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Concurrence of Helicobacter pylori Infection and Its Associated Factors in Korean Couples

Background This study evaluated the prevalence of Helicobacter pylori infection and the risk factors associated with H. pylori transmission among spouses. Methods We assessed the spousal concurrence of H. pylori infection using the Campylobacter-like organism (CLO) test under gastro-endoscopy in 132 couples. Based on the CLO test results, participants were categorized into H. pylori concurrent and independent groups. The chi-square test and Student t-test were performed for demographic comparisons between the concurrent and independent H. pylori groups. In addition, multivariate logistic regression analysis was performed to identify factors associated with concurrent H. pylori infection. Results The study revealed that the concurrence rate of H. pylori infection was 42.4% in married Korean couples. The odds ratio (OR) derived from the concurrence of H. pylori infection tended to decrease in older couples (OR, 0.975; 95% confidence interval [CI], 0.949–1.002; P=0.072). Gastric erosion was also associated with a decreased OR for concurrent infection (OR, 0.488; 95% CI, 0.295–0.808; P=0.005). Conversely, active duodenal ulcers were associated with an increased OR for concurrent infections (OR, 6.501; 95% CI, 1.267–33.346; P=0.025). Duodenal ulcer scars tended to increase the OR of concurrent infections (OR, 1.392; 95% CI, 0.815–2.380; P=0.226). Conclusion Spousal transmission and concurrence of H. pylori infection were negatively associated with gastric erosion; however, they were positively associated with active duodenal ulcers. Further studies are warranted to elucidate the mechanisms underlying these findings.


INTRODUCTION
Helicobacter pylori is a gram-negative bacillus that exists between the gastric mucous layer and the gastric epithelial cells. 1) This bacillus is considered a major cause of various gastrointestinal diseases such as gastritis, gastric and duodenal ulcers, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. Globally, approximately 4.4 billion individuals developed H. pylori infection in 2015. 2) In Korea, the number of individuals with H. pylori infection was estimated to be 13,571,123, with a prevalence rate of 54.0% in 2015. 2) A myriad of factors, including low socioeconomic status and poor hygiene, are associated with H. pylori infection. 3) However, the modes of transmission of H. pylori are still poorly understood. Person-to-person contact (fecal-oral and oral-oral) is considered the most common route of infection; 4,5) however, the disease may also be transmitted through contaminated water, 4,5) animal reservoirs, 4,5) and other environmental factors. 4,5) In addition, differences in patterns of household transmission and infection rates of H. pylori among geographic regions make it difficult to clearly determine the exact pathways of H. pylori infection.
Although parent-to-child transmission is the most common occurrence, conjugal transmission also plays a significant role in intra-familial transmission. An accumulating body of evidence indicates that H. pylori infection in one spouse is a major source of spread to other household members. 6) Singh et al. 6) showed that the infection rate in spouses of H. pylori-positive individuals was significantly higher than that in H. pylori-negative spouses. Similarly, previous studies also support that the presence of an H. pylori-positive spouse is an independent risk factor for H. pylori infection in the other partner. 7,8) Despite the existing pool of evidence, it remains uncertain which specific factors are associated with the conjugal transmission of H. pylori, especially in Korean adults. Therefore, the present study evaluated the prevalence of H. pylori infection and the risk factors associated with concurrent H. pylori infection among spouses.

Helicobacter pylori Tests
The participants underwent gastroscopy to confirm the presence of H. pylori-associated esophagogastroduodenal disease, and biopsies were obtained for the CLO test. After an overnight fast, the participants underwent gastroscopy with lidocaine administered as local anesthetic throughout the throat area. Some participants who needed conscious Target group (N=4,583) Total study population (n=264) Individuals whose spouses did not have a record of performing a CLO test, and those with a difference of 30 days or more in the date that the person and spouse performed the CLO test (n=4,143) Individuals who have taken non-steroidal antiinflammatory drugs, proton pump inhibitors, antibiotics, bismuth compounds, and mucosal protective drugs, which may affect the CLO test results, within the last 3 months of testing (n=114) Individuals who have -negative in the CLO test for themselves and their spouses (n=62) Helicobacter pylori sedation were administered intravenous midazolam. Biopsy specimens were obtained from each participant's gross lesions in the stomach and duodenum using biopsy forceps. Tissues were cultured in a CLO test kit (Delta West, Bentley, Australia), and the results were read within 2 hours. If the color of the culture medium changed from yellow to red, it was considered H. pylori-positive; however, if it remained yellow, the finding was considered negative. In particular, whenever a negative result was acquired within the 2 hours, the final reading was performed again after 24 hours.

Data Collection and Measurements
Information on demographic variables (age), socioeconomic status (education and occupation), lifestyle habits (smoking status and alcohol consumption), and gastrointestinal symptoms were obtained using a self-administered questionnaire at the time of visit for their health check-up. Upon consideration of aspects such as educational qualification (high school and college or higher), occupation (manual workers: fishermen, armed forces personnel, technical workers, production workers, and construction workers; non-manual workers: housewives, managers, service and sales workers, religious workers, politicians, medical workers, transport workers, white-collar workers, education workers, and unemployed individuals), smoking status (non-smokers: never and ex-smokers; and smokers: current smokers), and alcohol consumption status, the participants were categorized

Statistical Analysis
The

RESULTS
The study showed that the concurrence rate of H. pylori infection was 42.4% in married Korean couples. Table 1 presents a comparison of the general characteristics between the concurrent and independent groups. The mean ages of the independent and concurrent groups were 49.7±10.6 years and 47.1±10.3 years, respectively. Gastric erosion was also found to be higher in the independent group (66.5%) than in the concurrent group (48.2%). There were no significant differences in other characteristics, such as age, socioeconomic status, health behaviors, and biochemical variables between the two groups.

DISCUSSION
This study showed that concurrent H. pylori infection was observed in German study, 7) which was slightly lower than that in the present study. However, in an Italian study involving 161 participants, the prevalence of H. pylori concurrent infection was 74.5%. 10) Additionally, the concurrence rate of H. pylori was 75% among 25 Indian couples, which was much higher than in the current study. 6) Although the reason for these discrepancies remains unclear, it is suggested that both a heterogeneous study design and population contribute to the inconsistencies among studies worldwide.
An active duodenal ulcer was associated with an increased risk of conjugal H. pylori infection; however, duodenal ulcer scars were not associated with concurrent H. pylori infections. Because H. pylori infection is a well-known independent risk factor for active duodenal ulcers, [11][12][13][14] it can be inferred that participants with active duodenal ulcers had higher bacterial loads than participants free from duodenal ulcers. In conclusion, spousal transmission and the concurrence of H. pylori infections were negatively associated with age and gastric erosion; however, they showed a positive correlation with duodenal ulcers.
These results were consistent, even after correcting for age. This can be seen as a meaningful result because it elucidates spousal transmission