title: Towards a healthy stomach?Helicobacter pyloriprevalence has dramatically decreased over 23 years in adults in a Swedish community.
abstract: BACKGROUND
  In Western countries the prevalence ofHelicobacter pylori (H. pylori)infection may be declining but there is a lack of recent longitudinal population studies. We evaluated the changing epidemiology over a 23-year period in Sweden.
  
  
  METHODS
  In 1989, the validated Abdominal Symptom Questionnaire (ASQ) was mailed to a random sample of inhabitants (ages 22-80 years) in a Swedish community, and 1097 (87%) responded.H. pyloriserology was analysed in a representative subsample (n= 145). Twenty-three years later, the ASQ was mailed again using similar selection criteria, and 388 out of 1036 responders had an upper endoscopy with assessment ofH. pyloriand corpus atrophy status.
  
  
  RESULTS
  The prevalence of positiveH. pyloriserology decreased from 37.9% (1989) to 15.8% (2012), corresponding to a decrease in odds of 75% per decade (odds ratio (OR): 0.25; 95% confidence interval (CI): 0.11-0.59,p= 0.001) independent of age, gender, body mass index (BMI) and level of education, with a pattern consistent with a birth cohort effect. The prevalence increased with increasing age (p= 0.001). The prevalence ofH. pylorion histology in 2012 was 11.4% (95% CI 8.6-15.0). The prevalence of corpus atrophy on serology and/or histology in 2012 was 3.2% (95% CI 1.8-5.5); all cases were ≥57 years old.
  
  
  CONCLUSIONS
  The stomach is healthier in 2012 compared with 1989.H. pyloriprevalence in adults has decreased over the last two decades to a level where clinical management might be affected.
authors.affiliation: Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Agréus
authors.affiliation: Department of Medicine, Uppsala University, Uppsala, Sweden.
authors.forename: Per M
authors.initials: PM
authors.lastname: Hellström
authors.affiliation: Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Talley
authors.affiliation: Department of Surgery, Umeå University, Umeå, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Wallner
authors.affiliation: Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Forsberg
authors.affiliation: Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Vieth
authors.affiliation: Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany.
authors.forename: Lothar
authors.initials: L
authors.lastname: Veits
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Björkegren
authors.affiliation: Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Engstrand
authors.affiliation: Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Andreasson
keywords: Helicobacter pylori; corpus atrophy; epidemiology; longitudinal; population-based