Epidemiologic characteristics of Helicobacter pylori infection and sociodemographic features of reflux-related symptoms in Southeast Hungary
Authors: Bálint Lenke 
Published: July 2023

Background: Helicobacter pylori (H. pylori) infection is one of the most common chronic human bacterial infections worldwide, affecting up to half of the world’s population. The infection is predominantly acquired in childhood and usually persists throughout life. This bacterium is the main cause of gastritis, gastroduodenal ulcer, gastric adenocarcinoma, and mucosa-associated tissue lymphoma. Therefore, the eradication of H. pylori remains a public health concern. The prevalence of H. pylori has declined worldwide, although wide variation has been observed. It varies according to geographical location, ethnicity, age, and socioeconomic factors: high in developing countries and lower in the developed parts of the world. Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders worldwide, which develops when frequent regurgitation of the gastric acid irritates the esophagus, mouth, and/or respiratory system. GERD is a common clinical problem potentially decreasing quality of life. Large epidemiological studies have shown a global variation in the prevalence of symptomatic GERD. Aims: Recent epidemiologic studies have revealed decreases in the prevalence of H. pylori in Western Europe, in the United States, and have shown a global variation in the prevalence of symptomatic GERD. Conversely, little is known regarding the prevalence of H. pylori, and GERD-related symptoms in Central Europe, especially in Hungary, where a substantial population resides in rural areas, presumably with lower socio-economic conditions. Methods: In study I, one-thousand and one healthy blood donors [male/female: 501/500, mean age: 40 (18–65) years] were consecutively enrolled in Csongrád-Csanád and Békés counties. Data collection was performed using an anonymous questionnaire including 26 questions associated with demographic parameters, and medical status. In study II, a total of two-thousand and two blood donor volunteers [male/female: 1156/846, mean age: 39 (18–65) years] were consecutively enrolled, blood donors completed detailed questionnaires related to demographic data, presence and frequency of typical and atypical GERD-related symptoms. Results: In study I, the overall seropositivity of H. pylori was 32% in the studied healthy subjects. A significant positive association was observed between age and H. pylori positivity. According to childhood residence, the prevalence of H. pylori was significantly higher in rural areas than in urban areas (p = 0.0051). Furthermore, residence in rural areas for at least one year was associated with a significantly higher H. pylori prevalence than continuous urban residency (p = 0.0003). Parameters related to occupation were also associated with H. pylori infection. A higher prevalence was established for industrial workers and agricultural workers compared to office workers and non-agricultural workers, respectively. Coffee consumption, pet or domesticated animal rearing, and positive family history of gastric cancer were associated with H. pylori infection as well. In study II, among blood donors who had GERD-related symptoms at least monthly, we found significant correlations between typical GERD complaints and living on a farm currently or during childhood. An increased prevalence of GERD-related typical and/or atypical symptoms was shown among housewives and retired blood donors or individuals living on a farm currently. In the group of blood donors who had GERD-related symptoms daily, significant correlations were found between typical and/or atypical GERD complaints and living on a farm during childhood. Conclusion: We proved that in line with the global trends, the prevalence of H. pylori infection has decreased in Southeast Hungary with changes in society, including improvements in socioeconomic status and living standards, during recent decades. Meanwhile, the prevalence remains high in the middle-aged and older rural populations. Generally accepted risk factors for H. pylori positivity appeared valid for the studied population. The association between the prevalence of GERD-related symptoms among Southeast Hungarian blood donor volunteers and their sociodemographic features could not be as clear as in Western countries.