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Original article
Intergenerational reduction in Helicobacter pylori prevalence is similar between different ethnic groups living in a Western city
  1. Wouter J den Hollander1,2,
  2. I Lisanne Holster1,
  3. Bianca van Gilst1,
  4. Anneke J van Vuuren1,
  5. Vincent W V Jaddoe2,4,5,
  6. Albert Hofman5,
  7. Guillermo I Perez-Perez6,
  8. Ernst J Kuipers1,3,
  9. Henriëtte A Moll4,
  10. Martin J Blaser6
  1. 1Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
  2. 2The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands
  3. 3Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
  4. 4Department of Pediatrics, Erasmus University Medical Centre, Rotterdam, The Netherlands
  5. 5Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
  6. 6Departments of Medicine and Microbiology, New York University Langone Medical Centre, New York, USA
  1. Correspondence to Wouter J den Hollander, Erasmus MC University Medical Centre, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands; w.denhollander{at}


Objective Helicobacter pylori colonisation rates in childhood have declined in Western populations, but it is unknown whether this trend is similar in children of non-Western ethnic backgrounds, born in a Western country. We aimed to identify H. pylori status in children, and determine mother-to-child transmission and risk factors for colonisation.

Design Antibodies against H. pylori and cytotoxin-associated gene A (CagA) were measured in children participating in a population-based prospective cohort study in Rotterdam, the Netherlands. Information on demographics and characteristics was collected using questionnaires.

Results We analysed the serum of 4467 children (mean age 6.2 years±0.4 SD) and compared the results with the H. pylori status of their mothers (available for 3185 children). Overall, 438 (10%) children were H. pylori-positive, of whom 142 (32%) were CagA-positive. Independent risk factors for colonisation were: maternal H. pylori positivity (OR 2.12; 95% CI 1.62 to 2.77), non-Dutch ethnicity (OR 2.05; 95% CI 1.54 to 2.73), female gender (OR 1.47; 95% CI 1.20 to 1.80) and lower maternal education level (OR 1.38; 95% CI 1.06 to 1.79). Comparing mothers and children, we found an intergenerational decrease of 76% and 77% for Hp+CagA and Hp+CagA+-strains, respectively, consistent across all nine ethnic groups studied. Male gender, higher maternal educational level and no older siblings, were independently associated with absence of H. pylori.

Conclusions Although the highest H. pylori and CagA prevalence was found in children of non-Dutch ethnicities, the decreased colonisation rates were uniform across all ethnic groups, implying the importance of environmental factors in H. pylori transmission in modern cities, independent of ethnicity.


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