Abstract & Commentary
Synopsis: Pathogenic cagA+ strains of H pylori seem to be vanishing, changing our expectations regarding H pylori and human disease.
Source: Perez-Perez GI, et al. Gut. 2002;50:295-298.
Gastric colonization by Helicobacter pylori is probably as old as mankind. Most adults in developing countries are positive for this organism, while its prevalence is far lower in developed countries. In all settings, H pylori is more common in the elderly. The cagA+ strains of H pylori are associated with such unfavorable outcomes as peptic ulcers and gastric cancer, but they may also be correlated with decreased risk of esophageal diseases (eg, GERD). This study is from large numbers of Finnish subjects between 1973 and 1994 during which both cagA+ and cagA- prevalence fell. However, the prevalence of cagA+ strains fell more dramatically in subjects < 45 years of age (34% to 8%) than cagA- strains (falling from 12% to 6%). It was concluded that there is declining acquisition of cagA+ H pylori in younger subjects and that H pylori acquisition occurs primarily during childhood although low rates of adult acquisition do occur as well.
Comment by Malcolm Robinson MD, FACP, FACG
There seem to be many misconceptions about the significance and management of H pylori infections in our patients. Although there has been a statistical correlation between this organism and some nasty diseases, most people with gastric colonization by H pylori are asymptomatic and totally unaffected. This work suggests that infections with pathogenic H pylori are destined to become even less frequent than is currently the case. A recent article confirmed that most newly acquired H pylori infections happen before age 10,1 suggesting that treatment and prevention strategies should be directed at that age group. One should assess adult patients for H pylori only in the presence of peptic ulcer. The likelihood of any association between H pylori and disease will only get smaller as the years pass by.
Dr. Robinson is Medical Director, Oklahoma Foundation for Digestive Research; Clinical Professor of Medicine, University of Oklahoma College of Medicine, Oklahoma City, Okla.
Reference
1. Malaty HM, et al. Lancet. 2002;359:931-935.
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