomal DNA by the restriction endonucleases HaeIII or HindIII.

RESULTS: Of the patients, 54 were found to be H pylori positive. Of the respective spouses, 42 (78%) were also H pylori positive. In contrast, only two out of 10 (20%) partners of H pylori negative patients were infected. Ribopatterns of H pylori strains derived from 18 patients and their spouses showed that in each of eight couples a single strain had colonised both partners, while in the remaining 10 couples each partner was colonised by a distinct H pylori strain.

CONCLUSIONS: These data suggest person to person transmission within couples or exposure to a common source of infection.

Prevalence of Helicobacter pylori infection and related gastroduodenal lesions in spouses of Helicobacter pylori positive patients with duodenal ulcer.

Parente F, Maconi G, Sangaletti O, Minguzzi M, Vago L, Rossi E, Bianchi Porro G.

Departments of Gastroenterology, L. Sacco University Hospital, Milan, Italy.

BACKGROUND: To date, very few studies have evaluated the risk of infection among spouses of Helicobacter pylori positive patients and their results are conflicting. AIM: To assess the seroprevalence of H pylori infection in spouse of H pylori positive patients with duodenal ulcer as compared with age and sex matched volunteer blood donors, as well as the frequency of endoscopic gastroduodenal lesions in these spouses, according to the presence or absence of gastrointestinal complaints.

METHODS: Some 124 spouses (48% males) of patients with duodenal ulcer consecutively seen over a 10 month period were studied. They were all screened for serum IgG anti-H pylori antibodies and asked to complete a questionnaire with particular reference to the presence of chronic or recurrent dyspepsia. Upper gastrointestinal tract endoscopy with antral and corpus biopsy specimens taken for histological examination and urease rapid test was offered to all seropositive spouses. Volunteer blood donors (248), living in Milan and matched for age, sex, north-south origins, and socioeconomic status to the cases, were used as controls.

RESULTS: Spouses of patients with duodenal ulcer had a significantly higher seroprevalence of H pylori infection than controls (71% v 58%, p < 0.05); 30 of 88 (34%) H pylori positive spouses complained of dyspeptic symptoms compared with only four of 34 (12%) seronegative spouses (p < 0.02). At endoscopy, H pylori infection was confirmed in 48 of 49 (98%) seropositive spouses. The endoscopic findings in those spouses showed active duodenal ulcer in eight (17%), duodenal scar and cap deformity in two (4%), active gastric ulcer in two (4%), erosive duodenitis in three (6%), antral erosions in two (4%), antral erosions plus duodenitis in one, and peptic oesophagitis in another patient. The prevalence of major endoscopic lesions was significantly higher in symptomatic spouses than in those who had never been symptomatic.

CONCLUSIONS: These findings show that being the spouse of an H pylori positive patient with duodenal ulcer may increase the risk of H pylori colonisation and perhaps of peptic ulcer disease, and raises questions as to whether serological screening of cohabiting partners of H pylori positive patients with duodenal ulcer may be indicated.