Epidemiology

It is now well established that H. pylori infection is typically acquired in childhood [2]. Without eradication therapy in general, this infection will remain with the host for life. H. pylori remains a very common infection worldwide, with up to 50% of the world's population colonized with this bacterium. However, over the last century there has been a significant decline in the prevalence of this infection in the developed world [3]. The prevalence of this infection in Canadian children is approximately 5%. Interestingly, the prevalence is quite varied even within a population. For example, the Aboriginal or Native populations of Canada and children of immigrants from the Third World have a much higher prevalence of this infection compared to the rest of the population [4, 5]. It has also now become increasingly clear that H. pylori infection is a marker of poverty, and is found more commonly in individuals of low socioeconomic status and in areas where there is household overcrowding and poor sanitation [6-8]. Humans are the natural reservoir for H. pylori; however, the route of transmission is unclear. This could either be oral-oral or oral-fecal, although successful cultures of this bacterium from stool have proven to be extremely difficult [9]. The rate of acquisition of H. pylori over the last few decades in the industrialized world has decreased substantially and the observed increase in the prevalence in this infection with age is likely to be a cohort effect, with the old age groups being more likely to acquire the infection, and the younger age group being less likely to acquire the infection in childhood [10].

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