Risk Factors and Exposure Pathways of Helicobacter pylori Colonization

Abstract

TAB4-PD-10 Introduction: Helicobacter pylori (H. pylori) is one of the world's most widespread microorganism. Its acquisition in humans remains poorly understood. Epidemiologic studies have identified different pathways, including drinking water as reservoir for the bacterium. Only if the main pathways are known, effective prevention measures are possible to avoid a colonization and health effects later on. Methods: A repeated cross-sectional study and a case-control study have been carried out. H. pylori colonization was determined using the [13C]urea breath test. A self-administered or parent-completed questionnaire provided information on living conditions and lifestyle habits, including the use/drinking of well water. The statistical analysis based on data of 2888 children in the case of the cross-sectional study and of 91 subjects (72 adults, 19 children) using drinking water from nonmunicipal sources. Results: In the population-based cross-sectional study 6.2% of the children (mean age, 6.1 years) were tested to be H. pylori positive. H.pylori positivity increased significantly with drinking of water from nonmunicipal sources (odds ratio [OR] = 16.4, P < 0.001). Considering these results, the specific case-control study of specific well water using subjects was initiated. For these participants, an H. pylori prevalence of 30% was found with a crude OR = 8.3, P < 0.001 in case of drinking well water. In case of adjusted model (adjusted for age and sex), the OR for H. pylori-positive subjects and H. pylori-positive tested water was 5.3 (P < 0.05). Conclusions: The use/drinking of H. pylori-contaminated well water appears associated with the acquisition of a H. pylori colonization. From that point of view, it can be stated that well water is one important pathway of the H. pylori colonization. These facts clearly indicate to include the test of H. pylori of private used well water in the public health surveillance program.