Helicobacter pylori Infection: Prevalence and Clinical Relevance in a Large Company

Abstract

Although gastrointestinal (GI) illnesses account for considerable sick absenteeism, there have been few workplace studies of GI disorders. We determined the prevalence of Helicobacter pylori infection by serology and assessed its relation to upper GI tract complaints, personal ulcer history, and family history of stomach cancer in 6,143 employees (mean age, 40.4 years) at BASF's main chemical production facilities in Ludwigshafen, Germany. Employees were recruited during occupational health clinic visits (n = 4,488) and through broad communications efforts (n = 1,655). Participation among clinic attendees was 66%, and this recruitment method was particularly effective in reaching shift employees. Positive immunoglobulin G (IgG) serology (38.2%), ulcers (4.9%), nonulcer dyspepsia (20.4%), and a family history of stomach cancer (6.1%) were common occurrences in this work setting. Further diagnostic evaluation and eradication therapy was recommended for 795 employees (12.9%), based on a combination of positive serology and either upper GI tract complaints or family stomach cancer history, and has been completed for 541 employees. A weak but consistent association was seen between positive serology and cigarette smoking, and shift work was found to be associated with positive serology, but not with ulcer or nonulcer dyspepsia occurrence.

Medical program for shift workers – impacts on chronic disease and mortality outcomes

“…A higher prevalence of gastric and duodenal ulcers has been reported among shift compared to day work employees in several studies (30)(31). In our Helicobacter pylori initiative, shift work was not associated with a higher ulcer or non-ulcer dyspepsia prevalence, although it was associated with positive Helicobacter pylori serology (15). Taking part in the Helicobacter pylori initiative was a significant predictor of subsequent K20-K31 diagnoses, but inclusion of this factor in our incidence analysis for the present study did not diminish the elevated risk ratio for shift work in the category.…”

“…The increased occurrences of COPD among shift work employees at the start of the follow-up and in subsequent incidence rates could be partly due to a lack of specificity in our analyses regarding the number of cigarettes smoked per day. In a 1996 Helicobacter pylori intervention study (15) that included over 4600 participants from the present study, we found that shift work employees smoked more heavily than their corresponding day employees. Thus, cigarette smoking could be both more prevalent (and involve a greater daily intake of cigarettes) among shift compared to day work employees, but prevalence data were available only for our current analyses.…”

“…This strategy combines preventive health examinations, health promotion activities, and the provision of 24-hour on-site emergency medical services. As resources permit, the Medical Department also undertakes other disease prevention programs such as the Helicobacter pylori initiative mentioned earlier (15), and weight reduction and diabetes prevention programs (16)(17).…”

“…These regulations specify the nature of medical examinations to be conducted relative to specific health hazards and set minimum requirements for the provision of medical services. With the consent of the Works Council, the Medical Department may undertake additional disease prevention initiatives (15)(16)(17)21).…”

“…In 1983, representing employees and the works management of BASF, the Works Council entered into an agreement providing additional benefits for shift work employees in the form of (i) routine medical examinations including an assessment of suitability for shift work, (ii) health promotion retreats lasting up to three weeks, and (iii) financial compensation for employees leaving shift work for health reasons. BASF's Occupational Medical and Health Protection Department administers the medical examination and other related health promotion programs and also provides 24-hour, on-site emergency medical services for employees (14)(15)(16)(17). The Medical Department maintains a medical information system to support the various occupational health activities of the Department.…”