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[The modes of transmission of Helicobacter pylori infection]
1Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Policlinico Agostino Gemelli, Roma.
Abstract:
Helicobacter pylori plays an essential role in the development of several both acid-related and neoplastic gastroduodenal pathologies. There are still uncertainties about the transmission routes and the sources of H. pylori infection. Man is the only well established "reservoir" of H. pylori, while the role of other mammalians (cat, pig, primates), as sources of infection, is still controversy. Literature data suggest four different modalities of transmission of the infection: faeco-oral, oro-oral, gastro-oral, gastro-gastric. By faeco-oral route, the bacterium, excreted with faeces, might colonize water sources, becoming so available to be transmitted to man and other mammalians. By oro-oral route, H. pylori, which colonizes dental plaque and saliva, may be transmitted by saliva to other individuals. The gastro-oral route is the typical modality of transmission in the childhood, when H. pylori uses the mucous achlorhydric vomitus of the children to infect a new host. Finally, by gastro-gastric route the bacterium might be transmitted by endoscopic procedures. In conclusion, we believe the different modalities of transmission may be contemporaneously involved, since none per se is able to explain the widespread occurrence of H. pylori infection.
Insights
Understanding Helicobacter pylori transmission is key to preventing gastroduodenal diseases. Multiple routes, including fecal-oral and oral-oral, likely contribute to its widespread infection, with humans as the primary reservoir.
Area of Science:
- Microbiology
- Gastroenterology
- Infectious Diseases
Background:
- Helicobacter pylori is a significant factor in gastroduodenal pathologies, including neoplastic conditions.
- Uncertainties persist regarding H. pylori transmission routes and infection sources.
- While humans are established reservoirs, the role of other mammals remains debated.
Purpose of the Study:
- To review and synthesize current knowledge on H. pylori transmission routes.
- To explore potential sources of H. pylori infection beyond human reservoirs.
- To understand the mechanisms underlying the widespread prevalence of H. pylori.
Main Methods:
- Literature review of studies on H. pylori transmission.
- Analysis of proposed infection pathways: fecal-oral, oral-oral, gastro-oral, and gastro-gastric.
- Evaluation of evidence for various transmission modalities.
Main Results:
- Four primary transmission routes are suggested: fecal-oral, oral-oral, gastro-oral, and gastro-gastric.
- The fecal-oral route involves contamination of water sources.
- Oral-oral transmission occurs via saliva and dental plaque; gastro-oral via childhood vomitus; gastro-gastric via endoscopic procedures.
Conclusions:
- No single transmission route fully explains the prevalence of H. pylori infection.
- A combination of different transmission modalities likely contributes to the widespread occurrence of H. pylori.
- Further research is needed to elucidate the exact contribution of each transmission route and potential non-human reservoirs.