Abstract

Background and objectives: The prevalence of Helicobacter pylori infection differs in relation to the human population, age, living conditions, lifestyle, socioeconomic status and geographic location. The purpose of the present study was to evaluate the prevalence of H.pylori infection among students of Ibrahim Medical College, Dhaka, Bangladesh.

Materials and methods: This cross-sectional study was conducted at the K.A. Monsur Research Laboratory, Department of Microbiology, Ibrahim Medical College. A structured questionnaire was used to collect socio-demographic information and clinical history. Blood and stool samples were collected from each participant. Serum H. pylori CagA IgG and H.pylori IgA antibodies were determined using enzyme-linked immunosorbent assay (ELISA), and H. pylori stool antigen (HPSAg) was detected by immunochromatographic test (ICT).

Results: A total of 85 participants were enrolled in this study. The overall H. pylori infection rate was 69.4% by positive stool antigen test and /or the presence of H. pylori specific CagA IgG or IgA antibodies in serum. H. pylori stool antigen was detected in 9 (10.6%) individuals, of whom 8 (88.9%) were also positive for H. pylori specific CagA IgG and / or IgA antibodies. Among 85 participants, CagA IgG and IgA were positive in 43 (50.6%) and 46 (54.1%) students, respectively, while 31 (36.5%) were positive for both antibodies. IgA positivity rate was significantly higher (p≤0.005) in individuals who tested positive for CagA-IgG compared to those negative for CagA-IgG antibody. Gastrointestinal symptoms were reported by 17 (20.0%) participants, while 68 (80.0%) were asymptomatic. No significant difference in antibody positivity rates was observed between symptomatic and asymptomatic individuals in this study.

Conclusion: The study revealed that H. pylori infection is common among the medical students in Bangladesh. This underscores the importance of improving awareness and early detection strategies among medical students to minimize transmission and associated health risks.

July 2025; Vol. 19(2):009.  DOI: https://doi.org/10.55010/imcjms.19.019

*Correspondence: Shahida Akter, Department of Microbiology. Ibrahim Medical College, 1/A Ibrahim Sarani, Shegunbagicha, Dhaka-1000, Bangladesh. Email: shahidamicro@gmail.com

© 2025 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License(CC BY 4.0).

Introduction

Helicobacter pylori (H. pylori) is a gram-negative, spiral-shaped, microaerophilic bacterium that colonizes the human gastric mucosa. A large number of people remain asymptomatic despite being infected with H. pylori [1]. Once acquired, the infection persists throughout life unless treated with specific antimicrobials [2]. Chronic infection by H. pylori is recognized as the leading cause of gastric and duodenal ulcer disease and is also associated with gastric adenocarcinoma and mucosa- associated lymphoid tissue (MALT)[3,4].

A 2017 meta-analysis found that the overall global prevalence of H.pylori infection was 44.3%, with a higher rate of 50.8% in developing countries compared to 34.7% in developed countries [5]. In 2024, the prevalence of H. pylori infection among the asymptomatic urban population of Bangladesh was reported to be 40.5% [6]. In 2022, H. pylori-specific IgG and IgA antibodies were detected in 64.9% and 55.1% of participants, respectively, among the asymptomatic rural population in Bangladesh [7]. H. pylori infection is primarily transmitted through fecal-oral, oral-oral, or gastro-oral routes, often due to poor sanitation, overcrowding, contaminated water, and low levels of education, especially in early childhood [8-10].

Prevalence of H. pylori is strongly age-dependent, rising steadily from childhood through middle age, and then declining in the very elderly due to gastric atrophy and increased antibiotic use [11]. Both Habib et al. and Rahman et al. reported that the highest rates of infection were observed in individuals under 30 years of age, with detection rates of 78.3% and 50%, respectively [12,13]. Accurate diagnosis and effective management of H.pylori infection can greatly contribute to its eradication and prevent disease complications.

Data on the prevalence of H. pylori infection among medical college students in Bangladesh are limited. Studying this population is particularly important because of their frequent exposure to healthcare settings, which has been implicated as a significant risk factor for acquiring H. pylori infection by several studies [14,15]. Liu et al. reported that the overall prevalence of H. pylori infection was 70.0% among medical personnel, compared to that of 44.6% among the general population in China [16]. In addition, the students often share communal living spaces, such as hostels, which may further facilitate transmission. As future healthcare providers, identifying asymptomatic carriers and associated risk factors can inform early interventions and guide targeted public health strategies for this group [17]. The present study aimed to evaluate the prevalence of H. pylori infection among medical students affiliated with a tertiary-level hospital in Dhaka, Bangladesh, by detecting H. pylori antigen in stool and, H. pylori-specific IgA and CagA-IgG antibodies in serum using serologic methods.

Materials and Methods

Sample collection and laboratory work were done at K. A. Monsur Research Laboratory, at the Department of Microbiology of Ibrahim Medical College, Dhaka. This cross-sectional study was conducted in 2021 among 85 fourth-year MBBS students studying at Ibrahim Medical College. Fourth-year students were selected purposively as the MBBS curriculum covers Microbiology during the fourth year. After explaining the nature and purpose of the study, all participants provided informed written consent. A structured questionnaire was used to record socio-demographic information and clinical history. The study was approved by the Institutional Ethical Committee and Research Review Board of Ibrahim Medical College. All consenting fourth-year students were included in the study, irrespective of age, gender, nationality or presence of dyspeptic symptoms. Dyspeptic symptoms were defined as having two or more of the following gastrointestinal symptoms: dyspepsia, abdominal pain, nausea, vomiting and belching [18]. Individuals without any of these symptoms were considered as asymptomatic for H. pylori infection. Students who had taken antibiotics, colloidal bismuth compounds, proton pump inhibitors (PPIs) or H2 blockers within four weeks prior to sample collection were excluded.

H. pylori infection was defined if an individual was found positive for H.pylori antigen in stool and/or anti-H. pylori CagA-IgG and/or anti-H. pylori IgA in serum using serologic methods [7]. Approximately 2.5 ml blood sample was collected from each participant. After centrifugation at 1500 rpm for 10 minutes, separated serum was stored at -20℃ and used later for detection of H. pylori IgA and CagA-IgG antibodies. Approximately 20-30 grams of fresh stool sample was collected from each participant in a clean, wide-mouth and screw-capped container, and tested for H. pylori stool antigen within 6 hours of collection. Stool antigen was detected by immune chromatography using ABON one strip H.pylori antigen ICT test device (Inverness Medical Innovation Hong Kong Ltd., Hong Kong). Approximately 50 mg of stool was obtained from at least three different areas of each stool specimen. The stool was then mixed with supplied extraction buffer solution using a vortex mixer, and centrifuged at 4000 rpm for 5 minutes. After centrifugation, two drops of supernatant were transferred into the sample well of the test device and kept at room temperature for 10 minutes. The result was then recorded. A positive result was indicated by the presence of purple-pink line along with the control line. When only the control line appeared, the result was considered negative. If no control line appeared, the result was termed as invalid. Serum anti-H. pylori CagA-IgG and anti-H.pylori IgA antibodies were determined by quantitative enzyme-linked immune sorbent assay (ELISA) using commercial kits namely CagA IgG ELISA and Helicobacter pylori IgA ELISA (DRG International Inc., USA), respectively. The tests were performed and interpreted according to the manufacturer’s instructions. The present study did not evaluate the sensitivity and specificity of the test methods. However, the manufacturer (DRG International Inc., USA) reported that the sensitivity and specificity of both ELISA kits are greater than 90% for detecting H. pylori-specific antibodies. This is comparable to previously reported results for other H. pylori ELISAs, which demonstrated a sensitivity of 97.6% and a specificity of 90.5%. [19]. Participants who were positive for H. pylori stool antigen were treated with a proton pump inhibitor (PPI) and the two antibiotics, amoxicillin and metronidazole, for 14 days to eradicate H. pylori infection [20,21]. Statistical analyses were performed using Statistical Product and Service Solutions (SPSS), version 20. Categorical values between two groups were compared using chi-square test. Differences were considered statistically significant at p≤ 0.05.

Result

A total of 85participants were enrolled in this study, with a mean age of 22.01 (SD ±1.14) years. Of them, 29 (34.11%) were male and 56 (65.88%) were female. All participants came from middle- or upper-class backgrounds with the majority having graduate parents (87.1% of fathers, and 71.8% of mothers). All subjects reported practicing hand hygiene and drinking safe water. Among 85 participants tested, 59 (69.4%) were positive for H. pylori infection either by positive stool antigen test or by the presence of serum H. pylori-specific CagA-IgG or IgA antibodies.

Table-1: Comparison of H. pylori stool antigen with the presence of serum anti-H. pylori CagA-IgG and anti-H. pylori IgA antibodies

Among 85 individuals tested, 9 (10.6%) were positive for H. pylori stool antigen, of whom 8 were also positive for H. pylori-specific CagA-IgG and/or IgA antibodies. Out of 76 stool antigen-negative cases, 50 demonstrated positive result for CagA-IgG and/or IgA antibodies. There was no significant association between stool antigen positivity and presence of H. pylori-specific antibodies among the study population. Overall, 58 (68.2%) participants tested positive for H. pylori infection using antibody-based methods. (Table-1).

Table-2: Comparison of serum anti-H. pylori CagA-IgG with anti-H. pylori IgA of the study population (N=85)

Among 85 enrolled students, anti-H. pylori CagA-IgG and IgA antibodies were detected in 43 (50.6%) and 46 (54.1%) individuals, respectively. Both antibodies were detected in 31 cases. IgA positivity rate was significantly higher (p≤0.005) in individuals who tested positive for CagA-IgG compared to those who were negative for Cag-IgG antibody. (Table-2)

Table-3: The relationship between serum anti-H. pylori CagA-IgG and anti-H.pylori IgA antibodies among symptomatic and asymptomatic cases.

Table-3 shows that, out of 85 participants, 17 (20.0%) complained of gastrointestinal symptoms whereas 68 (80.0%) were asymptomatic. No significant difference was observed in antibody positivity rates between symptomatic and asymptomatic individuals in this study.

Table-4: Comparison of H. pylori stool antigen with the symptomatic and asymptomatic cases

Table-4 shows that, out of 85 participants, 17 (20.0%) complained of gastrointestinal symptoms whereas 68 (80.0%) were asymptomatic. A statistically significant association was found between stool antigen positivity and the presence of symptoms among the study population.

Discussion

It is widely recognized that H. pylori is associated not only with peptic ulcer disease but also with gastric carcinoma and MALT lymphoma [22]. Several studies have shown that the prevalence of H. pylori among medical personnel tends to be higher than that in general population, one reason being their frequent exposure to hospital settings [23-25]. The present study aimed to evaluate prevalence of H. pylori infection among fourth-year MBBS students studying at Ibrahim Medical College, Dhaka.

In this study, an individual was considered positive for H. pylori infection based on a positive stool antigen test and/or the presence of H. pylori-specific CagA-IgG and/or IgA antibodies in serum. Overall, 69.4% of the study population tested positive for H. pylori infection in this study. However, an overall detection rate of 79.5% was observed in a previous study conducted in Bangladesh among asymptomatic rural children and adolescents [7]. The comparatively lower detection rate in this study may be attributed to better hygienic practices among medical students, who predominantly came from higher educational and socio-economic backgrounds [26].

Approximately 10.6% of individuals demonstrated a positive stool antigen test in the current study. Detection of H. pylori antigen in stool indicates active infection [27]. Rajan et al. found a stool antigen positivity rate of 8.4% in a hospital-based study in Singapore, which is consistent with this finding [28]. In contrast, Mazumder et al. detected stool antigen in 24.9% of enrolled children and adolescents in a rural area of Bangladesh [7]. This discrepancy may be attributed to lower hygienic practices among children compared to the adult subjects in the current study, as well as differences in socio-economic status and availability of sanitation facilities.

The prevalence of H. pylori-specific antibodies was reported as 55.8% using immunochromatography among students at a medical university in Iraq, compared to an overall 68.2% antibody positivity rate observed in the present study [29]. This discrepancy may be due to the higher sensitivity of ELISA-based assays in contrast to ICT.

Although 8 of the 9 participants who were positive for H. pylori stool antigen also tested positive for CagA-IgG and/or IgA antibodies, the association was not statistically significant, likely due to the small number of stool antigen-positive cases.

In our study, IgA positivity rate was significantly higher in individuals who tested positive for CagA-IgG antibody compared to those who were negative for CagA-IgG which corroborates the finding of Rautelin et al. (2000), who theorized that CagA- positive infections may induce a markedly higher IgA response than CagA-negative infections. CagA is an immunodominant protein of H. pylori, which is associated with cytoskeletal rearrangements and morphological changes in the host cell [30-33]. Previous research suggests that CagA-positive H. pylori strains are more likely to induce gastric inflammation and the subsequent development of peptic ulcer disease and gastric cancer compared to infections with CagA-negative strains [34-37].

In the present study, 31 (36.5%) participants tested positive for both CagA-IgG and IgA antibodies. Rautelin et al. observed that two-thirds of the subjects demonstrating both CagA-IgG and IgA antibodies had more severe gastric inflammation and were probably at higher risk for severe long-term sequelae [33]. In this study, antibody positivity did not differ significantly between participants with and without gastrointestinal symptoms, which is consistent with the findings of several studies conducted in Bangladesh and other Asian countries [38-41].

The current study showed that a large proportion of the study population demonstrated both IgA and CagA-IgG classes of H. pylori-specific antibodies. The simultaneous presence of these antibodies is important, regardless of symptom status, as it increases the risk of complications such as peptic ulcer disease and gastric carcinoma.

 Stool antigen (HpSA) positivity was observed in35.2%ofsymptomatic individuals. Detection of H. pylori antigen (HpSA) in stool among symptomatic individuals indicates an active infection. Patients having two or more gastrointestinal symptoms were more likely to demonstrate a positive stool antigen test which is consistent with the findings of other studies conducted in Bangladesh and other Asian countries [27,42,43].

The organism is primarily transmitted through contaminated water and food, as well as direct person-to-person contact. Therefore, raising awareness among medical students is essential to help reduce the transmission. A limitation of our study was that only fourth-year MBBS students were included. However, it is fundamental to conduct large-scale studies which not only investigate the prevalence of the H. pylori among medical students but also thoroughly evaluate the determinants contributing to its transmission.

Conclusion

The study revealed that H. pylori infection is highly prevalent among medical students in Bangladesh. Given the risk of transmission and potential ling-term complications, it is essential to increase awareness and implement early detection strategies in this population. Further large-scale studies are required to assess the prevalence across different groups and to identify the key determinants contributing to infection and transmission.

Conflict of interest

The authors declare that there is no conflict of interest.

Funding

This study was funded by Ibrahim Medical College.

Author contributions

Authors’ contributions SA: sample/data collection, laboratory work, data entry and analysis and manuscript writing; RK: data collection, laboratory work. AM: Data entry and analysis, editing of manuscript.SN and EK sample/data collection; SPSS: data entry; MM: data collection, data entry. FR: sample/data collection, laboratory work, data entry and analysis; MSAJ: Idea generation, study design, data analysis.

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Cite this article as:

 Akter S, Khatun R, Melan A, Rumana SN, Khandker E, Mahmud M, et al. The prevalence of Helicobacter pylori infection among students of a medical college in Bangladesh. IMC J Med Sci. 2025; 19(2):009. DOI:https://doi.org/10.55010/imcjms.19.019