short report

714 1 3Do gender and age influence the frequency of Helicobacter pylori infection?

SummaryBackground 13C urea breath test (UBT) is a noninvasive method for detection of Helicobacter pylori (H. pylori) infection. The aim of this study was to determine age and gender differences in patients with positive UBT.

Patients and methods During the period 2008–2011, a total of 3,000 patients, who did not receive Hp eradica-tion therapy before our study, underwent UBT in Labora-tory of Clinical Hospital Sveti Duh. Data were analyzed according to age and gender.

Results A total of 1,400 patients were positive (47 %), 670 males and 730 females (the male/female ratio for positive UBT was 0.92). The male predominance was found in people born between 1930 and 1939, 1940 and 1949, and 1960 and 1969, respectively. The majority infected are born between from 1940 and 1979, with the highest point from 1950–1969.

Conclusions Our study results confirm the impor-tance of epidemiologic characteristics of Hp infection in our region.

Keywords H. pylori infection · 13C urea breath test · Age and gender differences  · Without eradication therapy  · Croatia

Beeinflussen Geschlecht und Alter die Häufigkeit der Infektion mit Helicobacter pylori?

ZusammenfassungGrundlagen Der 13-C-Urea Harnstoff Test (UHT) ist eine nicht invasive Methode zum Nachweis einer Helicobac-

ter pylori (HP) Infektion. Ziel dieser Studie war es zu prüfen, ob es Alters- und Geschlechts-Unterschiede bei Patienten mit positiven HP Test gibt.

Methodik Im Zeitraum von 2008 bis 2011 wurde bei insgesamt 3000 Patienten, die vor der Studie keine HP Eradikationstherapie erhalten hatten, ein UHT im Labor des Sveti Duh Spitals durchgeführt. Die Ergebnisse wur-den nach Alter und Geschlecht analysiert.

Ergebnisse 1400 (47 %) hatten einen positiven Test, wobei 670 männlichen und 730 weiblichen Geschlechts waren (Mann/Frau Quotient: 0,92). Ein Überhang an Männern wurde in den Altersgruppen der Geburtsjahre 1930–39, 1940–49 und 1960–69 gefunden. Die meisten Infektionen wurden bei den Patienten gefunden, die zwi-schen 1940 und 1979 geboren waren, wobei der Höhe-punkt bei den Geburtsjahren 1950–69 lag.

Schlussfolgerungen Die Ergebnisse unserer Studie bestätigen die Wichtigkeit epidemiologischer Charakte-ristika der Infektion mit HP in unserer Region.

Schlüsselwörter Helicobacter pylori Infektion  · 13-C-Urea Atem Test  · Alter und Geschlechtsunterschiede  · Eradikationstherapie · Kroatien

Introduction

Helicobacter pylori (H. pylori) is one of the most com-mon bacterial pathogen in humans and more than half of the population is colonized with this Gram-negative flagellated spiral bacterium [1], but only few of the infected individuals develop clinical symptoms of this colonization. H. pylori infection is mainly required in the childhood and is strongly associated with the patho-genesis of chronic active gastritis, peptic ulcers, and gas-tric malignancies [2]. H. pylori eradication treatment is indicated in patients with peptic ulcer disease, mucosa associated lymphoid tissue (MALT) lymphoma, atrophic

M. Marušic, MD, PhD () · K. Majstorovic Barac · A. Bilic · D. Jurcic · S. Gulic · P. Grubic Rotkvic · J. BagoDepartment of Gastroenterology, Internal Medicine Clinic,Clinical Hospital Sveti Duh, Sveti Duh 64, 10000 Zagreb, Croatiae-mail: marinko.marusic1@zg.t-com.hr

Received: 29 August 2012 / Accepted: 14 September 2013 / Published online: 22 October 2013© Springer-Verlag Wien 2013

Wien Klin Wochenschr (2013) 125:714–716DOI 10.1007/s00508-013-0433-0

Do gender and age influence the frequency of Helicobacter pylori infection?

Marinko Marušic · Karolina Majstorovic Barac · Ante Bilic · Dragan Jurcic · Saša Gulic · Petra Grubic Rotkvic · Josip Bago

short report

7151 3 Do gender and age influence the frequency of Helicobacter pylori infection?

gastritis, post- gastric cancer resection or patients who are first degree relatives of patients with gastric cancer [3] and, for those reasons, it is very important do recog-nize and to treat those patients. Various factors influence the prevalence of H. pylori infection. It seems that there are no gender differences in the prevalence of H. pylori infection, but existing data show that infected females have a higher bacterial load and are potentially more infectious for their children than males [4]. Further-more, developing countries with better hygienic status have lower incidence of H. pylori infection [5]. During the last few decades numerous studies were published to establish the gold standard for the diagnosis of H. pylori infection. H. pylori infection can be diagnosed by inva-sive and noninvasive methods. Invasive methods require endoscopy- and biopsy- based tests, including microbi-ological culture, histology, rapid urease test (CLO test), and polymerase chain reaction. Serology, stool antigen test, and urea breath (UBT) test are considered as non-invasive tests. Conventional UBT with administration of liquid solution has been regarded as an accurate method for the noninvasive diagnosis of H. pylori infection. Its sensitivity and specificity have been shown to range from 90 to 100 %, compared with biopsy-based tests [6]. Since there were no recent demographic data on the H. pylori positive patients for our region, the aim of our study was to investigate age and gender differences in patients with UBT positive test.

Patients, materials, and methods

In this retrospective cross-sectional study that was con-ducted between 2008 and 2011 in the Laboratory of Clini-cal Hospital Sveti Duh, Zagreb, Croatia, we investigated demographic data (age and gender) from 1,400 UBT pos-itive patients (47 % from entire study group), who were not treated from H. pylori infection before.

Permission to review medical records was obtained from the Local Ethics Committee. Before entering the study, each patient reviewed and signed an informed consent form approved by the Local Ethics Committee. Standards of Good Clinical Practice and The declaration of Helsinki were followed.

The 13C-urea breath test was performed after overnight fast and collection of baseline exhaled-breath sample. To delay gastric empting, each patient got a glass of orange juice (200 ml). Then 75 mg of 13C-urea dissolved in 30 ml of water was administered orally. 30 min later, the second breath sample was obtained. All breath samples were analyzed in an isotope-ratio mass spectrometer (IRMS, Wagner Analysen Technik, Bremen, Germany). An increase of 13C02 exceeding the baseline value by more than 4‰ indicated the presence of H. pylori.

Associations of Hp positivity with gender and age were analyzed using the Chi-square test. A p-value of < 0.05 was considered statistically significant.

Results

Between 2008 and 2011 in our laboratory we analyzed UBT findings from a total of 3,000 patients, who did not receive H. pylori eradication therapy before our study. A total of 1,400 patients were positive, 670 males and 730 females (the male/female ratio for positive UBT was 0.92). We found a statistically significant difference between male and female infected with H. pylori in people born between 1930 and 1989. The male predominance was found in people born between from 1930 and 1939, 1940 and 1949, and 1960 and 1969, respectively. The majority infected are born between 1940 and 1979, with the high-est point from 1950–1969 (Table 1).

Discussion

The prevalence of H. pylori infection in developing coun-tries is about 80 %, while in developed countries it amounts only 20–50 %. According to recent data, seroprevalence of H. pylori infection in dyspeptic patients in Croatia, which was determined by ELISA and CFT, was 92.3 %/89.5 %, respectively [7]. Besides age, there are various factors influencing the prevalence of H. pylori infection, such as low socioeconomic status (poor living conditions in multimember families, especially in childhood, water contamination) and place of residence [8]. In the pres-ent study, we analyzed the relationship between H. pylori positivity and gender and age. Recent data have shown different results. Researches from Israel (2011) demon-strated high UBT results in early childhood, decrease through the first 3 decades of life and then plateau until the 7th decade, at which point they begin to increase. Females have significantly higher results than males in all age groups [9]. Gruber et al. [10] in 2008 found no gen-der differences in the studied population, while age, race, and socioeconomic status influenced the prevalence of H. pylori positivity. Patients aged 50 years and below were likely to have positive UBT comparing to those above the age of 50 [10]. On the other hand, researches from Serbia in 2011 found that H. pylori infection does not depend on

Table 1 Distribution of Helicobacter pylori positive patients according to age and gender

People born between Male Female Total P

1920–1929 14 10 24 n.s.

1930–1939 43 20 63 0.001

1940–1949 114 80 194 0.001

1950–1959 171 250 421 0.001

1960–1969 214 160 374 0.001

1970–1979 100 150 250 0.001

1980–1989 14 60 74 0.001

1990–1999 – – – –

Grand total 670 730 1,400 –

n.s. no significance

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716 1 3Do gender and age influence the frequency of Helicobacter pylori infection?

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patients age and gender, as well as on blood group type or Rh factor which they also investigated [11].

Recent data from Pakistan showed no significant asso-ciation between H. pylori infection and gender, while the prevalence of infection increased with age, from child-hood to adolescence, with maximum in adults, 19 + years. The female group followed that trend, while the male group showed the highest prevalence for the adolescents [12]. In Turkey in 2007, H. pylori positivity in symptomatic patients amounted 68 % and this rate was lower at age 4–9, comparing to the other age groups and it was not related to gender and AB0 and Rh blood groups and gastrointes-tinal diagnosis as well [13]. In another study from north-ern Brazil, H. pylori seroprevalence was 80 % and did not increase with age, but increased with the lower socio-economic status [14]. Prevalence of H. pylori infection in Czech Republic was not related to gender, but it was related to low socioeconomic conditions and increased with age [15]. Apart from the above, Martel and Parsonnet [16] showed the male predominance of H. pylori infec-tion in . Considering distribution of H. pylori infection in the adult population of Croatia, Babus et al. [17] in 1997 found that the rate of infection increases with aging, rang-ing from 51.6 % in the 3rd decade of life through nearly 70 % in the 6th decade of life [17]. On the other hand, in the previously mentioned study, Marusic et al. [7] in 2008 found that the seroprevalence of H. pylori infection in dyspeptic patients in Croatia was not age dependent [7].

Our study demonstrates a male predominance in H. pylori positivity in all subjects older than 60 years and in those born between early 40s and early 50s (1960–1969). A female predominance was found in the other age groups. The majority infected are in people born between 1940 and 1979, with the highest point from 1950–1969 (Table 1), which confirms the results of Babus et al. [17] that the most infected are over 60 years old [17].

The present data indicate that it is necessary to inves-tigate the local prevalence of H. pylori infection, focus-ing on specific age groups to treat the infected because of obvious changes of epidemiologic characteristics of H. pylori infection. Moreover, further investigations are needed to study another risk factors and transmission routes in our region.

Conflict of interestThe authors declare that there is no conflict of interest.

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