Helicobacter pylori Prevalences and Risk Factors among School Beginners in a German Urban Center and Its Rural County.In 1998, the Helicobacter pylori Helicobacter pylori A gramnegative rod-shaped bacterium that lives in the tissues of the stomach and causes inflammation of the stomach lining. Mentioned in: Indigestion, Ulcers Helicobacter pylori [[sup.13]C]urea breath test urea breath test GI disease A noninvasive test for the presence of H pylori in the stomach, based on H pylori's urease activity. See Helicobacter pylori. was offered to all school beginners (birth cohort 1991/1992) in the city of Leipzig and in Leipzig County, Germany, to determine the colonization colonization, extension of political and economic control over an area by a state whose nationals have occupied the area and usually possess organizational or technological superiority over the native population. prevalence and potential transmission pathways of the bacterium. A total of 3,347 school beginners participated in the test, and 2,888 parents completed the detailed, self-administered questionnaire. The H. pylori Noun 1. H. pylori - the type species of genus Heliobacter; produces urease and is associated with several gastroduodenal diseases (including gastritis and gastric ulcers and duodenal ulcers and other peptic ulcers) Heliobacter pylori prevalence was 6.5% [95% confidence interval confidence interval, n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. (CI), 5.3-7.6] in the city and 5.7% (CI, 4.2-7.0) in the county. Using cluster analysis Cluster analysis A statistical technique that identifies clusters of stocks whose returns are highly correlated within each cluster and relatively uncorrelated across clusters. Cluster analysis has identified groupings such as growth, cyclical, stable, and energy stocks. (WARD's method, Euclidean distances In mathematics, the Euclidean distance or Euclidean metric is the "ordinary" distance between two points that one would measure with a ruler, which can be proven by repeated application of the Pythagorean theorem. ), we identified different sets of variables (confirmed by multivariate The use of multiple variables in a forecasting model. logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. analyses [odds ratios (ORs)] that are significantly associated with H. pylori positivity. Among city children, the risk is significantly increased with contact to a pet hamster hamster, Old World rodent, related to the voles, lemmings, and New World mice. There are many hamster species, classified in several genera. All are solitary, burrowing, nocturnal animals, with chunky bodies, short tails, soft, thick fur, and large external cheek (OR = 2.4; 95% CI, 1.2-4.7; p [is less than] 0.015) and travels to Asian countries (OR = 3.7; 95% CI, 1.6-8.7; p [is less than] 0.002). Among county children, H. pylori positivity increased significantly with drinking of water from nonmunicipal sources (OR = 16.4; 95% CI, 3.1-88.5; p [is less than] 0.001), more than 3 children living in a household (OR = 4.2; 95% CI, 1.2-14.6; p [is less than] 0.02), and contact with pet hamsters (OR = 2.4; 95% CI, 1.0-5.7; p [is less than] 0.04). These data suggest that, in a general population sample, indirect fecal-oral transmission and living conditions living conditions npl → condiciones fpl de vida living conditions npl → conditions fpl de vie living conditions living are important risk factors in the spread of H. pylori infection. However, clinical symptoms do not necessarily indicate H. pylori positivity. Key words: [sup.13]C breath test, Germany, Helicobacter pylori, prevalences, risk factors, rural county, school beginners, urban center. Environ Health Perspect 109:573-577 (2001). [Online 21 May 2001] http://ehpnet1.niehs.nih.gov/docs/2001/ 109p573-577herbarth/abstract.html Helicobacter pylori is one of the most common pathogens. Since the observations of Warren and Marshall in 1983/1984 (1), its significance as a causal agent Noun 1. causal agent - any entity that produces an effect or is responsible for events or results causal agency, cause physical entity - an entity that has physical existence for peptic ulcers Peptic ulcers Wounds in the stomach and duodenum caused by stomach acid and the bacterium Helicobacter pylori. Mentioned in: Tube Compression of the Esophagus and Stomach and public health problems is evident. Numerous papers have been published discussing potential risk factors of transmission and infection. In a recent review of H. pylori epidemiologic studies epidemiologic study A study that compares 2 groups of people who are alike except for one factor, such as exposure to a chemical or the presence of a health effect; the investigators try to determine if any factor is associated with the health effect , the European Helicobacter pylori Study Group (2) concluded that "The route of transmission still remains unclear." The authors observed problems in the interpretation of some past studies in relation to study design, selection and size of the study population, and the statistical methods applied. The recommendation was that future epidemiologic studies take these aspects into consideration. The large number of cases and the high cost of medical treatment have now turned the focus of epidemiologic research toward certain risk populations. Preschool children are thought to be the main risk population (3). Generally accepted risk factors for the aquisition of H. priori infection are socioeconomic status socioeconomic status, n the position of an individual on a socio-economic scale that measures such factors as education, income, type of occupation, place of residence, and in some populations, ethnicity and religion. , childhood living conditions (4), and large family size (5). In a recent German study, family history of gastric disease correlated with aquisition of the bacterium (6), whereas pets have not been considered a risk factor (7). As far as the routes of transmission are concerned, the results have been contradictory (2). There is no doubt that the bacterium gains entry to the stomach via the mouth. Oral-oral, fecal-oral, and iatrogenic iatrogenic /iat·ro·gen·ic/ (i-a´tro-jen´ik) resulting from the activity of physicians; said of any adverse condition in a patient resulting from treatment by a physician or surgeon. spread, as well as several vectors such as domestic cats, nonhuman primates nonhuman primate see primate. , and the domestic housefly housefly, common name of the fly Musca domestica, found in most parts of the world. The housefly, a scavenger, does not bite living animals but is dangerous because it carries bacteria and protozoans that cause many serious diseases, e.g. , have all been discussed as possible routes of transmission; however, a major route has not been identified (8). Because this organism appears to be ubiquitous and may be picked up anywhere, we hypothesized that indirect fecal-oral transmission could possibly be a dominant pathway in its acquisition. Thus, we conducted this study to determine potential sources of H. pylori in the environment of young children. The data are based on a detailed parent-completed questionnaire designed to explore a wide range of possible risk factors and an H. pylori colonization screening test administered to the entire 1998 school entry population in Leipzig, Germany, as well as its rural region, the County of Leipzig. Materials and Methods The Leipzig Helicobacter pylori study was a joint project of the UFZ UFZ Ultra-Wideband Friendly Zone (Centre for Environmental Research Leipzig-Halle, GmbH), the University Children's Hospital A children's hospital is a hospital which offers its services exclusively to children. The number of children's hospitals proliferated in the 20th century, as pediatric medical and surgical specialties separated from internal medicine and adult surgical specialties. Leipzig, and the Departments of Public Health, City and County of Leipzig, conducted in the fall and winter of 1997/1998. The investigation included all children eligible to enter grade one in the fall of 1998. Participation was voluntary, and the test was scheduled to be administered during the mandatory medical examinations carried out by the Departments of Public Health. The study involved the administration of the gastric H. pylori colonization test using the stable-isotope-aided in vivo in vivo /in vi·vo/ (ve´vo) [L.] within the living body. in vi·vo adj. Within a living organism. in vivo adv. [[sup.13]C]urea breath test and a detailed, parent-completed questionnaire. The [[sup.13]C]urea breath test involved two breath samples, one taken before and another 30 min after drinking 75 mL orange juice with 75 mg [[sup.13]C]urea (99.3 atom% [sup.13]C; chemical purity chemical purity, n the degree to which a substance is undiluted or unmixed with extraneous material, typically expressed as a percentage (%). according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. U.S. Pharmacopeia pharmacopeia /phar·ma·co·pe·ia/ (-ko-pe´ah) an authoritative treatise on drugs and their preparations. See also USP. pharmacopei´al United States Pharmacopeia see under U. assay: 99.8%; Chemotrade Leipzig, portioned out by the Children's Hospital pharmacy). A child was considered infected with H. pylori (positive) when the [sup.13]C values of the two exhaled carbon dioxide carbon dioxide, chemical compound, CO2, a colorless, odorless, tasteless gas that is about one and one-half times as dense as air under ordinary conditions of temperature and pressure. test samples (measured by a [sup.13]C isotope analyzer, FANci; Dr. Fischer Analysen, Leipzig, Germany) differed significantly. The underlying biochemical principle is that [[sup.13]C]urea is split in the stomach only in the presence of H. priori. We used the epidemiologic questionnaire to elicit information on education, employment, and medical history of the proband's parents and siblings, past and present home address, living conditions, water supply, leisure-time garden plots, and a detailed medical history of the child. Information was sought on the family's nationality and travels to foreign countries. Further questions focused on the child's past and present contacts to various pets and different sources of drinking water drinking water supply of water available to animals for drinking supplied via nipples, in troughs, dams, ponds and larger natural water sources; an insufficient supply leads to dehydration; it can be the source of infection, e.g. leptospirosis, salmonellosis, or of poisoning, e.g. . Further details regarding the study's methodology have been described elsewhere (9). The criterion for a child's participation in the study was the parents' written, informed consent. Only children with a consent form signed by at least one parent could take the H. pylori breath test. A total of 3,347 of the 3,919 eligible school beginners undergoing the medical examination participated in the voluntary H. pylori [[sup.13]C]urea breath test (response rate 85.4%) (9). Mean age of the children was 6.1 years (range 5.2-7.0 years). The life-time prevalences and potential risk factors in the transmission of the infection, and thus in association with an H. pylori positive test, were analyzed using STATISTICA for Windows (10). Because more children participated in the H. pylori test than parents completed questionnaires, this assessment is based on the data of only those children with an H. pylori test and a completed questionnaire (responses to all variables under investigation). Thus, this analysis includes the data of 1,844 (73.8%) of the 2,498 city children and 1,044 (73.5%) of the 1,421 county children. Initially, we selected for the analysis 47 variables assumed to be possible risk factors for acquiring the H. pylori bacterium. Thirty of these were tentative sources of infection, such as domestic crowding, water and food, pets, hygienic hy·gien·ic adj. 1. Of or relating to hygiene. 2. Tending to promote or preserve health. 3. Sanitary. and sanitary living conditions of residence, weekend cottage, travels to foreign countries. The other 17 variables were clinically potential diagnostic indicators. To identify the most important variables in terms of risk associated with the outcome variable (H. pylori positivity), we performed a cluster analysis [Ward's method (11), Euclidean distances]. The cluster analysis was carried out using a subset of all cases to avoid overestimation o·ver·es·ti·mate tr.v. o·ver·es·ti·mat·ed, o·ver·es·ti·mat·ing, o·ver·es·ti·mates 1. To estimate too highly. 2. To esteem too greatly. of the cluster variables entering the multivariate logistic regression. We used the Ward's method to derive small clusters. This process was repeated with differing case data sets and continued until stable clusters were obtained. All variables identified in this way were entered into the logistic regression. We began the multivariate logistic regression calculations with an initial model. The. model was varied by adding and eliminating variables until we reached a stable model (assessment based on p-value). We calculated all stepwise stepwise incremental; additional information is added at each step. stepwise multiple regression used when a large number of possible explanatory variables are available and there is difficulty interpreting the partial regression logistic regressions with identical, complete sets of variables in order to be able to compare the results. To avoid an overestimation in the regression analysis In statistics, a mathematical method of modeling the relationships among three or more variables. It is used to predict the value of one variable given the values of the others. For example, a model might estimate sales based on age and gender. , the cluster analysis was carried out on successive, arbitrary 75% subsamples of the available population data. The model was defined as stable when the calculated odds ratio value of the significant variables no longer changed during the process. Authorities of the city of Leipzig granted permission for participation of preschool children in the study, and the study was approved by the Ethics Committee ethics committee A multidisciplinary hospital body composed of a broad spectrum of personnel–eg, physicians, nurses, social workers, priests, and others, which addresses the moral and ethical issues within the hospital. See DNR, Institutional review board. of the University of Leipzig The University of Leipzig (German Universität Leipzig), located in Leipzig in the Free State of Saxony (former Kingdom of Saxony), Germany, is one of the oldest universities in Europe. . Results Table 1 summarizes the demographics of the study population and the study areas. A total of 3,347 (85.4%) of the school beginners in 1998 (city and county of Leipzig) took part in the H. pylori survey. Nonresponders could not be analyzed in detail because parents could not be questioned about the reasons for not letting their children participate in the study. Our data are based on an approximately 73% subsample sub·sam·ple n. A sample drawn from a larger sample. tr.v. sub·sam·pled, sub·sam·pling, sub·sam·ples To take a subsample from (a larger sample). comprised of city and rural children who participated in the test and returned the parent-completed questionnaire with responses to all questions. Among this preschool population, a total of 179 children (119 city and 60 county) were found to be infected with H. pylori. The prevalences of H. pylori colonization are presented in Table 1.
Table 1. Demographics and prevalences of the study population
and study area.
City County Total
Population 445,846 211,032 656,878
Medical examinations (n) 2,498 1,421 3,919
Questionnaires completed (n) 1,881 1,069 2,950
H. pylori tests (n) 2,228 1,119 3,347
Children with questionnaire 1,844 1,044 2,888
and test (n)
Positive tests (n) 120 59 179
H. pylori prevalence(a) 6.5% 5.7% 6.2%
95% CI 5.3-7.6 4.2-7.0 5.3-7.1
(a) based on data set of children with a completed questionnaire
and H. pylori test.
The risk factors assumed to play a role in the transmission of H. pylori infection and their frequency of occurrence among these probands Proband is a term used most often in medical genetics and other medical fields to denote a particular subject (person or animal) being studied or reported on. On pedigrees, the proband is noted with an arrow and the box (male) or circle (female) shaded accordingly. are summarized in Tables 2 and 3.
Table 2. Potential risk factors for H. pylori transmission entered
into cluster analysis and their occurrence.
Percent(a)
p-Value
(city
vs.
Transmission factors Acronyms City County Total county)
Domestic crowding
Persons per
apartment (n)
1-2 P1-2 12.8 6.1 10.4 < 0.0000
3-4 P3-4 72.8 76.1 73.9 0.0620
5 P5 9.1 12.8 10.4 0.0024
6-10 P6-10 5.0 4.8 4.9 0.8173
Living space per
person
< 16 [m.sup.2] R16 13.5 14.2 13.7 0.6215
16-25 [m.sup.2] R25 57.2 50.5 54.9 0.0011
25-50 [m.sup.2] R50 28.2 34.1 30.2 0.0018
> 50 [m.sup.2] R > 50 1.1 1.2 1.1 0.8186
Siblings in family
(n)
0 S0 38.9 31.1 36.0 < 0.0000
1 S1 42.5 48.3 44.6 0.0030
2 S2 11.5 14.7 12.7 0.0142
3 S3 4.2 2.8 3.7 0.0588
4 S4 1.9 1.8 1.8 0.8505
5 S5 0.6 0.4 0.5 0.4820
> 5 S > 5 0.4 0.6 0.5 0.4568
Water- and foodborne
factors
Residence with RpW 98.4 98.2 98.4 0.6916
public water
supply
Garden with public GpW 17.7 22.9 19.6 0.0006
water supply
Garden with well GwW 4.5 4.9 4.6 0.6200
water
Drinking well GdwW 1.3 0.7 1.1 0.1311
water (in the
garden)
Use of human GhFert 4.6 3.1 4.1 0.0488
excrement as
garden
fertilizer
Contact with pets
Dog AD 35.6 45.1 39.0 < 0.0000
Cat AC 32.1 48.0 37.9 < 0.0000
Fish AF 15.3 16.4 15.7 0.4209
Rabbit AR 18.1 27.9 21.7 < 0.0000
Bird AB 22.1 25.5 23.4 0.325
Guinea pig AGP 26.5 25.9 26.3 0.7240
Hamster AHA 4.6 6.0 5.1 0.0997
Horse AHO 3.0 8.8 5.1 < 0.0000
Sanitary standards
(residence and
personal
hygiene)
Toilet inside HWC 98.3 98.1 98.2 0.6946
apartment
Washbasin in HWB 89.9 92.0 90.6 0.0614
washroom
Washing of hands HWHT 88.9 90.9 89.6 0.0885
after use of
toilet
Washing of hands HWHE 89.1 92.6 90.4 0.0021
before meals
Toilet-training
(dry and
bowel-trained) TTU + TTB 7.8 5.3 6.9 0.0176
Travels to foreign
countries
Northern Europe TNEU 12.9 13.5 13.1 0.6447
Southern Europe TSEU 34.4 34.7 34.5 0.8700
Eastern Europe TEEU 0.0 10.1 3.7 < 0.0000
Turkey and TTNA 15.0 13.3 14.3 0.2084
North Africa
Africa TAFR 2.8 1.9 2.4 < 0.0000
Asia TASI 2.2 1.9 2.1 0.5861
South America TSAM 0.9 0.5 0.7 0.2298
Carribean Islands TCAR 1.6 2.5 1.9 0.0895
(a) Based on data set of children with a completed questionnaire and
H. pylori test shown in Table 1. Acronyms are used in Figure 1.
Table 3. Clinical predictors of H. pylori infection among probands and
their family members and their occurrence in percent.
Percent(a)
p-Value
(city vs.
Diagnostic predictors Acronyms City County Total county)
Illness/symptoms in
family members
Gastric/duodenal
ulceration
Mother IFUM 1.9 1.9 1.9 1.0000
Father IFUF 1.5 1.9 1.6 0.4204
Gastric/duodenal
cancer
Mother IFCM 0.2 0.6 0.3 0.0767
Father IFCF 0.2 0.1 0.1 0.5276
Endoscopy (lifetime) IFENDO 17.9 20.1 18.7 0.1429
Recurrrent abdominal IFRAP 7.1 9.6 8.0 0.0175
pain
Recurrent belching IFRBELCH 3.6 4.4 4.0 0.2853
Recurrent bloating IFBLOAT 3.5 4.5 3.8 0.1804
Recurrent heartburn IFHB 7.1 10.0 8.1 0.0062
Illness/symptoms in
child
Colicky baby ICCOLIB 4.3 4.2 4.3 0.8975
Recurrent vomiting as ICRVOMB 2.3 1.9 2.1 0.4736
a baby
Recurrent abdominal ICRAP 16.0 16.0 16.0 1.0000
pain
Recurrent belching ICRBELCH 1.1 1.1 1.1 1.0000
Recurrent bloating ICBLOAT 0.5 0.5 0.5 1.0000
Recurrent heartburn ICHB 0.2 0.0 0.1 0.1458
Medication (heartburn) ICMEDS 12.8 12.8 12.8 1.0000
(a) based on data set of children with a completed questionnaire and
H. pylori test shown in Table 1.
Results of the cluster analysis of the total population (city and county) are presented in Figure 1. The main cluster, the variables close to the target HP test (H. pylori positivity), includes the varibles with the least geometric distance from the target. These variables were entered into the multivariate logistic regression analysis to determine odds ratios and significance levels. When applied separately to the data sets (Leipzig city and Leipzig County), cluster analyses of the same 47 selected variables showed that the distance of some cluster variables to the target, H. pylori positivity, varied for the city and county, indicating differences in their importance in the association. The variable "contact with pet hamsters" was associated more closely with H. pylori positivity in the city children than in the county children. In contrast, the variables "use of human excrement excrement /ex·cre·ment/ (eks´kri-mint) 1. feces. 2. excretion (2). ex·cre·ment n. Waste matter or any excretion cast out of the body, especially feces. as garden fertilizer" and the "drinking of water from nonmunicipal sources" appear closer linked to the target variable in the county. The odds ratios (Table 4) show that not all variables clustering close to the target are significant. [GRAPH OMITTED] Table 4. Significant odds ratios of risk factors for city and county children and for the total population. Transmission routes OR 95% CI p-Value Contact with pet hamsters City 2.4 1.2-4.7 0.015 County 2.4 1.0-5.7 0.04 City + County 2.1 1.2-3.7 0.009 Travels to Asian countries City 3.7 1.6-8.7 0.002 Total 3.1 1.4-6.8 0.005 Drinking water in garden County 16.4 3.1-88.5 0.001 Total 2.8 1.0-8.3 0.05 > 3 children in household County 4.2 1.2-14.6 0.02 Total 2.6 1.1-6.6 0.024 City odds ratios are based on 1,785 complete data sets; p = 0.003. County odds ratios are based on 976 complete data sets; p = 0.0005. City + County odds ratios are based on 2,727 complete data sets; p = 0.0008. Among city children, the models with significant associations with H. pylori positivity are "contact with pet hamsters" (OR = 2.4; 95% CI, 1.2-4.7; p [is less than] 0.015) and "travels to Asian countries" (OR = 3.7; 95% CI, 1.6-8.7; p [is less than] 0.002); among county children, there are significant associations for "drinking of water from nonmunicipal sources" (OR = 16.4; 95% CI, 3.1-88.5; p [is less than] 0.001), "more than 3 children in the household" (OR = 4.2; 95% CI, 1.2-14.6; p [is less than] 0.02) and "contact with pet hamsters" (OR = 2.4; 95% CI, 1.0-5.7; p [is less than] 0.04). The model for the entire sample population, based on 2,727 data sets, is highly significant (p = 0.0008). The variables included are "contact with pet hamsters'' (OR = 2.1; 95% CI, 1.2-3.8; p [is less than] 0.009), "travels to Asian countries" (OR=3.1; 95% CI, 1.4-6.6; p [is less than] 0.005), "drinking of water from nonmunicipal sources" (OR = 2.8; 95% CI, 1.0-8.2; p [is less than] 0.05) and "more than 3 children in the household" (OR = 2.6; 95% CI, 1.1-5.9; p [is less than] 0.024). Although we included reported clinical symptoms in a child or a family history of recurrent abdominal pain Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem. , dyspepsia dyspepsia: see indigestion. , gastric/peptic ulceration ulceration /ul·cer·a·tion/ (ul?ser-a´shun) 1. the formation or development of an ulcer. 2. an ulcer. ul·cer·a·tion n. 1. Development of an ulcer. 2. , etc. in the model to test their general and specific importance as risk factors, this analysis indicated that these host factors did not significantly contribute to the prediction of H. pylori positivity. For example, inclusion of the symptoms "recurrent abdominal pain" and "recurrent belching belching see eructation. " into the regression model for the total population (Table 5) only weakened the association. The p-value of the model, in spite of remaining significant, increased from 0.0008 (without the clinical indicators clinical indicator Patient care An objective measure of the clinical management and outcome of Pt care ) to 0.0028. Table 5. Clinical symptoms as diagnostic predictors of H. pylori positivity for the total population. Diagnostic predictors OR 95% CI p-Value Recurrent abdominal pain 1.1 0.7-1.6 0.792 Recurrent belching 1.6 0.5-5.6 0.429 Odd ratios based on 2,715 complete data sets; p=0.003. Discussion Compared to similar studies (4-7), this investigation is, to our knowledge, the largest study of a homogeneous cohort population at risk for H. pylori (Table 1). Moreover, this study allowed the comparison of an almost complete birth cohort of urban and rural children (city and its surrounding county). Also, 95.8% of the children were white, which further indicates the homogeneity Homogeneity The degree to which items are similar. of the cohort. We found no significant difference in the prevalence of H. pylori colonization between city (6.5%) and county (5.7%) children (a total of 6.2%; Table 1). The prevalences are within the norm expected for a developed country, where an acquisition of the bacterium among children is estimated to be less than 1% per year (12). In a recent study of preschool children in a southern German city with a high proportion of foreigners, the total mean prevalence was 11.3%, with 4.9% among German children, and thus comparable to our findings (13). The risk factor analysis showed some unexpected results. The analyses, cluster analysis, and odds ratio calculations indicated four significant risk factors suggestive of suggestive of Decision making adjective Referring to a pattern by LM or imaging, that the interpreter associates with a particular–usually malignant lesion. See Aunt Millie approach, Defensive medicine. being routes for the acquisition of H. pylon pylon (Greek: “gateway”) In modern construction, a tower that gives support, such as the steel towers between which electrical wires are strung or the piers of a bridge. , bacteria (Table 4, Figure 1): * "Travels to Asian countries" as a possible source of infection; the prevalence of H. pylori is much higher in Asian countries than in Central Europe Central Europe is the region lying between the variously and vaguely defined areas of Eastern and Western Europe. In addition, Northern, Southern and Southeastern Europe may variously delimit or overlap into Central Europe. (14-16) * "Large family size," also a known risk factor (16) * "Contact with pet hamsters" * "Drinking water from nonmunicipal sources." The latter two are less known risk factors and require further discussion. In a recent paper, Bode et al. (7) found no significant association with cats, guinea pigs guinea pig (gĭn`ē), domesticated form of the cavy, Cavia porcellus, a South American rodent. It is unrelated to the pig; the name may refer to its shrill squeal. , birds, and rabbits. Our results for these types of pets support their findings. However, the multivariate logistic regression analysis in our study population confirmed the cluster analysis, and indicated that "contact with pet hamsters" significantly increased the odds (OR = 2.1) of infection with H. pylori (Table 4). Furthermore, among rural children the risk of being infected with H. pylori increased with the "drinking of water from nonmunicipal sources" (OR = 16.4; Table 4). This may occur at allotment gardens, where well water may be used for human consumption. The result of the cluster variable analysis of "use of human excrement as fertilizer" (top-dressing) on vegetation in gardens was closely associated with the target H. pylori positivity among county children, even though the regression analysis showed a nonsignificant non·sig·nif·i·cant adj. 1. Not significant. 2. Having, producing, or being a value obtained from a statistical test that lies within the limits for being of random occurrence. association. These findings point to the possibility that handling and/or eating vegetables (as well as grass and flowers), which may be contaminated contaminated, v 1. made radioactive by the addition of small quantities of radioactive material. 2. made contaminated by adding infective or radiographic materials. 3. an infective surface or object. with (human) feces feces or excrement or stools Solid bodily waste discharged from the colon through the anus during defecation. Normal feces are 75% water. The rest is about 30% dead bacteria, 30% indigestible food matter, 10–20% cholesterol and other fats, , could be a route of acquiring the infection. H. pylori has been isolated from human feces Human feces (also faeces — see spelling differences), also known as stools, vary significantly in appearance, depending on the state of the whole digestive system, influenced by diet and health. Normally they are semisolid, with mucus coating. (17) and has been found to be associated with the consumption of uncooked vegetables (18). Furthermore, consuming water from sources other than public supplies or drinking contaminated water is a risk factor in developing countries (19), and Carballo et al. (20) reported that untreated water is a possible source of H. pylori infection. Early results of an epidemiologic and microbiologic investigation now being carried out by our team suggest that, even in Central Europe, well water could be a source of H. pylori infection (21). The H. pylori bacterium appears to survive in water in a coccoid coccoid resembling a coccus. form, even in very cold water (22). All of these studies lend support to the hypothesis that indirect fecal--oral transmission may be an important pathway by which the bacterium gains entrance into the human body, with children being especially at risk. The clinical predictors investigated did not seem to be significant in this population (Tables 3 and 5). No significant associations were found for "gastric/duodenal disease," "recurrent abdominal pain," or "recurrent heartburn heartburn, burning sensation beneath the breastbone, also called pyrosis. Heartburn does not indicate heart malfunction but results from nervous tension or overindulgence in food or drink. " in children or in their families. Measurement errors associated with the low within- and between-population occurrence (Table 3) are balanced by the odds ratio analysis that is based on the total population (city and county) with 2,715 complete data sets. These odds ratios and confidence intervals suggest that the errors were minimized (Table 5). The role of clinical symptoms as indicators of H. pylori infection remains controversial (23), but similar findings have been reported indicating that "chronic abdominal pain" in childhood (24,25) may not necessarily indicate H. pylori positivity. Conclusion In this study we demonstrated that H. pylon. colonization in this preschool population is significantly related to risk factors such as "contact with pet hamsters," "travels to Asian countries," and "drinking of water from nonmunicipal sources." This suggests that indirect fecal--oral transmission may play a key role in the spread of this infection. These factors appear to be as important as household density, which was found to increase the risk of H. pylori infection when more than three children live in a household. However, relative to these risks, the clinical symptom indicators investigated do not seem to play the same significant role in predicting H. pylon, colonization. Although, at present, the recommendations of the European Society for Primary Care Gastroenterology gastroenterology Medical specialty dealing with digestion and the digestive system. In the 17th century Jan Baptista van Helmont conducted the first scientific studies in the field; William Beaumont published his own observations in 1833. do not support a "test and treat" strategy (26), our goal was to show that epidemiologic screenings of population-based, nonsymptomatic children offer information about current prevalences and risk factors, thus, contributing to future recommendations. REFERENCES AND NOTES (1.) Marshall BJ, Warren JR. 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Gut 41(suppl 1):A39 (1997). (21.) Krumbiegel P, Boeckler D, Lehmann I, Jerks S, Fritz G J, Babel Babel (bā`bəl) [Heb.,=confused], in the Bible, place where Noah's descendants (who spoke one language) tried to build a tower reaching up to heaven to make a name for themselves. W, Richter T, Herbarth O. Is water a source of H. pylori infection in Central Europe? [Abstract]. Gut 47(suppl 1):A46 (2000). (22.) McKeown I, Orr P, MacDonald S, Kabani A, Brown R, Coghlan G, Dawood M, Embil J, Sargent M, Smart G, et al. Helicobacter pylori in the Canadian Arctic: seroprevalence and detection in community water samples. Am J Gastroenterol 94:1823-1829 (1999). (23.) Wewer V, Christiansen KM, Andersen LP, Henriksen FW, Hansen JP, Tvede M, Krasilnikoff PA. Helicobacer pylori infection in children with recurrent abdominal pain. Acta Paediatr 83:1276-1281 (1994). (24.) Leicht C, Richter T, Handrick W, Kehrer U, Krumbiegel P. Der [[sup.15][N.sub.2]]Harnstoff-Urintest zur Diagnostik von Helicobacter pylori bei Kindern mit Bauchschmerzen. Monatsschr Kinderheilkd 144:1167-1168 (1996). (25.) Tindberg Y. H. pylori and abdominal pain in school children [Abstract]. Gut 47(suppl1):A94 (2000). (26.) Rubin GP, Meineche-Schmidt V, Roberts AP, Childs SM, de Wit NJ. The management of Helicobacter pylori infection in primary care. Guidelines from the ESPCG. Eur J Gen Pract 5:98-104 (1999). Olf Herbarth,(1) Peter Krumbiegel,(1) Gisela J. Fritz,(2) Matthias Richter,(1) Uwe Schlink,(1) Detlef M. Muller,(3) and Thomas Richter(3) (1) Department of Human Exposure Research and Epidemiology, UFZ-Centre for Environmental Research Leipzig-Halle, Leipzig, Germany; (2) Environmental Hygiene and Epidemiology; and (3) Children's Hospital, University of Leipzig, Leipzig, Germany Address correspondence to O. Herbarth, Department of Human Exposure Research and Epidemiology, UFZ Leipzig-Halle, Permoserstrasse 15, 04318 Leipzig, Germany. Telephone: +49-341-235-2365. Fax: +49-341-235-2288. E-mail: herbarth@ expo.ufz.de We thank W. Braun and W. Kiess, University Children's Hospital, B. Gronemann, Public Health Department, Leipzig; and F.-J. Gutsmuths and R. Remane, Public Health Services health services Managed care The benefits covered under a health contract , City and County of Leipzig. We are grateful to all of the participating doctors and technical staff of the Public Health Services, Division of Children and Adolescents, City and County of Leipzig, for incorporating our study into their work schedule and the medical students, S. Jedwilayties, J. Donaubauer, T. Richter, S. List, D. Boeckler, J. Nounia, B. During, P. Mehlhorn, J. Uri, and H. Pawlowski, for carrying out the tests. We especially thank all of the children and their parents for their interest and participation in the study. This study was funded by the UFZ-Centre for Environmental Research Leipzig-Halle, GmbH. Received 28 June 2000; accepted 4 January 2001. |
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