title: Review article: the prevalence of Helicobacter pylori and the incidence of gastric cancer across Europe.
abstract: BACKGROUND
  There is little up-to-date review evidence on the prevalence of Helicobacter pylori across Europe.
  
  
  OBJECTIVE
  To establish regional and national patterns in H. pylori prevalence across Europe. Secondly, to establish trends over time in H. pylori prevalence and gastric cancer incidence and, thirdly, to report on the relationship between H. pylori prevalence and age group across Europe.
  
  
  METHODS
  A review of H. pylori prevalence from unselected surveys of adult or general populations across 35 European countries and four European regions since 1990. Secondly, an analysis of trends over time in H. pylori prevalence and in gastric cancer incidence from cancer registry data.
  
  
  RESULTS
  Helicobacter pylori prevalence was lower in northern and western Europe than in eastern and southern Europe (P < 0.001). In 11 of 12 European studies that reported on trends, there were sharp reductions in H. pylori prevalence (mean annual reduction = 3.1%). The mean annual reduction in the incidence of gastric cancer across Europe from 1993 to 2007 was 2.1% with little variation regionally across Europe (north 2.2%, west 2.3%, east 1.9% and south 2.0%). Sharp increases in age-related prevalence of H. pylori often levelled off for middle age groups of about 50 years onwards, especially in areas with high prevalence.
  
  
  CONCLUSIONS
  This review shows that H. pylori prevalence is much higher in less affluent regions of Europe and that age-related increases in prevalence are confined to younger age groups in some areas. There were sharp reductions in both H. pylori prevalence and gastric cancer incidence throughout Europe.
authors.affiliation: Medical School, Swansea University, Swansea, UK.
authors.forename: S E
authors.initials: SE
authors.lastname: Roberts
authors.affiliation: Medical School, Swansea University, Swansea, UK.
authors.forename: S
authors.initials: S
authors.lastname: Morrison-Rees
authors.affiliation: Medical School, Swansea University, Swansea, UK.|West Wales General Hospital, Carmarthen, UK.
authors.forename: D G
authors.initials: DG
authors.lastname: Samuel
authors.affiliation: Medical School, Swansea University, Swansea, UK.
authors.forename: K
authors.identifier: http://orcid.org/0000-0003-0691-6282
authors.initials: K
authors.lastname: Thorne
authors.affiliation: Medical School, Swansea University, Swansea, UK.
authors.forename: A
authors.initials: A
authors.lastname: Akbari
authors.affiliation: Medical School, Swansea University, Swansea, UK.
authors.forename: J G
authors.initials: JG
authors.lastname: Williams
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005060:Europe / Q000453:epidemiology; D005260:Female; D016481:Helicobacter Infections / Q000453:epidemiology*; D016480:Helicobacter pylori; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015995:Prevalence; D012959:Socioeconomic Factors; D013274:Stomach Neoplasms / Q000453:epidemiology*; D011795:Surveys and Questionnaires