Environmental, medical, behavioural and disability factors associated with Helicobacter pylori infection in adults with intellectual disability.
Adults with ID who lived in institutions carry H. pylori twice as often—screen them yearly.
01Research in Context
What this study did
The team asked adults with intellectual disability about their homes, health, and behavior. They tested breath and stool for Helicobacter pylori, a stomach germ.
Some adults had always lived with family. Others had lived in large institutions for years.
What they found
Eight or nine out of every ten ex-institutional adults carried the germ. Less than half of the never-institutionalized adults did.
Longer stay, roommates who drooled or soiled, chronic illness, and more severe disability each raised the risk.
How this fits with other research
Douraghi et al. (2012) saw the same pattern in kids. Three-quarters of institutionalized children with ID also tested positive, and risk climbed with age and years in care.
Richman et al. (2001) came first. Their 50-year look back found stomach cancer caused nearly half of cancer deaths in institutional adults. The new survey adds the germ that likely drives those cancers.
K-Alanay et al. (2007) widened the lens. They tracked many infections, not just H. pylori, and still found institutions topping the risk chart. The message stays the same: living in close care spreads bugs.
Why it matters
If you support adults who once lived in institutions, add a stool or breath test for H. pylori to their yearly medical check. Treating the germ can cut stomach pain, ulcers, and future cancer risk. When you write care plans, list long institutional stay and incontinent roommates as medical red flags that merit faster GI referral.
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02At a glance
03Original abstract
In institutionalized adults with intellectual disability (ID), Helicobacter pylori infection occurs at approximately twice the rate it appears in the general population, and it may be responsible for the twofold higher rates of peptic ulcer disease and gastric cancer in this population. Medical, behavioural and additional environmental factors, as well as level of ID, may be related to the risk of infection with H. pylori. One hundred and sixty-eight adults with ID who were currently, had previously been or had never been institutionalized underwent a biopsychosocial evaluation. This included assessment of: level of ID using the Adaptive Behaviour Scale (ABS) Part I; levels of maladaptive behaviour using the ABS Part II; demographic, medical and environmental factors; as well as H. pylori tests using serology and faecal antigen. The overall rates of past or current infection with H. pylori in institutionalized and previously institutionalized participants were about twice that of the overall group of never-institutionalized participants, i.e. 87% and 79% compared to 44%, respectively (P < 0.001). The rates of H. pylori infection appeared to increase with age in the never-institutionalized group, but were consistently high across all ages in the other groups. The rate of infection was higher in those institutionalized for more than 5 years (95% versus 76%, P=0.02), in those with flatmates with excessive oral secretions (65% versus 21%, P < 0.001) or faecal incontinence (67% versus 27%, P < 0.001), and in those with more chronic illness and medications. All mean domain scores of the ABS Part I (Intellectual Disability) were significantly lower (indicating more severe ID) in the group currently infected with H. pylori compared to their non-infected counterparts. The majority of mean domain scores of the ABS Part II (Behaviour) were also worse, with half of these score differences reaching statistical significance in the currently infected group. The presence of alarm symptoms (e.g. vomiting, weight loss, haematemesis and melena), iron deficiency and body mass index were not significantly different in currently infected subjects. Adults with ID appear to be particularly at risk of infection with H. pylori. Environmental associations with infection include past or current institutionalization, a longer period of institutionalization, living with flatmates with excessive oral secretions and faecal incontinence. Medical associations include chronic disease and more medications, but not alarm symptoms or body mass index. Demographic associations may include increasing age in never-institutionalized adults, but no age effect in currently or previously institutionalized individuals. Psychosocial associations include more severe ID and maladaptive behaviour with current infection.
Journal of intellectual disability research : JIDR, 2002 · doi:10.1046/j.1365-2788.2002.00359.x