Helicobacter pylori infection in Europe: current perspectives

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Date: Aug. 2013
Publisher: Expert Reviews Ltd.
Document Type: Report
Length: 6,853 words
Lexile Measure: 1490L

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Author(s): Anthony O'Connor [*] 2 , Colm O'Moráin 1

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antibiotics; gastric cancer; GERD; H. pylori; resistance; treatment

The management of Helicobacter pylori has changed greatly since the publication of guidelines by the European Helicobacter Study Group (EHSG) in 1997 [1] . These guidelines helped to harmonize practice throughout Europe and beyond where previously there had been much variance between national guidelines. Our understanding has certainly grown in the interim, but have we arrived at a similar point as in 1997 where there is more confusion than consensus [2] ? Although H. pylori remains the most successful human pathogen affecting half of the world's population, where prevalence rates in developed countries are falling [3] . A US study of 485 asymptomatic individuals aged 15-80 years of age showed that prevalence increased at a rate of 1% per year of life [4] . This was similar to findings from Europe [5] .

Bearing in mind that most infections occur in childhood, it is safe to assume that infection rates are falling. Infection rates are also closely linked to socio-economic factors such as levels of education and living standards which have both improved steadily in Europe since the 1950s [6] . Currently, the overall prevalence of H. pylori infection in Europe is in the region of 20-40% with regional variations. In broad terms, in relation to H. pylori infection, Europe can be divided into three regions. In each of these regions there are variances in the prevalence of the infection, the access to diagnosis and treatment and the incidence of the sequelae. For instance, northern Europe, which includes of the Scandinavian countries, the UK, Ireland, France, Germany, Belgium and The Netherlands have an overall prevalence of infection of around 10-30% with rates higher in older adults [7,8] . The burden of gastric cancer is relatively low but not inconsiderable in these countries with an age standardized rate of, for example, 5.5 in the UK and 5.0 in Norway [9] . Antibiotic resistance rates are low but rising [10] . Central and southern Europe, which encompasses most of the Mediterranean countries, Austria and Hungary, has higher prevalence at around 30-40% and significantly higher antibiotic resistance rates than northern Europe [11,12] . Gastric cancer is more prevalent with age standardized rates of, for example, 13.7 in Portugal. Eastern Europe has similar rates of infection to southern Europe but significantly more gastric cancer [9,13] . The age standardized cancer rate in Russia is 17.5. Less is known about antibiotic resistance in this region but in countries such as Lithuania, Slovakia and Poland at least it appears to be similar to northern Europe (Figure 1) [12] .

When applying guidelines on H. pylori infection to Europe, there is a need to review the literature on H. pylori taking into account the needs of European patients. These relate to social, demographic, resource and clinical parameters. Most European populations enjoy high living standards, which contributes to a high prevalence of gastroesophageal reflux disease (GERD), functional dyspepsia and obesity. In addition, the access to healthcare afforded to most Europeans means that patients with these common conditions...

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Gale Document Number: GALE|A341859532