Guimaraes, N., Azevedo, N.F., Figueiredo, C., Keevil, C.W. and Vieira, M.J.
A multiroute way of transmission for Helicobacter pylori
Helicobacter, 12, (4(P142)), . (doi:10.1111/j.1523-5378.2007.00540_20.x).
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Background. Twenty-five years after the first successful cultivation
and isolation of Helicobacter pylori, the scientific community is
still struggling to understand the way(s) how this bacterium is
transmitted among human populations.
Aim. In this work, we aimed at evaluating the likelihood of gastrooral,
oral-oral, and fecal-oral routes of infection, and also to which
extent iatrogenic and zoonotic transmission, breastfeeding, water
and food ingestion are likely to contribute to H. pylori transmission.
Methods. A literature search was conducted using PubMed and
ISI Web of Knowledge, which included the following text search
terms: Helicobacter pylori and epidemiology/epidemiological. Only
original articles published in English were considered. For each
putative route of transmission, the percentage of papers that
supported a positive association with the presence of H. pylori was
calculated. Positive associations were considered when the impact
of factors related to a specific transmission pathway were statistically
Results. Overall, data indicate that successful colonisation by
H. pylori is most probably derived from direct person-to-person
contact (100% positive association). Furthermore, exposure of
humans to H. pylori derived from environmental sources is a very
common event (64% for zoonotic transmission, 76% for water,
and 75% for food, respectively).
Discussion. Even with the possible pitfalls of this type of analysis,
which include the possible existence of confounding factors not
accounted for in some of the studies, and the natural tendency to give
relevance and present data that are significant rather than data that
are not, the case for a multiroute way of transmission is compelling.
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