Is Helicobacter pylori Infection an Occupational Hazard for Anesthesiologists?

Abstract

In the process of doing their daily job, anesthesiologists are exposed to the secretions of the upper airways and stomachs of their patients. These secretions may carry pathogens, which can lead to clinically significant infections. Among these pathogens is Helicobacter pylori (formerly Campylobacter pylori) [1]. First described in 1983, H. pylori has been implicated as the major etiological factor in chronic type B gastritis [2]. In addition, there seems to be a strong association between the presence of H. pylori and peptic, as well as gastric, ulcers. Furthermore, infection with H. pylori has been linked to an increased risk of developing gastric carcinoma [3]. The mode of transmission of this organism is unclear: both oral-oral and fecal-oral routes have been postulated. Epidemiological studies of H. pylori indicate an increased prevalence with age, lower socioeconomic status, and being born outside the United States [4]. Of concern to anesthesiologists, studies have shown that gastroendoscopists and nurses seem to have an increased prevalence of H. pylori antibodies, which may be suggestive of an occupational hazard [5-7]. In contrast, dentists do not seem to be at increased risk [8]. The purpose of this study was to determine the prevalence of H. pylori antibodies among a group of practicing anesthesiologists. Methods This study was reviewed and approved by our human investigation committee. The clinical faculty members and residents of the department of anesthesia at Yale University were approached and asked to participate in this study. Each subject completed a self-administered survey form. The survey included the following items: age, gender, country of origin, years of clinical practice (including residency training), race, any history of chronic dyspepsia, use of antacids or H2 blockers, previous diagnosed H. pylori infections, and previous diagnosis of peptic or gastric ulcer. The presence of immunoglobulin G antibodies to H. pylori was determined by using the AccuStat[trade mark sign] H. pylori test (Boehringer Mannheim, Indianapolis, IN). The test kit uses a qualitative immunochemical membrane assay. The two investigators (KHS and ASH) performed all testing. Quality control testing was performed as suggested by the manufacturer. According to published studies, this test has a sensitivity of 83%-89% and a specificity of 78%-91% compared with biopsy-proven disease [9-11]. Subjects were given their results and counseled as necessary. Data were analyzed using descriptive and comparative (chi squared) statistics and are reported as mean +/- SD. Results Fifty-three practicing anesthesiologists were tested in 1998. Although general medical clearance is required for hospital appointment, H. pylori testing is not routinely performed. The mean (range) demographics of the group were age 39 +/- 7.9 (28-56) yr, years of clinical practice 9 +/- 7.5 (1-30), male 67%, and American-born 47%. Fifteen (28%) reported chronic dyspepsia and 12 (23%) reported using antacids or H2 blockers over the last month. Of this group, two subjects (4%) tested positive. Our results were then compared with two published controlled groups from the eastern United States. The first control group was from Charlottesville, VA, and its data were collected in 1988 [6]. It consisted of 510 healthy blood donors (age 41 [20-77] yr). Using an enzyme-linked immunoadsorbent assay (ELISA) (Pylori Screen; New Horizons Diagnostics, Columbia, MD), the authors found that 72 (14%) individuals were seropositive to H. pylori. The second control group consisted of 441 volunteer blood donors (age 42 [20-91] yr). The samples were collected in 1992 in Tennessee [5]. This group was tested using a different ELISA made by Biomerica Inc (Newport Beach, CA). Using this assay, 114 (25%) of the donors were found to be seropositive. The percentage of H. pylori positivity among the anesthesiologists, 4% (2 of 53), differed significantly from that of the combined control groups: 19% (187 of 951) (P < 0.01). There was no association found between H. pylori antibody status and age, gender, country of origin, or years of clinical practice among the group of tested anesthesiologists. Discussion Intrinsic to the care of patients is the potential of exposure to pathogens. Anesthesiologists spend extended time in close proximity to their patients. In addition, they are often exposed to body fluids while performing endotracheal intubations and starting IV lines [12]. The low detected prevalence among this group of anesthesiologists was surprising given the high percentage of subjects born outside the United States, a well described risk factor. The low prevalence may be due to a number of factors, including higher socioeconomic status (compared with the general population), contact with low-risk patients (compared with gastroenterologists), and the controlled environment of the operating room (compared with the gastrointestinal clinic). In conclusion, H. pylori infection does not seem to be an occupational hazard for anesthesiologists.