Abstract
We concur overall with Taylor's presentation of what is known about the dynamics of Helicobacter pylori infection in childhood (1). but we would like to emphasize that many more questions than answers remain. Because H. pylori infection is not normally detectable at onset, information about incidence must be inferred from age-specific prevalence or repeated screening for prevalent infection over time (2). The infection does not appear to confer lasting immunity, and currently, there is no way to determine whether uninfected individuals have been infected in the past (3). Thus, the average duration of naturally acquired infections and the proportion that are self-limiting is not known for any population or age group. Few studies have examined the infection status of asymptomatic individuals over time. Prospective studies that observe infection status at frequent time intervals have been particularly rare; thus, detailed information regarding the natural history of the infection, peak age ranges for acquisition, and factors that may differentially influence acquisition, persistence, and recurrence is limited. Taylor speculates that antibiotics and characteristics of H. pylori strains may account for spontaneous elimination of infection in children. Emerging evidence suggests that factors that influence the ecology of the gastric niche or the immune response may also influence persistence. In recent laboratory studies, feeding H. pylori-infected mice algae meals with a high antioxidant concentration induced immune changes associated with reduced bacterial load (4). This finding complements an observed inverse association between consumption of fruits and vegetables and H. pylori prevalence in Colombian children (5). We would expect the age-related peaks in acquisition and elimination to vary considerably across popu-
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