Towards a healthy stomach? Helicobacter pylori prevalence has dramatically decreased over 23 years in adults in a Swedish community

Abstract

Background: In Western countries the prevalence of Helicobacter pylori (H. pylori) infection may be declining but there is a lack of recent longitudinal population studies. We evaluated the changing epidemiology over a 23-year period in Sweden. Materials and methods: In 1989, the validated Abdominal Symptom Questionnaire (ASQ) was mailed to a random sample of inhabitants (ages 22-80 years) in a Swedish community, and 1097 (87%) responded. H. pylori serology was analysed in a representative subsample (n ¼ 145). Twenty-three years later, the ASQ was mailed again using similar selection criteria, and 388 out of 1036 responders had an upper endoscopy with assessment of H. pylori and corpus atrophy status. Results: The prevalence of positive H. pylori serology decreased from 37.9% (1989) to 15.8% (2012), corresponding to a decrease in odds of 75% per decade (odds ratio (OR): 0.25; 95% confidence interval (CI): 0.11-0.59, p ¼ 0.001) independent of age, gender, body mass index (BMI) and level of education, with a pattern consistent with a birth cohort effect. The prevalence increased with increasing age (p ¼ 0.001). The prevalence of H. pylori on histology in 2012 was 11.4% (95% CI 8.6-15.0). The prevalence of corpus atrophy on serology and/or histology in 2012 was 3.2% (95% CI 1.8-5.5); all cases were !57 years old. Conclusion: The stomach is healthier in 2012 compared with 1989. H. pylori prevalence in adults has decreased over the last two decades to a level where clinical management might be affected.

Prevalence of clarithromycin-resistant Helicobacter pylori in children living in South of Sweden: a 12-year follow-up

“…The present study demonstrated a 12% prevalence of gastric HP-DNA positivity in children living in the southernmost parts of Sweden referred to a tertiary university hospital for an upper endoscopy between 2005 and 2016, which is in line with reports from North of Stockholm (11.3% in histology data) [14]. We further found a 21% global prevalence of crHP regardless of indication for endoscopy, and this level was consistent between the groups.…”

“…As a proxy of the general population, we therefore attempted to estimate the prevalence of HP in children not primarily investigated for HP (Group II), however, the result of prior HPSA testing seems to be a determining factor for the indication chosen by the referring doctor, and the prevalence in Group II is therefore probably an underestimation, and for Group I, an overestimation is likely based on the fact that more than 95% of those with HP in biopsies had a prior positive HPSA test result between 2013 and 2016. The prevalence of gastric HP-DNA amongst children not primarily investigated for HPrelated indications and estimated at 5.4% is close to the prevalence of 6.3% in histology data found in individuals aged 20-45 years from Stockholm [14]. Still, it is probably biased despite our efforts to avoid that, and the overall prevalence of 11.8% in our study is most likely a better approximation, compared with the all age groups prevalence of 11.3% in histology in the Stockholm study [14].…”

“…The prevalence of gastric HP-DNA amongst children not primarily investigated for HPrelated indications and estimated at 5.4% is close to the prevalence of 6.3% in histology data found in individuals aged 20-45 years from Stockholm [14]. Still, it is probably biased despite our efforts to avoid that, and the overall prevalence of 11.8% in our study is most likely a better approximation, compared with the all age groups prevalence of 11.3% in histology in the Stockholm study [14]. Another weakness is that lack of information about previous antibiotic use, including eradication, and the migrant status of the participating children originating from other countries, which both would select for increase in crHP [18].…”

Epidemiology of Helicobacter pylori infection

“…Prevalence continues to decline in Sweden. 30 In Latvia on the other hand there has been no evidence of a fall in prevalence in children over the last 10 years. 31…”

Helicobacter pylori eradication in the Swedish population

“…In parts of Asia, where the prevalence of H. pylori is high, the bacterium is also eradicated to prevent gastric cancer, sometimes even in asymptomatic individuals [2]. In Sweden, where the prevalence of H. pylori is lower (11%) [3,4], there is no population screening for H. pylori, so eradication is usually restricted to symptomatic patients. However, recent consensus states that all individuals with documented H. pylori infection should receive eradication [5].…”