Rural health alert: Helicobacter pylori in well water

Reavis, C. (2005) Journal of the American Academy of Nurse Practitioners, 17 (7); 283-9.

Helicobacter pylori (HP) is an infectious organism that causes inflammation of the stomach (gastritis) which can result in indigestion and severe abdominal pain. More serious conditions can develop as the inflammation progresses, including gastric ulcers and cancer. HP infection is believed to cause more than 75% of stomach ulcers. There are 2.5 million new cases of HP infections in the USA each year. The pathogenesis and transmission of HP are not well understood and some populations may be more vulnerable to HP than others. Untreated drinking water has been suggested as one possible source of infection.

This paper presents an exploratory research project which was undertaken in a specified population of farm workers in Southeast Georgia USA to determine: the prevalence rate of HP gastritis, related cofactors contributing to gastritis with and without a positive diagnosis of HP, the relationship of contaminated drinking water to gastritis, and relative risk of acquiring HP gastritis from contaminated drinking water.

Both a descriptive and inferential design was used in this study. A sample of farm workers living in one of three counties in Southeast Georgia was chosen on a first-come basis when data collectors visited the sites. Recruitment was assisted by a local organisation, the Southeast Georgia Communities Project. To be eligible for the study subjects had to be Hispanic, 17 years or older, had lived in the present housing for a least 1 month, spoke Spanish or English clearly and had recent/past memory function. From the three counties, five wells were selected for sample collection. There were 147 farm workers who lived around the selected five water sources who volunteered for the study. The farm workers were given a survey to complete about cofactors related to HP gastritis. Well water samples were collected from the wells and analysed for HP. Four wells were the experimental group and one well was from a city source and was treated with chlorine, this was the control well.

The overall prevalence rate of the response variable (clinical symptoms of gastritis with and without a prior diagnosis of HP gastritis) was 14.6 (8.82-20.3) per 100 farm workers surveyed during this study period. Analysis of the data showed a weak relationship between the well water contaminated with HP and symptoms of HP infection ( p = 0.0744). Subjects drinking from the control well had symptoms of gastritis with a prevalence rate of 17.24 per 100 wells surveyed, while those drinking farm water without HP had a prevalence rate of 10.59 per 100 wells surveyed. The city water and the farm water without HP showed no significant difference in their relationship to the response variable ( p =0.26). It was found that farm workers whose drinking water was contaminated with HP had a 2.6 times higher risk of clinical symptoms of gastritis. There was no relationship found between symptoms of HP gastritis and dietary habits. There was no statistically significant relationship found between signs/symptoms of HP infection and hand washing.

This study showed a positive relationship between well water contaminated with HP and signs and symptoms of gastritis. The study findings can be used to make the public more aware of HP gastritis and to educate patients about the possible aetiologies of HP.