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Taylor CS, McMahon MV, Ward ZJ, Alarid-Escudero F, Camargo MC, Laszkowska M, Roa J, Yeh JM. Birth cohort and age-specific trends in global Helicobacter pylori seroprevalence: a scoping review. LANCET REGIONAL HEALTH. AMERICAS 2025; 41:100877. [PMID: 40321652 PMCID: PMC12049731 DOI: 10.1016/j.lana.2024.100877] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/27/2024] [Accepted: 08/13/2024] [Indexed: 05/08/2025]
Abstract
Gastric cancer persists around the world as one of the leading causes of cancer-related death, despite declines in recent years. The declining prevalence of H pylori, the primary risk factor for gastric cancer, has contributed to this reduction and understanding changes in seroprevalence trends over time may yield further insight into gastric cancer incidence trends. We conducted a scoping review to compile data on H pylori seroprevalence in asymptomatic populations to assess global trends by age and birth cohort. We found that published data suggest H pylori seroprevalence declined among recent birth cohorts and increased with age, with trends differing between regions and sub-regions subject to data availability. The Americas lacked sufficient data to enable more robust assessment of H pylori trends by both age and birth cohort. Funding NCI: U01CA265729, P30 CA008748; NIDDK: K08 DK125876.
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Affiliation(s)
- Chelsea S. Taylor
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | | | - Zachary J. Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Fernando Alarid-Escudero
- Center for Health Policy, Department of Health Policy, Freeman Spogli Institute, School of Medicine, Stanford University, CA, USA
| | - M. Constanza Camargo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, 20850, USA
| | - Monika Laszkowska
- Gastroenterology, Hepatology, and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jorge Roa
- Data Science Lab, Hertie School, Berlin, Germany
| | - Jennifer M. Yeh
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA, USA
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2
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McMahon MV, Taylor CS, Ward ZJ, Alarid-Escudero F, Camargo MC, Laszkowska M, Roa J, Yeh JM. Helicobacter pylori infection in the United States beyond NHANES: a scoping review of seroprevalence estimates by racial and ethnic groups. LANCET REGIONAL HEALTH. AMERICAS 2025; 41:100890. [PMID: 40321653 PMCID: PMC12049726 DOI: 10.1016/j.lana.2024.100890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 08/29/2024] [Accepted: 09/03/2024] [Indexed: 05/08/2025]
Abstract
Gastric cancer in the United States is characterised by marked racial and ethnic disparities. Widespread declines in Helicobacter pylori prevalence have contributed to declining gastric cancer incidence. However, H pylori prevalence shows the same persistent racial and ethnic disparities seen in gastric cancer. The most recent population estimates of H pylori prevalence in the United States are from the late 1990s and early 2000s and only include three specific racial and ethnic groups. We conducted a scoping review to supplement existing population estimates and assess H pylori seroprevalence trends over by age and birth cohort with available data. We found the extant data suggest considerable variation in H pylori prevalence between racial and ethnic groups in the United States and evidence that age and birth cohort trends may differ between groups. We also found that the extant data were limited in generalizability and insufficient to describe trends in many cases.
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Affiliation(s)
| | - Chelsea S. Taylor
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Zachary J. Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Fernando Alarid-Escudero
- Department of Health Policy, School of Medicine, Stanford University, CA, USA
- Center for Health Policy, Freeman Spogli Institute, Stanford University, CA, USA
| | - M. Constanza Camargo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Monika Laszkowska
- Gastroenterology, Hepatology, and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jorge Roa
- Data Science Lab, Hertie School, Berlin, Germany
| | - Jennifer M. Yeh
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA, USA
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3
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Lee NR, King A, Vigil D, Mullaney D, Sanderson PR, Ametepee T, Hammitt LL. Infectious diseases in Indigenous populations in North America: learning from the past to create a more equitable future. THE LANCET. INFECTIOUS DISEASES 2023; 23:e431-e444. [PMID: 37148904 PMCID: PMC10156139 DOI: 10.1016/s1473-3099(23)00190-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 05/08/2023]
Abstract
The COVID-19 pandemic, although a profound reminder of endured injustices by and the disparate impact of infectious diseases on Indigenous populations, has also served as an example of Indigenous strength and the ability to thrive anew. Many infectious diseases share common risk factors that are directly tied to the ongoing effects of colonisation. We provide historical context and case studies that illustrate both challenges and successes related to infectious disease mitigation in Indigenous populations in the USA and Canada. Infectious disease disparities, driven by persistent inequities in socioeconomic determinants of health, underscore the urgent need for action. We call on governments, public health leaders, industry representatives, and researchers to reject harmful research practices and to adopt a framework for achieving sustainable improvements in the health of Indigenous people that is both adequately resourced and grounded in respect for tribal sovereignty and Indigenous knowledge.
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Affiliation(s)
- Naomi R Lee
- Department of Chemistry and Biochemistry, Northern Arizona University, Flagstaff, AZ, USA
| | - Alexandra King
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Deionna Vigil
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dustin Mullaney
- Department of Biology, Northern Arizona University, Flagstaff, AZ, USA
| | - Priscilla R Sanderson
- Department of Health Sciences, College of Health and Human Services, Northern Arizona University, Flagstaff, AZ, USA
| | - Taiwo Ametepee
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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4
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Congedi J, Williams C, Baldock KL. Epidemiology of Helicobacter pylori in Australia: a scoping review. PeerJ 2022; 10:e13430. [PMID: 35669956 PMCID: PMC9165601 DOI: 10.7717/peerj.13430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/21/2022] [Indexed: 01/14/2023] Open
Abstract
Background Helicobacter pylori (H. pylori), a bacterium implicated in the development of peptic ulcer and gastric cancer, is estimated to infect around half the world's population. Its prevalence in Australia is unclear. This scoping review aimed to evaluate all Australian literature providing estimates of the prevalence of H. pylori. Methods Australian studies examining H. pylori prevalence from 1982 onwards were eligible for inclusion. Medline, Embase and Scopus databases, and grey literature sources, were searched. Two independent reviewers undertook a two-stage screening process. Data were extracted by two independent reviewers using a pre-specified template. Results Of 444 identified studies, 75 were included in the review. H. pylori prevalence in Australian population-based studies (n = 8) ranged from 38.0% in 1991 to 15.1% in 2002; however, estimated prevalence across all non-clinical population studies in diverse sub-groups (n = 29) has varied dramatically. Decreased prevalence has been more marked in populations with gastrointestinal symptoms and conditions compared to non-clinical populations. Data on H. pyloriprevalence in vulnerable populations are lacking. Conclusions This is the first scoping review of Australian studies reporting H. pylori prevalence. A wide range of study designs, population groups, geographic regions, and diagnostic methods was included, involving data collected over a 50-year period (1969 to 2018). The summary of H. pylori prevalence estimates over time in this review points to a decrease in prevalence in Australia, particularly among populations with gastrointestinal symptoms and illnesses; however, it is unknown whether there is inequity in prevalence trends across vulnerable sub-groups of the Australian population. Future research and interventions supporting the health and wellbeing of vulnerable populations is required to ensure equitable health gains are made for all.
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Affiliation(s)
- Jillian Congedi
- UniSA Allied Health and Human Performance, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Craig Williams
- UniSA Clinical and Health Sciences, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Katherine L. Baldock
- UniSA Allied Health and Human Performance, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
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5
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Yuan C, Adeloye D, Luk TT, Huang L, He Y, Xu Y, Ye X, Yi Q, Song P, Rudan I. The global prevalence of and factors associated with Helicobacter pylori infection in children: a systematic review and meta-analysis. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:185-194. [PMID: 35085494 DOI: 10.1016/s2352-4642(21)00400-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Synthesised data on the prevalence of, and factors associated with, paediatric Helicobacter pylori infection at the global level remain scarce. We aimed to estimate the global prevalence of H pylori infection and its associated factors in children and adolescents. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, MEDLINE, and Scopus for observational population-based studies published between database inception and Oct 25, 2021, without language or geographical restrictions. We included studies that reported the prevalence of H pylori infection in children aged 18 years or younger. Records were screened and data were extracted using a standardised extraction form. We estimated the worldwide prevalence of H pylori infection in children (our main outcome) using multilevel mixed-effects meta-regression and then stratified prevalence by diagnostic method (serology vs urea breath tests or stool antigen tests). We analysed the significance of associated factors using a random-effects meta-analysis. This study is registered in PROSPERO, CRD42020209717. FINDINGS We identified 3181 records, of which 198 articles with 632 data points from 152 650 children were included. The overall global prevalence of H pylori infection in children was 32·3% (95% CI 27·3-37·8), which varied by diagnostic test (28·6% [23·0-35·0] for serology vs 35·9% [29·2-43·2] for urea breath tests or stool antigen tests). Regardless of diagnostic test, the prevalence of H pylori infection was significantly higher in low-income and middle-income countries than in high-income countries (43·2% [36·5-50·2] vs 21·7% [16·9-27·4]; p<0·0001) and in older children than in younger children (41·6% [35·6-47·8] in 13-18-year-olds vs 33·9% [28·6-39·7] in 7-12-year-olds vs 26·0% [21·4-31·0] in 0-6-year-olds; p<0·0001). Paediatric H pylori infection was significantly associated with lower economic status (odds ratio [OR] 1·63 [95% CI 1·46-1·82]), more siblings or children (1·84 [1·44-2·36]), room sharing (1·89 [1·49-2·40]), no access to a sewage system (1·60 [1·22-2·10]), having a mother infected with H pylori (3·31 [2·21-4·98]), having a sibling or siblings infected with H pylori (3·33 [1·53-7·26]), drinking unboiled or non-treated water (1·52 [1·32-1·76]), and older age (OR per year 1·27 [1·15-1·40]). INTERPRETATION H pylori infection is still highly prevalent in children and adolescents globally. Our findings can help to guide further research and the development and implementation of preventive and therapeutic measures to reduce H pylori infection in children. FUNDING None.
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Affiliation(s)
- Changzheng Yuan
- School of Public Health, the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China; National Clinical Research Centre for Child Health, Zhejiang University School of Medicine, Hangzhou, China; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Davies Adeloye
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Tzu Tsun Luk
- School of Nursing, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Liyan Huang
- School of Public Health, the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China; National Clinical Research Centre for Child Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Yusa He
- School of Public Health, the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China; National Clinical Research Centre for Child Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunhan Xu
- Department of Maternal and Child health, School of Public Health, Peking University, Beijing, China
| | - Xinxin Ye
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qian Yi
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peige Song
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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6
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Huang JG, Lim SYS, Aw MM, Quak SH. Antibiotic resistance patterns and therapeutic outcomes of pediatric Helicobacter pylori infection in a high-migrant Singaporean cohort. Helicobacter 2022; 27:e12868. [PMID: 34958710 DOI: 10.1111/hel.12868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Variation in Helicobacter pylori (H. pylori) disease in terms of prevalence and antibiotic resistance prevails globally requiring a need to develop region-specific surveillance. We aimed to assess the influence of immigration factors upon the interpretation of local Singaporean epidemiological trends in antimicrobial susceptibility patterns and therapeutic outcomes in children with culture-positive H. pylori. MATERIALS AND METHODS We retrospectively analyzed eradication outcomes of children with culture-proven H. pylori infections between 2011 and 2020 at our center, and we also analyzed the antimicrobial susceptibility profiles of the corresponding H. pylori isolates. The cohort was classified into two groups: (1) Native Singaporeans and (2) Non-native Singaporeans (First-/Second-generation immigrants and Non-residents) to correlate with resistance patterns and eradication outcomes. H. pylori culture was done via Kirby-Bauer disk diffusion for the era 2011-2016 and bioMérieux E test for 2016-2020. RESULTS A total of 70 children (median age 14 [2-17] years) were included in the analysis. 42.9% (30/70) of the cohort displayed some form of antibiotic resistance; clarithromycin resistance was the most prevalent (30.0%), followed by metronidazole (27.5%) and amoxicillin (7.1%). Comparing to natives, non-native Singaporeans were significantly younger at presentation (mean 11.7 vs. 13.7 years, p = 0.043), and a significantly higher proportion of non-natives carried clarithromycin-resistant (51.4% vs. 8.6%, p < 0.001), metronidazole-resistant (47.1% vs. 8.6%, p < 0.001), or multidrug-resistant (resistant to ≥2 drugs) (40.0% vs. 2.9%, p < 0.001] strains. Non-natives were significantly more likely to fail first-line eradication therapy (48.5% failure vs. 23.3%, p = 0.038). The proportion of pan-sensitive H. pylori was significantly lower in first-generation (25.0%, p = 0.001) and second-generation (42.9%, p = 0.018) immigrants compared to natives (82.86%). These conclusions did not vary when the analysis was repeated for each culture method. CONCLUSIONS An antibiotic susceptibility-based approach should be advocated for all patients but especially so for non-natives, who are at higher risk for antimicrobial resistant strains and poorer eradication outcomes.
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Affiliation(s)
- James Guoxian Huang
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Si Ying Sheryl Lim
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Marion Margaret Aw
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Seng-Hock Quak
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
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Hussain Shah SR, Almugadam BS, Hussain A, Ahmad T, Ahmed S, Sadiqui S. Epidemiology and risk factors of Helicobacter pylori infection in Timergara city of Pakistan: A cross-sectional study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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8
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Simkin J, Nash SH, Barchuk A, O'Brien DK, Erickson AC, Hanley B, Hannah H, Corriveau A, Larsen IK, Skovlund CW, Larønningen S, Dummer TJB, Bruce MG, Ogilvie G. Stomach Cancer Incidence and Mortality Trends among Circumpolar Nations. Cancer Epidemiol Biomarkers Prev 2021; 30:845-856. [PMID: 33627381 DOI: 10.1158/1055-9965.epi-20-1618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/14/2021] [Accepted: 02/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Stomach cancer incidence and mortality rates are declining across circumpolar nations, but the burden may not be distributed equally across subpopulations, including Indigenous peoples. Our objective was to examine stomach cancer incidence and mortality trends across circumpolar populations. METHODS Cancer incidence and mortality data from 1999-2016 were obtained from the Canadian Cancer Registry, Canadian Vital Statistics, CDC WONDER, NORDCAN, Northwestern Russian cancer registries, and National Cancer Reports. The direct method was used to calculate 10-year rolling age-standardized incidence and mortality rates to the world (WHO 2000-2025) and 2011 Canadian standard populations. Standardized incidence rate ratios (SRR) were calculated. Data were stratified by sex, year, and region. U.S. data were broken down by race [White; American Indian/Alaska Native (AIAN)]. Race data were not available from non-U.S. cancer registries. RESULTS Most populations showed declining incidence and mortality rates over time. Incidence rates among Greenland males and females, Alaska AIAN males and females, and Northern Canadian both sexes were elevated compared with regional counterparts and remained stable. The largest male SRR was observed among Alaska AIAN versus Alaska Whites [SRR = 3.82; 95% confidence interval (95% CI), 2.71-5.37]. The largest female SRR was observed among Alaska AIAN versus Alaska Whites (SRR = 4.10; 95% CI, 2.62-6.43). CONCLUSIONS Despite stomach cancer incidence and mortality rates declining overall, some northern and Indigenous populations experience elevated and stable incidence and mortality rates. IMPACT There is a need to address disparities observed among circumpolar subpopulations. Given similarities in incidence, mortality, and risk factor prevalence across circumpolar regions, addressing disparities could benefit from coordinated international action.
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Affiliation(s)
- Jonathan Simkin
- Cancer Control Research, BC Cancer, British Columbia, Canada. .,School of Population and Public Health, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Sarah H Nash
- Alaska Native Tribal Health Consortium, Anchorage, Alaska
| | - Anton Barchuk
- European University at Saint Petersburg, Saint Petersburg, Russia.,NN Petrov National Cancer Research Medical Center of Oncology, Saint Petersburg, Russia
| | - David K O'Brien
- Alaska Cancer Registry, Health Analytics and Vital Records Section (HAVRS), Alaska Department of Health and Social Services, Anchorage, Alaska
| | - Anders C Erickson
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Brendan Hanley
- Office of the Chief Medical Officer of Health, Department of Health and Social Services, Government of Yukon, Whitehorse, Yukon Territory, Canada
| | - Heather Hannah
- Department of Health and Social Services, Government of Northwest Territories, Yellowknife, Northwest Territories, Canada
| | - Andre Corriveau
- Department of Health and Social Services, Government of Northwest Territories, Yellowknife, Northwest Territories, Canada
| | | | | | | | - Trevor J B Dummer
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, British Columbia, Canada.,Centre of Excellence in Cancer Prevention, School of Population and Public Health, University of British Columbia, British Columbia, Canada
| | - Michael G Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Gina Ogilvie
- Cancer Control Research, BC Cancer, British Columbia, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, British Columbia, Canada.,Women's Health Research Institute, BC Women's Hospital + Health Centre, Vancouver, British Columbia, Canada
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9
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Willems P, de Repentigny J, Hassan GM, Sidani S, Soucy G, Bouin M. The Prevalence of Helicobacter pylori Infection in a Quaternary Hospital in Canada. J Clin Med Res 2020; 12:687-692. [PMID: 33224369 PMCID: PMC7665871 DOI: 10.14740/jocmr4348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/29/2020] [Indexed: 11/11/2022] Open
Abstract
Background Helicobacter pylori (H. pylori) prevalence in Canada has been estimated to be around 20% to 30%. However, H. pylori prevalence is declining in industrialized countries. We conducted a retrospective study on a population of patients referred for esophagogastroduodenoscopy (EGD) in a Canadian quaternary hospital to see the current prevalence of H. pylori infection and identify its main risk factors. Methods We performed a retrospective cross-sectional study from the Electronic Medical Records of 500 patients who visited our endoscopy clinic and who had biopsies to search for H. pylori infection. In addition to the outcome of the biopsies, we collected demographic characteristics of patients, EGD indication and endoscopic findings. Results The overall prevalence of H. pylori was 13.0% (65/500) among our population. We found no association with age, sex, tobacco or alcohol consumption. However, we noticed a significantly higher prevalence of H. pylori among African (25.0%; 8/32), Asian (30.8%; 4/13) and South American (34.9%; 15/43) born subjects when compared to the Caucasian group (8.0%; 28/350) (all P < 0.05). Conclusions The prevalence of H. pylori in Canada is declining, particularly among its Caucasian population. The race seems to be the strongest risk factor associated with this infection.
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Affiliation(s)
- Philippe Willems
- Gastroenterology Division, Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, QC, Canada
| | - Janie de Repentigny
- Gastroenterology Division, Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, QC, Canada
| | - Galab M Hassan
- Gastroenterology Division, Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, QC, Canada
| | - Sacha Sidani
- Gastroenterology Division, Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, QC, Canada
| | - Genevieve Soucy
- Pathology Division, Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, QC, Canada
| | - Mickael Bouin
- Gastroenterology Division, Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, QC, Canada
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10
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Ma I, Guo M, Pillai DR, Church DL, Naugler C. Is the Utilization of Helicobacter pylori Stool Antigen Tests Appropriate in an Urban Canadian Population? Am J Clin Pathol 2020; 153:686-694. [PMID: 32145011 PMCID: PMC7159178 DOI: 10.1093/ajcp/aqz210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Helicobacter pylori stool antigen test (HpSAT) appropriateness was investigated by assessing its testing and positivity rates in Calgary, Canada. METHODS The laboratory information system was accessed for all patients who received an HpSAT in 2018. Testing volume, test results, age, and sex of patients were collected. Sociodemographic risk factors and geospatial analysis were performed by matching laboratory data to the 2016 census data. Testing appropriateness was defined as a concordance between testing and positivity rates for each sociodemographic variable. RESULTS In 2018, 25,518 H pylori stool antigen tests were performed in Calgary, with an overall positivity rate of 14.7%. Geospatial mapping demonstrated significant distribution variations of testing and positivity rates of HpSAT in the city. Certain sociodemographic groups studied (eg, recent immigrants) appeared to be appropriately tested (testing rate relative risk [RR] = 2.26, positivity rate RR = 4.32; P < .0001), while other groups (eg, male) may have been undertested (testing rate RR = 0.85, positivity rate RR = 1.14; P < .0001). CONCLUSIONS Determining concordance of testing and positivity rate of a laboratory test can be used for assessing testing appropriateness for other diseases in other jurisdictions. This study demonstrated some at-risk patients may be missed for H pylori testing.
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Affiliation(s)
- Irene Ma
- Calgary Laboratory Services, Calgary, Canada
| | - Maggie Guo
- Calgary Laboratory Services, Calgary, Canada
| | - Dylan R Pillai
- Departments of Pathology and La Medicine
- Calgary Laboratory Services, Calgary, Canada
- Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Deirdre L Church
- Departments of Pathology and La Medicine
- Calgary Laboratory Services, Calgary, Canada
- Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Christopher Naugler
- Departments of Pathology and La Medicine
- Calgary Laboratory Services, Calgary, Canada
- Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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11
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Inference from the analysis of genetic structure of Helicobacter pylori strains isolates from two paediatric patients with recurrent infection. BMC Microbiol 2019; 19:184. [PMID: 31395006 PMCID: PMC6686460 DOI: 10.1186/s12866-019-1554-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 07/26/2019] [Indexed: 01/06/2023] Open
Abstract
Background Helicobacter pylori recurrence after successful eradication is an important problem. Children are particularly vulnerable to reinfection, by intrafamilial transmission which facilitates the acquisition or recombination of new genetic information by this bacterium. We investigated the evolutionary dynamics of 80 H. pylori strains isolated from two paediatric patients with recurrent infection (recrudescence and reinfection). Results We characterized the virulence genes vacA (s1, m1, s2, and m2), cagA, cagE, and babA2 and performed multilocus sequence typing (MLST) on 7 housekeeping genes (atpA, efp, ureI, ppa, mutY, trpC, and yphC) to infer the evolutionary dynamics of the H. pylori strains through phylogenetic and genealogic inference analyses, genetic diversity analysis and the exploration of recombination events during recurrent infections. The virulence genotype vacAs1m1/cagA+/cagE+/babA2 was present at a high frequency, as were the EPIYA motifs EPIYA-A, −B and -C. Furthermore, the housekeeping genes of the H. pylori strains exhibited high genetic variation, comprising 26 new alleles and 17 new Sequence Type (ST). In addition, the hpEurope (76.5%) and hspWAfrica (23.5%) populations predominated among the paediatric strains. All strains, regardless of their ancestral affiliation, harboured western EPIYA motifs. Conclusions This study provides evidence of the evolutionary dynamics of the H. pylori strains in two paediatric patients during recrudescence and reinfection events. In particular, our study shows that the strains changed during these events, as evidenced by the presence of different STs that emerged before and after treatment; these changes may be due to the accumulation of mutations and recombination events during the diversification process and recolonization of the patients by different genotypes. Electronic supplementary material The online version of this article (10.1186/s12866-019-1554-z) contains supplementary material, which is available to authorized users.
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Shi H, Xiong H, Qian W, Lin R. Helicobacter pylori infection progresses proximally associated with pyloric metaplasia in age-dependent tendency: a cross-sectional study. BMC Gastroenterol 2018; 18:158. [PMID: 30373520 PMCID: PMC6206908 DOI: 10.1186/s12876-018-0883-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/11/2018] [Indexed: 12/15/2022] Open
Abstract
Background The elderly population presents higher morbidity of H. pylori associated diseases in proximal stomach. The specific pathogenesis and mechanism have not been clearly addressed. The gastric environment for H. pylori colonization is dynamic with increasing age. The aim of present study is to investigate the correlation among the distribution of H. pylori, mucosal inflammation, gastric microenvironment and age. Methods A total of 180 patients with dyspepsia symptoms were divided into young, middle-aged and elderly groups. Biopsies were obtained from each patient in five locations: great curvature (mid-corpus, mid-antrum), lesser curvature (mid-corpus, mid-antrum) and incisura angularis (IA), analyzed for H. pylori density, mucosal inflammation and histopathology. Results The infection rate of H. pylori increased linearly with age (p < 0.001) in corpus, but not in antrum and IA. The H. pylori density was significantly aggravated in IA (p = 0.002) and corpus (p < 0.001) in elderly patient, but not in antrum. The mucosa inflammation scores were consistent with the severity of H. pylori colonization among three age groups. In elderly patients, the pyloric glands present more frequently in corpus, comparing with young and middle-aged group. A significant positive correlation among aggravating severity of H. pylori infection, mucosal inflammation and pyloric metaplasia in corpus with increasing age (p < 0.001) was occurred. Conclusions With increasing age, both topographic distribution of H. pylori and the expansion of pyloric glands increased in a distal-to-proximal gastric direction. Pyloric metaplasia in corpus was correlated with the risk of aggravated H. pylori colonization and associated inflammation in elderly population.
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Affiliation(s)
- Huiying Shi
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Hanhua Xiong
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Wei Qian
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Rong Lin
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China.
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Colonic Abnormalities in Manitoban Children with Helicobacter pylori Gastritis. Gastroenterol Res Pract 2018; 2018:6840390. [PMID: 29805445 PMCID: PMC5902056 DOI: 10.1155/2018/6840390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/12/2018] [Indexed: 01/06/2023] Open
Abstract
Objectives Association between Helicobacter pylori (H. pylori) and colonic pathology is underinvestigated. The aim of this work was to examine the prevalence and nature of colonic changes in children diagnosed with H. pylori gastritis. Methods A comprehensive retrospective review of the medical records for all Manitoban children (≤17 years) diagnosed with H. pylori gastritis from January 1996 to May 2015 was conducted. Children with H. pylori gastritis who had colonoscopy were identified. Patients' demographics, indications for colonoscopy, laboratory and endoscopic findings, and colonic histopathological abnormalities were documented. Results A total of 231 children were found to have H. pylori gastritis. The mean age at diagnosis was 12.3 ± 4.1 years; 108 (46.6%) were girls. Of the 231 patients, 37 (16%) patients were found to have colonoscopy performed. Indications for colonoscopy included bleeding per rectum, significant weight loss, and hypoalbuminemia. Twenty-two (59%) of 37 children who had colonoscopy had significant endoscopic and histopathological findings on colonoscopy including polyposis and colitis. Boys with colonic changes were diagnosed at an earlier age compared to those without (11.5 ± 7.0 versus 15.0 ± 2.0, p < 0.049). Conclusions Our study may suggest a possible association between H. pylori and a subset of colonic changes in children.
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Mori H, Suzuki H, Matsuzaki J, Masaoka T, Kanai T. Antibiotic resistance and gyrA mutation affect the efficacy of 10-day sitafloxacin-metronidazole-esomeprazole therapy for Helicobacter pylori in penicillin allergic patients. United European Gastroenterol J 2017; 5:796-804. [PMID: 29026593 PMCID: PMC5625875 DOI: 10.1177/2050640616688995] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/20/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIM Helicobacter pylori (H. pylori) eradication regimen has not been standardized for patients with penicillin allergy. We investigated the association between the efficacy of a 10-day sitafloxacin, metronidazole, and esomeprazole triple regimen and antibiotic resistance, in patients with penicillin allergy. METHODS Penicillin-allergic patients infected with H. pylori were enrolled between March 2014 and November 2015. The minimum inhibitory concentrations (MICs) of sitafloxacin and metronidazole, and the gyrA mutation status of the H. pylori strains were determined before treatment. The cut-off points for antimicrobial resistance were defined as 8.0 µg/ml for metronidazole and 0.12 µg/ml for sitafloxacin. The patients received the triple therapy (20 mg esomeprazole, bid; 250 mg metronidazole, bid; and 100 mg sitafloxacin, bid) for 10 days. Successful eradication was evaluated using the [13C] urea breath test or the H. pylori stool antigen test. RESULTS Fifty-seven patients were analyzed, and the overall eradication rate was 89.5%. The eradication rate in cases of double antibiotic resistance to metronidazole and sitafloxacin was 40.0%, whereas for other combinations of resistance, this was above 90.0%. Finally, the eradication rate of gyrA mutation-negative strains was 96.2%, whereas for gyrA mutation-positive strains, it was 83.9%. Adverse events were reported in 31.6% of cases, all of which were mild and tolerable. CONCLUSION Ten days of sitafloxacin and metronidazole triple therapy was safe and highly effective in eradicating H. pylori in penicillin-allergic patients. Double resistance to metronidazole and sitafloxacin was an important predicting factor for eradication failure. However, 10 days of the sitafloxacin and metronidazole triple therapy was highly effective if the strain was susceptible to either sitafloxacin or metronidazole.
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Affiliation(s)
- Hideki Mori
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Hidekazu Suzuki
- Medical Education Center, Keio University School of Medicine, Tokyo, Japan
| | - Juntaro Matsuzaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Division of Molecular and Cellular Medicine, National Cancer Center Research Institute, Tokyo, Japan
| | - Tatsuhiro Masaoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Colmers-Gray IN, Vandermeer B, Greidanus RI, Kolber MR. Helicobacter pylori status among patients undergoing gastroscopy in rural northern Alberta. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:e547-e554. [PMID: 27629690 PMCID: PMC5023365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the Helicobacter pylori status of patients who underwent gastroscopy. DESIGN Retrospective chart review. SETTING Peace River Community Health Centre in rural northwestern Alberta. PARTICIPANTS Data were collected from patients who had a gastroscopy performed by either of 2 family physicians between January 1, 2011, and December 31, 2012. MAIN OUTCOME MEASURES The proportion of patients who had positive test results for H pylori overall and among first-time gastroscopy patients. For first-time gastroscopy patients, the associations between H pylori infection and patient age, sex, residence, and procedural indications and findings were explored. RESULTS A total of 251 gastroscopies were conducted in 229 unique patients during the study period. Overall, 12.4% (95% CI 8.3% to 16.4%) of patients had positive results for H pylori and among the 159 first-time gastroscopy patients, 17.6% (95% CI 11.7% to 23.5%) had positive test results for H pylori. Helicobacter pylori status did not differ significantly by geography, sex, or age. The prevalence of H pylori was higher among patients with H pylori-related indications for gastroscopy (such as dyspepsia and upper gastrointestinal tract bleeding) than among patients with other indications; however, H pylori infection was not statistically significantly greater in patients diagnosed with peptic ulcer disease. CONCLUSION The prevalence of H pylori infection among patients undergoing gastroscopy in rural northern Alberta appears lower than other Canadian estimates. In regions with low H pylori rates, patients with dyspepsia might be better served by acid suppression and nonsteroidal anti-inflammatory drug cessation before investigating for H pylori infection. Population-based research is required to further describe regional differences in H pylori rates.
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Affiliation(s)
- Isabelle N Colmers-Gray
- Medical student at the University of Alberta in Edmonton at the time of the study, and is now an emergency medicine resident
| | - Ben Vandermeer
- Biostatistician in the Alberta Research Centre for Health Evidence in the Department of Pediatrics at the University of Alberta
| | | | - Michael R Kolber
- Associate Professor in the Department of Family Medicine at the University of Alberta and a family physician in Peace River.
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Adu-Aryee NA, Aabakken L, Dedey F, Nsaful J, Kudzi W. Comparison of endoscopic based diagnosis with Helicobacter urease test for Helicobacter pylori infection. BMC Res Notes 2016; 9:421. [PMID: 27576901 PMCID: PMC5004304 DOI: 10.1186/s13104-016-2237-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 08/23/2016] [Indexed: 01/27/2023] Open
Abstract
Background Helicobacter pylori is an important risk factor for gastritis, peptic ulcers and gastric cancer. The prevalence in developed countries is lower than 40 % but higher than 80 % in some developing countries. It is 75 % in Ghana. The Helicobacter urease test (HUT) is performed at endoscopy and gives an accurate diagnosis. The HUT is not routinely done at our facility and presumption of H. pylori is made based on endoscopic findings and H. pylori eradication prescribed, as the incidence in the general population is presumed high. Is this endoscopic diagnosis sufficient for diagnosing and treating H. pylori? We aimed to assess the feasibility of an endoscopic based H. pylori diagnosis and its accuracy using a HUT as the gold standard in consecutive patients. Methods Seventy-six consecutive adult patients with dyspepsia were assessed by upper gastrointestinal endoscopy. A clinical diagnosis of H. pylori or not was made. Biopsy samples were collected for HUT. H. pylori was diagnosed if HUT was positive. The results were then compared. Results Median age of patients was 45.0 years. H. pylori prevalence detected by HUT was 51.3 % (95 % CI 40.0–63.0). Sensitivity of endoscopic diagnosis of H. pylori was 71.8 % (95 % CI 55.1–85.0) and specificity was 37.8 % (95 % CI 22.5–55.2). There was no association between clinical findings (73.7 %) and HUT (26.3 %) (OR = 0.80; [95 % CI 0.24–2.64], p = 0.682). There was also no association between endoscopic diagnosis (71.8 %) and HUT (28.2 %), (OR = 1.55; 95 % CI 0.59–4.06, p = 0.373). Conclusion Helicobacter pylori infection was not as high as that published in earlier reports. The endoscopic diagnosis alone is not sufficient to make a diagnosis of H. pylori.
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Affiliation(s)
- N A Adu-Aryee
- Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, P.O. Box GP 4236, Accra, Ghana
| | - L Aabakken
- Division of Gastroenterology, University of Oslo, Oslo, Norway
| | - F Dedey
- Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, P.O. Box GP 4236, Accra, Ghana
| | - J Nsaful
- Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, P.O. Box GP 4236, Accra, Ghana
| | - W Kudzi
- Centre for Tropical Clinical Pharmacology and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, P.O. Box GP 4236, Accra, Ghana.
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Laird-Fick HS, Saini S, Hillard JR. Gastric adenocarcinoma: the role of Helicobacter pylori in pathogenesis and prevention efforts. Postgrad Med J 2016; 92:471-7. [PMID: 27222587 DOI: 10.1136/postgradmedj-2016-133997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 04/24/2016] [Indexed: 12/20/2022]
Abstract
Gastric cancer is the third most common cause of cancer deaths in the world, prompting high-risk countries like South Korea and Japan to establish nationwide screening programmes. Helicobacter pylori is linked to the majority of gastric adenocarcinoma cases and to the vast majority of non-cardia gastric adenocarcinomas. Several studies have demonstrated the effectiveness of 'test-and-treat' programmes for H. pylori infection to prevent gastric cancer in high-risk populations. While this strategy has gained momentum, providers in low-risk developed countries may be unaware of the risk individual patients face, particularly those who have emigrated from high-risk regions and members of economically disadvantaged minority groups. Rapidly evolving science in recent years has made it difficult for clinicians to keep up with the current best practices. This article reviews the epidemiology of H. pylori and gastric cancer, screening and diagnostic tests and the current treatment regimens for clinicians.
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Affiliation(s)
- Heather S Laird-Fick
- Department of Medicine, Michigan State University, East Lansing, Michigan, USA Department of Medicine, EW Sparrow Hospital, Lansing, Michigan, USA
| | - Shivani Saini
- Department of Medicine, Michigan State University, East Lansing, Michigan, USA
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Pérez-Arellano JL, Carranza-Rodriguez C. [Population screening strategies in recent immigrant to Spain]. Enferm Infecc Microbiol Clin 2015; 34:45-52. [PMID: 26655674 DOI: 10.1016/j.eimc.2015.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 11/27/2022]
Abstract
The definition of terms that delimites the content of this paper are initially displayed. Subsequently, the main sources of information about the disease screening in immigrants and the entities considered susceptible of screening are showed. In a later section we review the diagnostic methodology used, separately considering the history, physical examination, the usual complementary tests and specific studies of both infectious and noninfectious diseases. Finally, with the limitations of the data available a proposal of a protocol for screening of diseases in recent immigrant is performed.
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Affiliation(s)
- José-Luis Pérez-Arellano
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España; Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
| | - Cristina Carranza-Rodriguez
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España; Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
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Lin D, Koskella B. Friend and foe: factors influencing the movement of the bacterium Helicobacter pylori along the parasitism-mutualism continuum. Evol Appl 2014; 8:9-22. [PMID: 25667600 PMCID: PMC4310578 DOI: 10.1111/eva.12231] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/14/2014] [Indexed: 12/11/2022] Open
Abstract
Understanding the transition of bacterial species from commensal to pathogen, or vice versa, is a key application of evolutionary theory to preventative medicine. This requires working knowledge of the molecular interaction between hosts and bacteria, ecological interactions among microbes, spatial variation in bacterial prevalence or host life history, and evolution in response to these factors. However, there are very few systems for which such broad datasets are available. One exception is the gram-negative bacterium, Helicobacter pylori, which infects upwards of 50% of the global human population. This bacterium is associated with a wide breadth of human gastrointestinal disease, including numerous cancers, inflammatory disorders, and pathogenic infections, but is also known to confer fitness benefits to its host both indirectly, through interactions with other pathogens, and directly. Outstanding questions are therefore why, when, and how this bacterium transitions along the parasitism–mutualism continuum. We examine known virulence factors, genetic predispositions of the host, and environmental contributors that impact progression of clinical disease and help define geographical trends in disease incidence. We also highlight the complexity of the interaction and discuss future therapeutic strategies for disease management and public health in light of the longstanding evolutionary history between the bacterium and its human host.
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A randomized controlled trial comparing sequential with triple therapy for Helicobacter pylori in an Aboriginal community in the Canadian North. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2014; 27:701-6. [PMID: 24340314 DOI: 10.1155/2013/143047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Helicobacter pylori infection occurs more frequently in Arctic Aboriginal settings than elsewhere in North America and Europe. Research aimed at reducing health risks from H pylori infection has been conducted in the Aboriginal community of Aklavik, Northwest Territories. OBJECTIVE To compare the effectiveness of the Canadian standard therapy with an alternative therapy for eliminating H pylori infection in Aklavik. METHODS Treatment-naive H pylori-positive individuals were randomly assigned to a 10-day regimen (oral twice-daily doses) with rabeprazole (20 mg): standard triple therapy (proton pump inhibitor, added clarithromycin [500 mg] and amoxicillin [1 g] [PPI-CA]); sequential therapy (ST) added amoxicillin (1 g) on days 1 to 5, and metronidazole (500 mg) and clarithromycin (500 mg) on days 6 to 10. Participants with clarithromycin-resistant H pylori were randomly assigned to ST or quadruple therapy. Treatment effectiveness was estimated as per cent (95% CI) with a negative urea breath test at least 10 weeks after treatment. RESULTS Of 104 (53 PPI-CA, 51 ST) randomized participants, 89 (49 PPI-CA, 40 ST) had post-treatment results. Per-protocol treatment effectiveness was 59% (95% CI 45% to 73%) for PPI-CA and 73% (95% CI 58% to 87%) for ST. Based on intention to treat, effectiveness was 55% (95% CI 41% to 69%) for PPI-CA and 57% (95% CI 43% to 71%) for ST. Of 77 participants (43 PPI-CA, 34 ST) with 100% adherence, effectiveness was 63% (95% CI 43% to 82%) for PPI-CA and 81% (95% CI 63% to 99%) for ST. CONCLUSIONS While additional evidence is needed to confirm that ST is more effective for Arctic Aboriginal communities than the Canadian standard H pylori treatment, these results show standard PPI-CA treatment to be inadequate for communities such as Aklavik.
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Gastric biopsies: the gap between evidence-based medicine and daily practice in the management of gastric Helicobacter pylori infection. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2014; 27:e25-30. [PMID: 24106732 DOI: 10.1155/2013/897423] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Many consider histology to be the gold standard for Helicobacter pylori detection. Because the number and distribution of H pylori organisms vary, particularly in patients taking proton pump inhibitors (PPIs), the American Gastroenterological Association recommends discontinuing PPIs two weeks before endoscopy, and taking biopsies from both the body and antrum. OBJECTIVE To assess the influence of clinical practice on the histopathological detection of H pylori infection. METHODS Electronic patient records were evaluated for the sites of gastric sampling and PPI use at endoscopy. One hundred fifty cases with biopsies taken from both antrum and body were randomly selected for pathological re-review with special stains. The gastric regions sampled, H pylori distribution and influence of clinical factors on pathological interpretation were assessed. RESULTS Between 2005 and 2010, 10,268 biopsies were taken to detect H pylori. Only one region was sampled in 60% of patients (antrum 47%, body 13%). Re-review of biopsies taken from both antrum and body indicated that the correct regions were sampled in only 85 (57%) patients. Of these, 54 were H pylori positive and 96 were H pylori negative. H pylori was present in the antrum in only 15% of the patients and body only in 21%. Of 96 H pylori-negative patients, two were reinterpreted as positive. Forty-seven per cent of patients were taking PPIs at endoscopy, contributing to both false-negative and false-positive diagnoses. CONCLUSION Despite national and international guidelines for managing H pylori infection, the American Gastroenterological Association guidelines are infrequently adhered to, with PPIs frequently contributing to false diagnosis; sampling one region only increases the likelihood of missing active infection by at least 15%.
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Prolonged treatment duration is required for successful Helicobacter pylori eradication with proton pump inhibitor triple therapy in Canada. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2014; 27:397-402. [PMID: 23862170 DOI: 10.1155/2013/801915] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Traditional seven-day proton pump inhibitor triple therapy for Helicobacter pylori eradication has recently shown disappointing results outside of Canada. Prolonging therapy may be associated with poorer compliance and, hence, may not have a better outcome in a real-world setting. OBJECTIVE To compare the outcomes of seven- and 14-day triple therapy for first-line treatment of H pylori infection in an effectiveness setting in Canada. METHODS A total of 314 consecutive treatment-naive, adult H pylori-infected patients were allocated to either a seven- or 14-day triple therapy regimen, with a subgroup of 172 consecutive patients quasi-randomized to treatment according to date of visit. Eradication was confirmed using either urea breath test or gastric biopsies. Analysis was by intention to treat. RESULTS Eradication was achieved in a higher proportion of patients who underwent 14-day versus seven-day treatment regimens (overall: 85% versus 70% [P≤0.001]; subgroup: 83% versus 64% [P≤0.01]). Although successful eradication was also associated with older age and a diagnosis of ulcer disease, multivariate analysis revealed only longer treatment duration and lack of yogurt ingestion as independent predictors of successful eradication. There was a trend toward reduced success in the latter years of the study. Side effects were similar in both groups and were not prevented by yogurt ingestion. CONCLUSIONS The currently recommended duration of proton pump inhibitor triple therapy in Canada should be increased from seven to 14 days, the latter having achieved an excellent result in this particular real-world setting. Yogurt added no benefit. Further study is required to compare 10-day with 14-day treatment regimens.
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Cheung J, Goodman KJ, Girgis S, Bailey R, Morse J, Fedorak RN, Geary J, Fagan-Garcia K, van Zanten SV, the CAN Help Working Group. Disease manifestations of Helicobacter pylori infection in Arctic Canada: using epidemiology to address community concerns. BMJ Open 2014; 4:e003689. [PMID: 24401722 PMCID: PMC3902307 DOI: 10.1136/bmjopen-2013-003689] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/23/2013] [Accepted: 11/06/2013] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Helicobacter pylori infection, linked to gastric cancer, is responsible for a large worldwide disease burden. H pylori prevalence and gastric cancer rates are elevated among indigenous Arctic communities, but implementation of prevention strategies is hampered by insufficient information. Some communities in northern Canada have advocated for H pylori prevention research. As a first step, community-driven research was undertaken to describe the H pylori-associated disease burden in concerned communities. DESIGN Participants in this cross-sectional study completed a clinical interview and gastroscopy with gastric biopsies taken for histopathological examination in February 2008. SETTING Study procedures were carried out at the health centre in Aklavik, Northwest Territories, Canada (population ∼600). PARTICIPANTS All residents of Aklavik were invited to complete a clinical interview and gastroscopy; 194 (58% female participants; 91% Aboriginal; age range 10-80 years) completed gastroscopy and had gastric biopsies taken. PRIMARY AND SECONDARY OUTCOME MEASURES This analysis estimates the prevalence of gastric abnormalities detected by endoscopy and histopathology, and associations of demographic and clinical variables with H pylori prevalence. RESULTS Among 194 participants with evaluable gastric biopsies, 66% were H pylori-positive on histology. Among H pylori-positive participants, prevalence was 94% for acute gastritis, 100% for chronic gastritis, 21% for gastric atrophy and 11% for intestinal metaplasia of the gastric mucosa, while chronic inflammation severity was mild in 9%, moderate in 47% and severe in 43%. In a multivariable model, H pylori prevalence was inversely associated with previous gastroscopy, previous H pylori therapy and aspirin use, and was positively associated with alcohol consumption. CONCLUSIONS In this population, H pylori-associated gastric histopathology shows a pattern compatible with elevated risk of gastric cancer. These findings demonstrate that local concern about health risks from H pylori is warranted and provide an example of how epidemiological research can address health priorities identified by communities.
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Affiliation(s)
- Justin Cheung
- Division of Gastroenterology, Royal Columbian Hospital, New Westminster, British Columbia, Canada
- Department of Medicine/Gastroenterology Division, University of Alberta, Edmonton, Alberta, Canada
| | - Karen J Goodman
- Department of Medicine/Gastroenterology Division, University of Alberta, Edmonton, Alberta, Canada
| | - Safwat Girgis
- Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Bailey
- Department of Medicine/Gastroenterology Division, University of Alberta, Edmonton, Alberta, Canada
- Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - John Morse
- Stanton Territorial Hospital, Yellowknife, Northwest Territories, Canada
| | - Richard N Fedorak
- Department of Medicine/Gastroenterology Division, University of Alberta, Edmonton, Alberta, Canada
| | - Janis Geary
- Department of Medicine/Gastroenterology Division, University of Alberta, Edmonton, Alberta, Canada
| | - Katharine Fagan-Garcia
- Department of Medicine/Gastroenterology Division, University of Alberta, Edmonton, Alberta, Canada
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Bin Mohanna MA, Al-Zubairi LM, Sallam AK. Prevalence of Helicobacter pylori and parasites in symptomatic children examined for Helicobacter pylori antibodies, antigens, and parasites in Yemen. Saudi Med J 2014; 35:1408-11. [PMID: 25399223 PMCID: PMC4362138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of Helicobacter pylori (H. pylori) and parasites in symptomatic children examined for H. pylori antibodies, antigens, and parasites in Yemen. METHODS A record-based study was carried out at Specialized Sam Pediatric Center in Sana'a, Yemen for 3 years between 2011-2013. Out of the 43,200 patients seen for different causes through that period, 1008 (2.3%) (females: 675 [67%]; males: 333 [33%]) had gastric complaints, and were subjected to an examination of blood and stool for H. pylori and parasites. Data regarding age and gender was also collected. RESULTS The age of the patients ranged from 3-15 years. The prevalence of H. pylori among children examined for H. pylori was 65%, 30% of them were males, and 35% were females (chi square [I2]=142, p<0.01]). The prevalence in the 6-8 years age group was 83%, and it was 52% in the age group of 12-15 years. The prevalence of giardiasis was 10%, and amoebiasis was 25%. CONCLUSION Prevalence of H. pylori infection among children was high, and was more prevalent in the age group of 6-8 years than in the other age groups. Females were more affected than males. Parasites (amoebiasis and giardiasis) infestation was less prevalent.
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Affiliation(s)
- Mabrook A. Bin Mohanna
- From the Department of Pediatrics, Faculty of Medicine and Health Sciences Sana’a University, Sana’a, Yemen.,Address correspondence and reprints request to: Dr. Mabrook A. Bin Mohanna, Associate Professor, Department of Pediatrics, Faculty of Medicine and Health Sciences, Sana’a University, PO Box 18660, Sana’a, Yemen. Tel. +96 (7) 1245492. E-mail:
| | - Lutf M. Al-Zubairi
- From the Department of Pediatrics, Faculty of Medicine and Health Sciences Sana’a University, Sana’a, Yemen.
| | - Abdul K. Sallam
- From the Department of Pediatrics, Faculty of Medicine and Health Sciences Sana’a University, Sana’a, Yemen.
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Papagiannakis P, Michalopoulos C, Papalexi F, Dalampoura D, Diamantidis MD. The role of Helicobacter pylori infection in hematological disorders. Eur J Intern Med 2013; 24:685-690. [PMID: 23523153 DOI: 10.1016/j.ejim.2013.02.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 02/13/2013] [Accepted: 02/21/2013] [Indexed: 12/14/2022]
Abstract
Helicobacter pylori (H. pylori) is a Gram-negative spiral bacterium, classified as a carcinogen of class I, according to the World Health Organization (WHO). The infection is a major cause of gastritis, gastric and duodenal ulcer disease and increases the risk of gastric cancer. It has been implicated in the pathogenesis of several gastrointestinal, systemic or hematological diseases. The present review aims in deciphering the role of the bacterium in hematological disorders, increasing the awareness of gastroenterologists, hematologists and internal medicine practitioners, regarding the bacterium-associated hematological diseases. The efficacy of H. pylori eradication in increasing the platelet count in adult patients with primary immune thrombocytopenia (ITP) has been confirmed, linking the infection with the disease. Moreover, as the bacterium causes iron deficiency anemia (IDA) by several mechanisms, recent guidelines indicate H. pylori infection (Hp-I) to be sought in IDA patients if histology is negative and to be eradicated if present. Furthermore, it has been widely recognized that anti-H. pylori treatment causes regression of the low-grade B-cell gastric MALT lymphomas. Despite the well established associations of Hp-I with the aforementioned hematological disorders, we highlight the possible role of the infection to other hematological diseases or conditions such as non-Hodgkin lymphomas of the stomach, monoclonal gammopathy of undetermined significance, megaloblastic anemia and myelodysplastic syndromes. We finally underline the elevated risk of childhood leukemia and of hemorrhage in patients with coagulation disorders, due to the infection.
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MESH Headings
- Anemia, Iron-Deficiency/complications
- Anemia, Iron-Deficiency/microbiology
- Anemia, Megaloblastic/complications
- Anemia, Megaloblastic/microbiology
- Helicobacter Infections/complications
- Helicobacter Infections/drug therapy
- Helicobacter pylori
- Hematologic Diseases/complications
- Hematologic Diseases/microbiology
- Humans
- Lymphoma, B-Cell, Marginal Zone/complications
- Lymphoma, B-Cell, Marginal Zone/microbiology
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/microbiology
- Monoclonal Gammopathy of Undetermined Significance/complications
- Monoclonal Gammopathy of Undetermined Significance/microbiology
- Myelodysplastic Syndromes/complications
- Myelodysplastic Syndromes/microbiology
- Purpura, Thrombocytopenic, Idiopathic/complications
- Purpura, Thrombocytopenic, Idiopathic/microbiology
- Stomach Neoplasms/complications
- Stomach Neoplasms/microbiology
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Affiliation(s)
- Panagiotis Papagiannakis
- Department of Haematology, Second Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki (AUTH), Faculty of Medicine, Thessaloniki, Greece
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den Hollander WJ, Holster IL, den Hoed CM, van Deurzen F, van Vuuren A, Jaddoe VW, Hofman A, Perez GIP, Blaser MJ, Moll HA, Kuipers EJ. Ethnicity is a strong predictor for Helicobacter pylori infection in young women in a multi-ethnic European city. J Gastroenterol Hepatol 2013; 28:1705-11. [PMID: 23808840 PMCID: PMC3822168 DOI: 10.1111/jgh.12315] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM At the same time that Helicobacter pylori prevalence is declining in Western countries, immigrants from developing countries with high H. pylori prevalence have settled in Western urban areas. Actual epidemiological data on H. pylori in a migrant community may help in realizing a more selective approach to assess H. pylori-related diseases. We aimed to define H. pylori prevalence as well as risk groups for H. pylori in a cohort of young women living in a multi-ethnic European city. METHODS We measured Immunoglobulin G (IgG) anti-H. pylori and CagA-antibodies in serum of pregnant women included in a population-based prospective cohort study, the Generation R study. Information on demographics and socioeconomic status was collected by questionnaires. Chi-square and logistic regression were used. RESULTS In total, 3146 (46%) of the 6837 tested women (mean age 29.7 ± 5.3) were H. pylori-positive and 1110 (35%) of them were CagA-positive. The H. pylori prevalence in Dutch women was 24%, which was significantly lower than in non-Dutch women (64%; P < 0.001). In particular, H. pylori positivity was found in 92% of Moroccan (odds ratio 19.2; 95% confidence interval 11.8-32.0), 80% of Cape Verdean (7.6; 5.0-11.5), 81% of Turkish (9.0; 6.7-12.1), 60% of Dutch Antillean (3.3; 2.3-4.7), and 58% of Surinamese women (3.0; 2.3-3.8). Among H. pylori-positive Dutch subjects, 19% were CagA-positive compared with 40% of the non-Dutch subjects (P < 0.001). CONCLUSIONS Despite a general trend of declining prevalence in Western countries, H. pylori remains highly prevalent in migrant communities, which may constitute target groups for screening and eradication to prevent H. pylori-related diseases.
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Affiliation(s)
- W. J. den Hollander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - I. L. Holster
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - C. M. den Hoed
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - F. van Deurzen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - A.J. van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - V. W. Jaddoe
- Department of Pediatrics, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - A. Hofman
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - G. I. Perez Perez
- Department of Medicine, New York University School of Medicine, New York, United States
| | - M. J. Blaser
- Department of Medicine, New York University School of Medicine, New York, United States
| | - H. A. Moll
- Department of Pediatrics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - E. J. Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Sethi A, Chaudhuri M, Kelly L, Hopman W. Prevalence of Helicobacter pylori in a First Nations population in northwestern Ontario. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2013; 59:e182-e187. [PMID: 23585621 PMCID: PMC3625100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To assess prevalence of Helicobacter pylori infection, reasons for referral for gastroscopy, and clinical findings of gastroscopy in a symptomatic First Nations population in northwestern Ontario from 2009 to 2011. DESIGN Three hundred four hospital charts of symptomatic patients who underwent upper endoscopy between June 2009 and March 2011 were reviewed. SETTING Meno Ya Win Health Centre in Sioux Lookout, Ont. PARTICIPANTS First Nations patients with dyspepsia undergoing gastroscopy. MAIN OUTCOME MEASURES Reason for referral, and clinical and histologic findings on gastroscopy. RESULTS The most common reasons for referral for gastroscopy were dyspepsia (59.2%) and undiagnosed anemia (18.1%). Overall, 66.8% of patients underwent biopsies; 37.9% of these patients tested positive for H pylori. Gastritis was encountered the most often, in 46.1% of patients; gastric ulcers in 6.9% of patients; and normal gastric mucosa was seen 36.8% of the time. The rate of H pylori infection is higher than in urban Canadian populations, but lower than in previous aboriginal prevalence estimates, particularly those based on seroprevalence values. CONCLUSION This study raises the clinical question of how eradication testing and treatment protocols should be addressed in remote regions with high disease prevalence. As more is learned about the role H pylori infection plays in serious gastrointestinal diseases, rural and aboriginal populations might need a special focus on testing availability and treatment close to home.
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Richardson KL, Driedger MS, Pizzi NJ, Wu J, Moghadas SM. Indigenous populations health protection: a Canadian perspective. BMC Public Health 2012; 12:1098. [PMID: 23256553 PMCID: PMC3541974 DOI: 10.1186/1471-2458-12-1098] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 12/18/2012] [Indexed: 01/01/2023] Open
Abstract
The disproportionate effects of the 2009 H1N1 pandemic on many Canadian Aboriginal communities have drawn attention to the vulnerability of these communities in terms of health outcomes in the face of emerging and reemerging infectious diseases. Exploring the particular challenges facing these communities is essential to improving public health planning. In alignment with the objectives of the Pandemic Influenza Outbreak Research Modelling (Pan-InfORM) team, a Canadian public health workshop was held at the Centre for Disease Modelling (CDM) to: (i) evaluate post-pandemic research findings; (ii) identify existing gaps in knowledge that have yet to be addressed through ongoing research and collaborative activities; and (iii) build upon existing partnerships within the research community to forge new collaborative links with Aboriginal health organizations. The workshop achieved its objectives in identifying main research findings and emerging information post pandemic, and highlighting key challenges that pose significant impediments to the health protection and promotion of Canadian Aboriginal populations. The health challenges faced by Canadian indigenous populations are unique and complex, and can only be addressed through active engagement with affected communities. The academic research community will need to develop a new interdisciplinary framework, building upon concepts from 'Communities of Practice', to ensure that the research priorities are identified and targeted, and the outcomes are translated into the context of community health to improve policy and practice.
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Affiliation(s)
- Katya L Richardson
- Centre for Disease Modelling, York Institute for Health Research, York University, Toronto, ON, M3J 1P3, Canada
| | - Michelle S Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0W3, Canada
| | - Nick J Pizzi
- Department of Computer Science, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
| | - Jianhong Wu
- Centre for Disease Modelling, York Institute for Health Research, York University, Toronto, ON, M3J 1P3, Canada
| | - Seyed M Moghadas
- Centre for Disease Modelling, York Institute for Health Research, York University, Toronto, ON, M3J 1P3, Canada
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Ulanova M, Tsang R, Altman E. Neglected infectious diseases in Aboriginal communities: Haemophilus influenzae serotype a and Helicobacter pylori. Vaccine 2012; 30:6960-6. [DOI: 10.1016/j.vaccine.2012.09.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 07/04/2012] [Accepted: 09/25/2012] [Indexed: 12/17/2022]
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