20 Years of H. pylori in Puerto Rico

Abstract

Introduction: The prevalence of H. Pylori infection is generally lower in the United States (31%) in comparison to Asia and Central/South America. In the U.S., infection appears to be more common in Hispanics and African Americans with prevalence being 64% and 52%, respectively; compared to 21% in whites. Previous studies have shown increased prevalence in Hispanics; these have taken place in cities with predominantly mixed populations. Previous data collected by our team in 1998 and 2011 shows H. pylori prevalence by antrum biopsy of 38.2% and 31.5%, respectively. Methods: We performed a study of 597 consecutive patients evaluated for upper gastrointestinal symptoms for H. pylori status between January 1st to December 31st, 2017. 46 studies were excluded because biopsies for H. pylori were not taken due to lack of indications (Barrett's surveillance, polyp removal, others). The group that underwent ambulatory EGD involved subjects between the ages 17—96. Several biopsies were taken from the antrum to test for the presence of the pathogen. After dividing the subjects by gender and age, results were compared to data from studies performed in the same endoscopy center during 1998 and 2011. Results: Of the 551 patients which underwent biopsy for H. Pylori, 16.3% (90/551) had positive results. When divided by gender, 17.4% (34/195) male and 15.7% (56/356) female subjects had a positive pathogenic status. When groups were divided by age, it was observed that prevalence from 15—29 years old was 2.6% (1/38), 30—44 years old was 10.4% (7/67), 45—59 years old was 16.5% (23/139), 65—74 years old was 19.0% (44/231) and >75 years old was 19.7% (15/76). These results continue the trend of decreasing prevalence when compared to the studies of 1998 (38.2%) and 2011 (31.5%). Conclusion: H. pylori prevalence has markedly decreased (more than expected) in Puerto Rico during the last 20 years. Our results are consistent with worldwide tendency of decreased prevalence. In addition, as expected, the prevalence increased as the population's age increases. However, ethnic group prevalence varies by location even in different areas of the same country. Prevalence, availability, type of therapy or even response to therapy also varies in different countries. Given that all patients studied had upper G.I. tract symptoms, the general population prevalence may even be lower than the one reported in this study.1211 Figure 1. Change in prevalence of H. pylori in Puerto Rico along twenty years.