Acute Helicobacter pylori Infection Is Followed by an Increase in Diarrheal Disease Among Peruvian Children

Abstract

ABSTRACT. Background. Cohort and case-crossover studies were conducted to evaluate whether new Helicobacter pylori infections are followed by increased diarrhea.Methods. Participants were 6-month-old to 12-yearold shantytown residents living near Lima, Peru. Baseline data were collected from community households. Health interviews were completed daily, and sera, drawn every 4 months, were tested for H pylori immunoglobulin G. Diarrhea rates among newly H pylori-infected (seroconverting) children were compared with rates among persistently uninfected and infected children using cohort and case-crossover analyses.Results. Sera were obtained from 345 children from January 1, 1995, through September 1, 1997. H pylori incidence was 12% per year (36 H pylori infections in 109 866 seronegative days). In adjusted cohort analyses, seroconverters had more diarrhea days (rate ratio: 2.0; 95% confidence interval: 1.6 -2.4), episodes, and sick days in the year after infection than did uninfected children; and more diarrhea days and sick days than did persistently infected children. This effect was strongest in the first 2 months. Case-crossover analyses supported these findings.Conclusion. Preventing H pylori infection may help reduce pediatric diarrheal disease. Pediatrics 2001;108(5). URL: http://www.pediatrics.org/cgi/content/full/108/5/ e87; Helicobacter pylori, diarrheal disease, cohort study, case-crossover study, Poisson regression, childhood, achlorhydria, incidence, serology.ABBREVIATIONS. IgG, Immunoglobulin G; EIA, enzyme-linked immunosorbent assay; OD, optical density; PAR, population-attributable risk; 95% CI, confidence interval; RR, rate ratio.H elicobacter pylori infection is extremely common, infecting 20% to 60% of adults in developed countries and nearly all adults in developing countries. 1-8 Chronic infection with H pyloriwhich is typically acquired in childhood and persists throughout life-causes a variety of chronic diseases: duodenal 9,10 and gastric 11 ulcers, gastric cancer, 12,13 and gastric lymphoma. 14,15 The health effects of acute H pylori infection, however, are unknown. Reports in adults suggest that newly established infection is accompanied by mild gastrointestinal symptoms, although no controlled studies have been performed. 16 -20 Childhood infection has been linked to chronic diarrhea and growth retardation. Whether H pylori causes these problems or is simply a marker for other factors is unclear. [21][22][23] Acute H pylori infections often cause transient hypochlorhydria beginning as soon as 2 weeks after infection. 18,20,24 -26 In a cluster of probable H pylori infections transmitted by nasogastric instrumentation, hypochlorhydria lasted for a median of 4 months after infection among 14 of the 17 adults who recovered normal gastric acidity; 3 adults remained hypochlorhydric during throughout the year-long study period. 17,19 Hypochlorhydria has also been demonstrated in newly H pylori-infected Gambian infants. 23 Although there are several potential mechanisms by which H pylori coul...

Association of Helicobacter pylori Infection and Height of Mexican Children of Low Socioeconomic Level Attending Boarding Schools

“…This effect was greater in the two months after infection. 27 In Thailand, no difference in the incidence of diarrheal disease according to the H. pylori infection was found among children less than five years of age, either in those who acquired the infection during the study in contrast to the prevalent cases or among these and children who remained negative during the follow-up. 26 In the Colombian cohort study, a positive association was found between the H. pylori -infected children and the days absent from nursery school because of respiratory infections.…”

“…However, results from studies on the incidence of diarrheic episodes in infected and noninfected children are not consistent. 26,27 Passaro and others in a retrospective cohort found that children seropositive for H. pylori had more and lengthier episodes of diarrhea the year after the acquisition of the infection than children who were not infected. This effect was greater in the two months after infection.…”

Virulence Genes and Neutral DNA Markers ofHelicobacter pyloriIsolates from Different Ethnic Communities of West Bengal, India

“…For example, studies using different inbred mouse lines have shown that the severity of inflammation, and thus potentially the risk of overt disease, that a given H. pylori strain can elicit is affected by the host genotype (17,18). Indeed, the historic importance of cholera and other diarrheal diseases as a major cause of death in the Indian subcontinent and the importance of H. pylori infection in increasing susceptibility to enteric pathogens (10,33,40) might have helped select for human genotypes that result in decreased virulence during chronic infection.…”

DNA-Level Diversity and Relatedness of Helicobacter pylori Strains in Shantytown Families in Peru and Transmission in a Developing-Country Setting

“…Our study focused on H. pylori strains from residents of Las Pampas de San Juan de Miraflores (PSJM), a periurban shantytown of 40,000 persons of low income (Յ$1,500 per family per year, on average) in Lima, Peru, that is representative of many developing-country societies. The health of the residents of PJSM has been under surveillance for more than 20 years by physicians and health care and social workers of the Peruvian nongovernmental organization Proyectos en Informtica, Salud, Medicina y Agricultura (PRISMA; http://www .prisma.org.pe/nwWeb/Portal/) (23,29,30,37). Most residents of PJSM become chronically infected with H. pylori in early childhood (30), as is typical in developing countries worldwide (8,19).…”

“…Such chronic H. pylori infections constitute major risk factors for duodenal and gastric ulcers and for gastric cancer, one of the most frequently lethal malignancies (3,13,33). Especially among the poor in developing countries, H. pylori infection also increases susceptibility to other food-and waterborne pathogens and contributes to iron deficiency anemia and malnutrition (10,37,46). This said, most infections seem to be benign; and some, it has been argued, can even be beneficial (7), although the latter view is controversial (25).…”