EPIDEMIOLOGICAL ASPECTS OF HELICOBACTER PYLORI INFECTION AND RELATED MORBIDITY IN VARIOUS POPULATIONS IN ISRAEL

Background: Helicobacter pylori infection causes peptic ulcer and gastric cancer in a small portion of infected people. It is not clear yet why only a subset of infected individuals develops disease. Israel with its diverse population composition provides an excellent setup to assess these questions.

Aim: To provide an overview on the epidemiology of Helicobacter pylori infection and related morbidity in Israel.

Methods: Several studies were conducted in general population samples. Status of H. pylori infection was determined using ELISA to measure IgG serum antibodies to H. pylori IgG or by stool antigen detection EIA and PCR. We also measured markers of gastric inflammation such as serum pepsinogens (PGs) levels.

Results: H. pylori infection prevalence was significantly higher among Arabs than Jews (83% vs 61% in adults, and 23% vs 46% in children). The prevalence was higher in relation to living in low socioeconomic status and crowding conditions, and presence of infected siblings in the household. In the Jewish population the infection prevalence was highest in those who were born in Africa/Asia. The prevalence of atrophic gastritis, as measured by serum PG (defined as PGI:PGII ratio<3) was significantly higher in Arabs than Jews, and it was increased among the elderly and in infections with virulent CagA strains.

Among school-age Arab children, H. pylori infection was an independent risk factor for extra-gastric conditions: anemia, and diminished linear growth and cognitive development.

Conclusions: The differences in H. pylori infection and its related illnesses between Arabs and Jews, likely reflect interactions between host and environmental factors, as well as virulence factors of the bacterium.