Helicobacter pylori infection causes peptic ulcer disease, gastric adenocarcinoma, gastric lymphoma, and probably nonulcer dyspepsia. Although the prevalence of infection is declining over time, the organism still infects approximately one half of the world's population. Only a minority will ever suffer serious consequences from their infection. This article reviews current knowledge about H. pylori and presents some of the dilemmas surrounding clinical and public health approaches to this widespread pathogen.

This study estimates the cost of osteoporosis in California, including health care services and the value of lives lost prematurely to the disease. Costs are estimated for diagnoses of "osteoporosis" and for the proportion of spine, forearm, hip and other fractures that are caused by the disease. The additional costs resulting from a secondary diagnosis of osteoporosis are also included. Osteoporosis accounted for over $2.4 billion in direct health care costs in 1998, and over $4 million in lost productivity resulting from premature death. Most of the cost results from hip fractures and other fractures. In fact, only 15% of costs are for people with a diagnosis of "osteoporosis" per se, and, of this group, most of the costs are associated with a secondary, not a primary diagnosis. The disease is largely a diagnosis of older white women: three-quarters of the hospitalization costs are incurred by women, 80% of those hospitalized are white, and three-quarters are over age 65 years. As would be expected, Medicare pays for most of the hospital care -- almost three-fourths of the total. Nursing home care represents the largest cost for people with osteoporosis, accounting for 59% of the money spent treating the disease.

Background & Aims: It is not known why some people with Helicobacter pylori infection develop gastric cancer whereas others do not. Whether the CagA phenotype of H pylori infection affected risk for cancer independently of other posited risk factors was evaluated.

Subjects: 242 persons who participated in a previous nested case-control study of gastric cancer. 179 (90 cases and 89 controls) were infected with H pylori as determined by enzyme linked immunosorbent assay (ELISA) in serum and 63 (13 cases and 50 controls) were uninfected.

Methods: Serum samples from cases and controls, obtained a mean of 14.2 years before diagnosis of cancer in the cases, were tested by ELISA for IgG antibodies against the CagA gene product of H pylori. They had previously been tested for pepsinogen I. Using logistic regression analysis, risk for cancer was compared among infected persons with CagA antibodies, infected persons without CagA antibodies, and uninfected persons.

Results: Subjects infected with H pylori who had CagA antibodies were 5.8-fold more likely than uninfected subjects to develop gastric cancer (95% confidence interval (95% CI) = 2.6-13.0). This was true for both intestinal (odds ratio (OR) 5.1, 95% CI = 2.1-12.2) and diffuse type (OR 10.1, 95% CI = 2.2-47.4) cancers. By contrast, H pylori infected subjects without CagA antibodies were only slightly, and not significantly, at increased risk for cancer (OR 2.2, 95% CI = 0.9-5.4) and any possible association was restricted to diffuse type carcinoma (OR 9.0, 95% CI = 1.2-65.8). Pepsinogen 1 50 ng/ml significantly increased risk for both cancer types in H pylori infected persons and lessened the magnitude of association between CagA and cancer. Educational attainment, cigarette smoking, and ABO blood group were not associated with malignancy.

Conclusions: When compared with uninfected subjects, persons infected with CagA positive H pylori are at considerably increased risk of gastric cancer. CagA negative H pylori are less strongly linked to malignancy and may only be associated with diffuse type disease.

Helicobacter pylori is categorized into two phenotypes on the basis of the presence or absence of the CagA protein. CagA protein-positive H. pylori are more closely associated with peptic ulcer disease and cancer. Whether CagA-positive strains are similarly represented among racial or ethnic groups in northern California was investigated. Sera from 152 H. pylori-infected healthy young adults were tested by ELISA for IgG against CagA. CagA antibodies were detected in 79.4% of blacks, 63.8% of Hispanics, and 50% of whites. After adjusting for demographic factors, blacks had significantly more infections with CagA-positive H. pylori than did whites (odds ratio [OR] = 5.0; 95% confidence interval [CI] = 1.6-15.3) or Hispanics (OR = 5.5, 95% CI = 1.9-16.0). Also, there was a higher prevalence of CagA in persons born in developing countries than in persons born in industrialized nations (OR = 3.5, 95% CI = 1.3-9.4). This suggests either a genetic predisposition of racial or ethnic groups to infection with particular H. pylori phenotypes or transmission of H. pylori within relatively segregated population groups.

Now in its Third Edition, this manual is an accessible, reliable source of guidance on clinical problems that are frequently encountered in the adult ambulatory care setting. More than 90 expert contributors from every branch of clinical medicine provide practical, knowledgeable answers to the questions arising in day-to-day patient care.Coverage encompasses all organ systems, with additional sections on constitutional symptoms, psychiatric and behavioral problems, infectious diseases, women's and men's health issues, and health maintenance. Chapters are either symptom-oriented or disease-oriented, depending on the way a condition presents in practice. Each chapter focuses on the questions clinicians encounter when caring for patients, such as how often the condition occurs, its natural history, and the effectiveness of preventive and therapeutic interventions. The authors offer succinct, practical advice and also explain the rationale for their recommendations. Annotated references at the end of each chapter direct the reader to additional information.

Now in its Third Edition, this manual is an accessible, reliable source of guidance on clinical problems that are frequently encountered in the adult ambulatory care setting. More than 90 expert contributors from every branch of clinical medicine provide practical, knowledgeable answers to the questions arising in day-to-day patient care.Coverage encompasses all organ systems, with additional sections on constitutional symptoms, psychiatric and behavioral problems, infectious diseases, women's and men's health issues, and health maintenance. Chapters are either symptom-oriented or disease-oriented, depending on the way a condition presents in practice. Each chapter focuses on the questions clinicians encounter when caring for patients, such as how often the condition occurs, its natural history, and the effectiveness of preventive and therapeutic interventions. The authors offer succinct, practical advice and also explain the rationale for their recommendations. Annotated references at the end of each chapter direct the reader to additional information.

The Writing Group for the Bypass Angioplasty Revascularization Investigation (BARI) Investigators (Alderman EL, Andrews K, Bourassa M, Brooks MM, Chaitman BR, Detre K, Faxon DP, Follman D. Frye RL, Hlatky M, Jones RH, Kelsey SF, Rogers WJ, Rosen AD, Schaff H, Sellers MA, Sopko G, Sutton-Tyrell K, Williams DO).