Helicobacter pylori infection in the young in Bangladesh: prevalence, socioeconomic and nutritional aspects

Abstract

The gastric acid barrier, an important host defence against small bowel infection, may be compromised by infection with Helicobacter pylori. In developing countries, H. pylori infection occurs early in life and prevalence of hypochlorhydria is high particularly in the malnourished, which may predispose a child to repeated gastrointestinal infection and diarrhoea. Diarrhoea being a leading cause of childhood mortality and morbidity in developing countries, we investigated the prevalence of H. pylori infection in children in a poor Bangladeshi community and explored its association with socioeconomic and nutritional status. METHODS: The study was conducted in a poor periurban community among 469 children aged 1-99 months. Parents were interviewed using a questionnaire. To detect active infection with H. pylori a 13C-urea breath test was performed and weight was recorded on a beam balance with a sensitivity of 20 g. RESULTS: In all, 61% of 36 infants aged 1-3 months were positive for H. pylori; this rate dropped steadily with increasing age and was 33% in 10-15 month old children and then rose to 84% in 6-9 year olds. Overall H. pylori infection had no association with nutritional state of the child, or family income but the infection rate was 2.5 times higher in children of mothers with no schooling. CONCLUSIONS: The H. pylori infection rate is very high in early infancy in a poor periurban community of Bangladesh. The reason for a drop in the infection rate in late infancy is unclear but could be due to initial clearance of the infection by the body's defence mechanisms but with possible alteration of the gastric mucosa which sustains infection. Maternal education may be protective and may operate through some unidentified proximate behavioural determinants. The rate of H. pylori infection in infants and young children may predispose them to repeated gastrointestinal infection and diarrhoea.

PIP: The gastric acid barrier is an important host defense against small bowel infection. The integrity of that barrier, however, may be compromised by infection with Helicobacter pylori. The authors investigated the prevalence of H. pylori infection among 469 children aged 1-99 months in a poor, periurban, Bangladeshi community and explored its association with socioeconomic and nutritional status. The children's parents were interviewed via questionnaire, while a C-urea breath test was conducted and weight recorded on a beam balance with a sensitivity of 20 g to detect active infection with H. pylori. 61% of 36 infants aged 1-3 months tested positive for H. pylori. However, the rate of infection declined steadily with increasing age to reach 33% among children aged 10-15 months. The rate of infection then rose to 84% in 6-9 year olds. Overall, H. pylori infection had no association with the nutritional state of the child or family income, but the infection rate was 2.5 times higher among children of mothers with no schooling. It is unclear why the infection rate dropped in late infancy. Initial clearance of the infection by the body's defence mechanisms could be responsible, albeit with the possible alteration of the gastric mucosa which sustains infection. Maternal education may be protective and may operate through some unidentified proximate behavioral determinants. The rate of H. pylori infection in infants and young children may predispose them to repeated gastrointestinal infection and diarrhea