Helicobacter pylori and the birth cohort effect: evidence of a continuous decrease of infection rates in childhood

OBJECTIVE: To investigate whether the decrease in rate of Helicobacter pylori infection in subsequent birth cohorts has continued during the last decades. METHODS: Determination by ELISA of IgG H. pylori antibodies in 314 serum samples from Dutch children (age 6-8 yr, n = 154) and young adolescents (age 12-15 yr, n = 160), collected in 1978 and 1993. RESULTS: The prevalence of H. pylori declined from 19% to 9% at age 6-8 yr and from 23% to 11% at age 12-15 yr. For the whole study population, a decline from 21% to 10% (p = 0.01) was observed between 1978 and 1993. On the basis of these data and an incidence of infection with H. pylori of 0.3% per year during the same period, a model for both past and future prevalence rates of H. pylori in the Dutch population was calculated. The outcome demonstrates a decrease from more than 50% around World War II to less than 20% for the whole population around year 2040. CONCLUSIONS: H. pylori infection rates in childhood have continued to decline until recent decades, demonstrating a persistent birth cohort effect. This decline will result in a very low prevalence of H. pylori infection in the Dutch population during the next decades, becoming even lower as the observed decline in children and young adolescents continues.