Predicting Trends in Helicobacter pylori

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´╗┐Predicting Trends in Helicobacter pylori
To assess the benefits of intervention programs against Helicobacter pylori infection, we estimated the baseline curves of its incidence and prevalence. We developed a mathematical (compartmental) model of the intrinsic dynamics of H. pylori, which represents the natural history of infection and disease progression. Our model divided the population according to age, infection status, and clinical state. Case-patients were followed from birth to death. A proportion of the population acquired H. pylori infection and became ill with gastritis, duodenal ulcer, chronic atrophic gastritis, or gastric cancer. We simulated the change in transmissibility consistent with the incidence of gastric cancer and duodenal ulcer over time, as well as current H. pylori prevalence. In the United States, transmissibility of H. pylori has decreased to values so low that, should this trend continue, the organism will disappear from the population without targeted intervention; this process, however, will take more than a century.

Helicobacter pylori, a common human bacterial pathogen, causes peptic ulcer disease, gastric cancer, and gastric mucosa-associated lymphoid tissue lymphoma. Current U.S. guidelines from the National Institutes of Health recommend antimicrobial treatment only for H. pylori patients with peptic ulcer disease. Because asymptomatic infection is very common, treatment of all asymptomatic persons would be expensive and might promote antibiotic resistance. Prophylactic and therapeutic vaccines against H. pylori are being developed; however, if vaccines are to be cost effective, companies must take into account the changing epidemiology of H. pylori and related diseases. Knowledge of these trends can also allow health agencies to predict resource allocations needed for these diseases.

In industrialized countries, H. pylori incidence has been decreasing in successive generations, without any targeted intervention. Quantifying the benefits of intervention in reducing disease incidence or cost requires an analytical model that estimates the natural course of H. pylori and associated diseases. The model could then estimate the decrease in H. pylori incidence that would result from an intervention strategy, relative to the natural course of infection.

We present an analytical framework to model H. pylori transmission dynamics and its subsequent disease progression. Our goal is to estimate future trends of H. pylori and associated diseases in the United States based solely on its natural history (i.e., without intervention).

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