According to a new study published in The American Journal of Gastroenterology, the overall prevalence of Helicobacter pylori infection in the United States is steadily declining, and this trend appears to have also translated into fewer H pylori-harboring ulcers in patients.
Sonnenberg and colleagues hypothesized that the decline in the occurrence of peptic ulcer disease, specifically gastric and duodenal ulcers, is secondary to a decline H pylori infection in the general population.
The team tested this hypothesis in a large US population undergoing esophagogastroduodenoscopy in private outpatient endoscopy centers using patient histopathologic records in the Inform Diagnostics database. Patient (n=1,289,641) data on the occurrence of gastric and duodenal ulcers were stratified by age, sex, ethnicity, H pylori status, year of diagnosis, and ulcer type and analyzed using multivariate logistic regression.
From 2009 to 2018, the prevalence of H pylori infection decreased from 11% to 9% (r=0.95; P <.001). Similarly, the fraction of H pylori-positive gastric and duodenal ulcers showed corresponding decreases from 17% to 14% (r=0.60; P =.039) and from 25% to 21% (r=0.60; P =.066), respectively.
Presently, only 17% of ulcers harbor H pylori. Overall, the prevalence of gastric ulcers was 3-fold higher than duodenal ulcers, and more duodenal ulcers were positive for H pylori than gastric ulcers. Men had more occurrences of H pylori infection than women (odds ratio, 0.85; 95% CI, 0.84-0.86; P <.0001).
Compared with the general population, the prevalence of H pylori was 2.6-fold higher among Hispanics and 3.2-fold higher among East Asians. However, these populations also had decreasing prevalence of H pylori infection, from 24% to 22% among Hispanics (r=0.81; P =.008) and from 21% to 15% among East Asians (r=0.94; P <.001). The fraction of H pylori-positive gastric ulcers was 35% in Hispanics and 37% in East Asians.
Limitations of the study included that the study population had a small fraction of patients with Medicaid, who may have different rates of H pylori infection. Additionally, only endoscopic and histopathologic data were available from the database. Thus, information on disease history, laboratory values, other risk factors, and medications was unavailable. Other tests for H pylori, such as serology, also were not included.
The authors also highlighted the strengths of the study, including using a large database in a diverse population and the consistency of histopathologic readings by board-certified pathologists.
“Twenty to thirty years ago, 60%–80% of gastric ulcers and more than 90% of duodenal ulcers were associated with H pylori infection,” wrote the authors, “More than 80% of all ulcers are nowadays unrelated to H pylori.”
Disclosure: Kevin O. Turner, DO, and Robert M. Genta, MD, are employed by Inform Diagnostics.
Sonnenberg A, Turner KO, Genta RM. Low prevalence of Helicobacter pylori-positive peptic ulcers in private outpatient endoscopy centers in the United States. Am J Gastroenterol. 2020;115(2):244-250.