Helicobacter pylori infection is strongly associated with gastric and duodenal ulcers in a large prospective study.
OBJECTIVE
Infection with Helicobacter pylori (H pylori) is a risk factor for peptic ulcer disease (PUD), but there are limited longitudinal data on the associations between infection and incident gastric or duodenal ulcers.


METHODS
Information on potential risk factors, lifetime history of PUD, and serologic measurements of H pylori infection were obtained from a German cohort of 9953 adults, 50 to 74 years old at baseline (2000-2002). The incidence of ulcers was determined by questionnaires sent to study participants and general practitioners 2 and 5 years later, and was validated by medical records.


RESULTS
A lifetime history of PUD was reported by 1030 participants, and during the follow-up period 48 had a first gastric and 22 had a first duodenal ulcer. Infection with H pylori strains that express cytotoxin-associated gene A (cagA) was significantly associated with a lifetime history of PUD (odds ratio, 1.75; 95% confidence interval [CI], 1.50-2.04). Based on longitudinal analyses with physician-validated end points, the adjusted hazard ratios for incident gastric and duodenal ulcer disease were 2.9 (95% CI, 1.5-5.5) and 18.4 (95% CI, 4.2-79.9), respectively, among patients infected with cagA-positive strains of H pylori.


CONCLUSIONS
In cross-sectional analysis, infection with cagA-positive strains of H pylori was associated with a 1.75-fold increased risk of peptic ulcer disease. Longitudinal analyses revealed an 18.4- and 2.9-fold increased risk for duodenal ulcer and gastric ulcer, respectively. The proportion of PUD that is attributable to H pylori infection might be larger than previously believed.
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany. b.schoettker@dkfz-heidelberg.de
Ben
B
Schöttker
Mariam A
MA
Adamu
Melanie N
MN
Weck
Hermann
H
Brenner
D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004381:Duodenal Ulcer / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori / Q000276:immunology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D013276:Stomach Ulcer / Q000453:epidemiology*; D011795:Surveys and Questionnaires
D000907:Antibodies, Bacterial