|
|
Letter
Helicobacter pylori,
Republic of Georgia
Katrina Kretsinger,* Jeremy Sobel,*
Nato Tarkhashvili,† Neli Chakvetadze,† Marina Moistrafishvili,† Merab
Sikharulidze,† Ben D. Gold,*‡ Marina Chubinidze,† and Paata Imnadze†
*Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †National
Center for Disease Control, Tbilisi, Republic of Georgia; and ‡Emory University
School of Medicine, Atlanta, Georgia, USA
Suggested
citation for this article
To the Editor: Helicobacter pylori infection is a principal
cause of chronic active gastritis and peptic ulcer disease as well as
gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma
(1). Poverty and crowding have been associated with infection
epidemiologically (2,3). The Republic of Georgia has
a per capita annual income of US $591, making it one of the poorest countries
in the world (4,5). Georgia also reports a high annual
incidence of gastric cancer, 17/100,000 population in 2002 (National Center
for Disease Control, Tbilisi, unpub. data), which suggests an elevated
prevalence of H. pylori infection. Testing and treatment for H.
pylori are not practiced in this country, and diagnostic capacity
for H. pylori is nonexistent. In October 2003, we conducted an
exploratory pilot study of H. pylori infection to begin characterizing
prevalence and risk factors for infection.
We studied a convenience sample of adults residing in or near the capital
city of Tbilisi. Urban participants were recruited in 11 of Tbilisi's
12 residential districts and in 1 district of Rustavi, a city 20 miles
south of Tbilisi. Rural participants were recruited from 3 villages within
10 miles of Tbilisi. In each district or village, we nonsystematically
selected 10 households and recruited 1 adult per household. Exclusion
criteria included age <18 years; reported allergy to omeprazole, clarithromycin,
or amoxicillin; or treatment with any antimicrobial agent within the preceding
2 weeks. This protocol was reviewed and approved by the Human Subjects
Review Board at the National Center for Disease Control, Tbilisi. Active
infection with H. pylori was measured by a validated, point-of-care
13C-urea breath test (Meretek Corporation, Lafayette, CO, USA)
(6). Participants responded to a questionnaire that requested
information about gastrointestinal symptoms during the preceding 12 months;
diagnosis of gastritis, peptic ulcer disease, and gastric cancer made
by a physician; family history of peptic ulcer disease or gastric cancer;
and knowledge about H. pylori. Low, medium, or high socioeconomic
status categories were designated on an ecologic basis, according to average
real estate prices and common perception of the living standard of the
participant's district or village of residence. Analyses were conducted
with SAS (SAS Institute, Cary, NC, USA) version 9.0. Measures of inference
are not reported because participants did not constitute a rigorously
selected population sample.
Of 136 persons eligible to participate in the study, 135 (99%) consented
to take part. Median age was 39 (range 19 – 79); 82 participants (61%)
were women. Twenty-seven (20%) reported having some knowledge of H.
pylori, but none had been tested or treated for the infection. Ninety-seven
(72%) participants had active H. pylori infection: 58 (71%) of
82 women and 39 (74%) of 53 men. Thirty (77%) of 39 participants ≥50
years of age tested positive for H. pylori compared to 67 (70%)
of 96 participants <50 years of age.
Seventy-one (84%) of 85 participants residing in neighborhoods of low-socioeconomic
status were infected versus 26 (52%) of 50 participants residing in neighborhoods
of medium- or high-socioeconomic status (crude prevalence odds ratio 4.68).
Twenty-three (85%) rural participants were infected compared to 74 (69%)
of 108 urban participants (crude prevalence odds ratio 2.64).
Gastrointestinal symptoms were common, but did not correlate with active
infection. One hundred five participants (78%) reported recurrent epigastric
pain within the past year; and 120 participants (89%) reported a variety
of gastrointestinal symptoms, including epigastric pain. Persons with
active infection were no more likely to report epigastric pain (75 [78%]
of 97) than persons without infections (30 [79%] of 38). One participant
reported gastric cancer and was H. pylori–positive. Seven participants
reported a family history of gastric cancer; all were H. pylori–positive.
Five participants, of whom 3 were H. pylori–positive, reported
a history of gastric surgery for peptic ulcer disease. More rural participants
(23 of 27) reported a history of ruptured ulcers or a family member with
gastric cancer than did urban participants (74 of 108). The frequency
of reported gastrointestinal symptoms was similar between urban and rural
participants.
To our knowledge, this is the first survey of H. pylori infection
in Georgia. We found a high rate of infection with H. pylori. Participants
also reported a very high rate of dyspeptic symptoms, although these were
not correlated with infection. This small convenience sample survey has
several limitations, however. First, our participants did not constitute
a systematically selected population sample. Second, rural populations
were underrepresented. Finally, we used neighborhood or village of residence
as a marker for socioeconomic status without specific income information
from the participants. Therefore, socioeconomic status misclassification
possibly occurred and the association between infection and socioeconomic
status may not be accurate.
Nevertheless, it is unlikely that we substantially over- or underrepresented
infection prevalence in the general population. Despite the limitations
of this study, our results clearly indicate that H. pylori is a
serious public health problem in Georgia. There is a pressing need to
educate medical professionals and the general public about H. pylori
infection and gastrointestinal illness and to introduce diagnosis of this
infection and appropriate treatment for it into standard medical practice.
In addition, rigorous population surveys that include children are needed
to identify high-risk groups of persons for targeted public health interventions
(7).
Acknowledgments
We thank John Heinrich
for facilitating the use of an accurate point-of-care test of active
H. pylori infection in the field. We also thank Maiko Chokheli,
Ekaterina Jhorjholiani, and Tamuna Zardiashvili for assistance with
data collecting.
This study was supported
by a grant from the Biotechnology Engagement Program (BTEP) #13, Department
of Health and Human Services. Dr. Gold is supported in part by a grant
from the National Institutes of Health, NIDDK (DK-53708).
References
- Suerbaum S, Michetti P. Helicobacter
pylori infections. N Engl J Med. 2002;347:1175–86.
- Frenck R, Clemens J. Helicobacter
in the developing world. Microbes Infect. 2003;5:705–13.
- Brown LM. Helicobacter
pylori: epidemiology and routes of transmission. Epidemiol Rev.
2000;22:283–97.
- Skarbinski J, Walker HK, Baker LC, Kobaladze A, Kirtava Z, Raffin
TA. The
burden of out-of-pocket payments for health care in Tbilisi, Republic
of Georgia. JAMA. 2002;287:1043–9.
- United Nations Development Programme. Human Development Report Georgia,
2000. [cited 2004 Feb 22]. Available from http://www.undp.org.ge/nhdr2000/NHDRGEO2000.pdf
- Gatta L, Ricci C, Tampieri A, Vaira D. Non-invasive
techniques for the diagnosis of Helicobacter pylori infection.
Clin Microbiol Infect. 2003;9:489–96.
- Gold BD. Helicobacter
pylori infection in children. Curr Probl Pediatr Adolesc Health
Care. 2001;31:247–66.
Suggested citation
for this article:
Kretsinger K, Sobel
J, Tarkhashvili N, Chakvetadze N, Moistrafishvili M, Sikharulidze M, et
al. Helicobacter pylori, Republic of Georgia [letter]. Emerg Infect
Dis [serial on the Internet]. 2005 May [date cited]. Available
from http://www.cdc.gov/ncidod/EID/vol11no05/04-0755.htm
|
