Helicobacter pylori and food products: a public health problem.

Helicobacter pylori is a major human pathogen causing gastritis and chronic superficial infection (CSG). It colonizes the stomach of more than 50% of humans and causes disease. This microorganism is associated with the gastric antral epithelium in patients with active chronic gastritis, peptic (gastric) or duodenal ulcers, and gastric adenocarcinoma H. pylori is present in feces, sewage, and water but is killed by routine chlorination. Therefore, in developing countries, consumption of sewage-contaminated drinking water and vegetables may pose a risk; properly cooking foods and chlorinating water reduces the risk of transmitting H. pylori to humans. In South America the consumption of raw vegetables fertilized with human feces has been found to be a risk factor for infection, and consumption of water from a municipal supply has been suggested as a risk factor for children. Epidemiological studies have found that H. pylori organisms colonize the stomach and duodenum of humans and many animal species and family clusters; it is believed to be orally transmitted person to person. This transmission is the major, if not exclusive, source of infection.H. pylori has been detected in the mouth from dental plaque. Recent observations in persons infected with H. pylori caused to vomit or have diarrhea showed that an actively unwell person with these symptoms could spread H. pylori in the immediate vicinity by aerosol, splashing of vomitus, infected vomitus, and infected diarrhea. In summary, H. pylori is usually spread by the fecal-oral route but possibly also by the oral-oral route and the spread of contaminated secretions. Thus, in developing countries, individuals catch H. pylori at a very young age from other persons (children) in their environment. In developed countries, H. pylori is more difficult to acquire and is usually transmitted from one family member to another, possibly by the fecal-oral route, or by the oral-oral route, e.g., kissing, vomitus. On occasion, transmission occurs from person to person via contaminated endoscopes. Other gastric Helicobacter-like organisms have now been observed in a variety of animals, including rodents, primates, swine, and ferrets, but, with the exception of primates and possibly cats, these isolates are clearly different from human isolates. Foodborne transmission would not be unusual.