What puts someone at risk for acquiring Helicobacter pylori (H. pylori) infection?

Risk Factors for H. pylori Infection

Poor socioeconomic status, inadequate sanitation, crowded living conditions, and family history are the primary risk factors for acquiring H. pylori infection. 1

Key Risk Factors

Socioeconomic and Environmental Factors

• Poor sanitation and hygiene conditions 1, 2

  • Lack of indoor plumbing/flush toilets
  • Absence of clean water supply
  • Houses located on unpaved streets 3
  • Use of traditional pit toilets or no toilet 2

• Crowded living conditions 1, 4

  • Large family size
  • Higher number of siblings 3
  • Crowded households during childhood 5
  • Nursery attendance 3

• Geographic and demographic factors

  • Being born in rural areas 4
  • First-generation immigrants from high-prevalence regions 1
    • Central and South America
    • Caribbean
    • Eastern Europe
    • Asia
    • India
  • Low-income communities with persistent poverty 1
  • Racial/ethnic background (in the US: Latino, African American, East Asian) 1

Family and Personal Factors

• Family history

  • Family members residing in same household with active H. pylori infections 1
  • Family history of peptic ulcer disease or gastric cancer 1

• Personal habits

  • Poor tooth brushing habits 5
  • Not washing hands after school 2
  • Consumption of unwashed fruits and vegetables 2
  • Smoking tobacco (>20 pack-years) 1, 4
  • Consumption of high-salt diet, red meat, and processed foods 1
  • Alcohol consumption (particularly high-proof) 4

• Age factors

  • Infection rates increase with age 6, 4
  • Highest prevalence often seen in older children (10-15 years) and adults 6

Transmission Patterns

H. pylori is primarily transmitted through:

• Fecal-oral route: Contaminated water or food 5
• Oral-oral route: Close personal contact 5
• Person-to-person transmission: Particularly within families 1

High-Risk Populations

According to consensus guidelines, the following groups should be considered at high risk and candidates for H. pylori testing 1:

• First-generation immigrants from high-prevalence areas
• Individuals with family history of gastric cancer
• Individuals with family history of peptic ulcer disease
• Family members of patients with active H. pylori infection
• High-risk racial/ethnic groups (in the US: Latino, African American, East Asian)
• Individuals living in persistent poverty conditions

Prevention Strategies

To reduce risk of H. pylori acquisition:

• Improve sanitation and hygiene conditions
• Ensure access to clean water
• Reduce household crowding
• Promote good personal hygiene practices
• Consider family-based testing and treatment when one member is infected 1, 7

Clinical Implications

Understanding these risk factors is important because H. pylori infection is associated with:

• Peptic ulcer disease
• Gastric cancer
• MALT lymphoma
• Various gastrointestinal diseases

The infection is typically acquired in childhood, with prevalence varying widely by geographic region (14-70%) 2. Early identification of at-risk individuals can facilitate timely testing and eradication, potentially reducing long-term complications.