International Archives of Occupational and Environmental Health (2018) 91:657–674
The occupational risk of Helicobacter pylori infection: a systematic
· Samantha Morais
· Ana Ferro
· Ana Rute Costa
· Pedro Norton
· Nuno Lunet
Received: 8 January 2018 / Accepted: 22 May 2018 / Published online: 29 May 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose The aim of this systematic review was to describe the prevalence of Helicobacter pylori infection in speciﬁc occu-
pational groups and to compare them with the general population.
Methods We searched PubMed® to identify original studies reporting the prevalence of H. pylori infection in occupational
groups. The diﬀerences between occupational groups and the general population were analyzed taking into account the
direction and statistical signiﬁcance of the diﬀerences observed when comparing each occupational group with a reference
group (either recruited in the same study or using an external comparator).
Results A total of 98 studies addressing the prevalence of H. pylori infection in occupational groups were included in the
systematic review. Overall, health professionals showed a signiﬁcantly higher prevalence of H. pylori infection than the
general population, especially among those working at gastrointestinal units. Similar results were found in subjects involved
in agricultural, forestry and ﬁshery, as well as in sewage workers, miners, and workers at institutions for the intellectually
disabled, although diﬀerences were less pronounced.
Conclusions Our results show an occupational risk of H. pylori infection supporting the role of oral–oral, fecal–oral, and
zoonotic transmission. Studies comparing speciﬁc occupational groups with adequate comparators may contribute to better
identify groups at higher risk of infection. The recognition of this infection as an occupational disease would result in early
detection and treatment, as well as prevention and control of its transmission in workplaces.
Keywords Helicobacter pylori · Prevalence · Occupations · Systematic review
Helicobacter pylori is a spiral, ﬂagellated, Gram-negative
bacterium (Marshall 2002) that is primarily found in the
gastric mucosa of humans (Testerman and Morris 2014).
Since its discovery in 1983 (Marshall and Warren 1984), it
has been recognized as a major causal factor of histological
changes leading to severe gastro-duodenal disease including
gastric cancer (IARC Working Group on the Evaluation of
Carcinogenic Risks to Humans 1994; Peleteiro et al. 2012).
Globally, H. pylori infection was estimated to aﬀect more
than half of the adult population (Parkin 2006) and to have
accounted for almost 80% of all gastric cancer cases in 2012
(89.0% in noncardia and 17.8% in cardia cancers) (Plummer
et al. 2016).
Electronic supplementary material The online version of this
article (https ://doi.org/10.1007/s0042 0-018-1315-6) contains
supplementary material, which is available to authorized users.
* Bárbara Peleteiro
EPIUnit, Instituto de Saúde Pública, Universidade do Porto,
Rua das Taipas 135, 4050-600 Porto, Portugal
Unidade de Saúde Ocupacional, Centro de Epidemiologia
Hospitalar, Centro Hospitalar de São João, Alameda
Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
Departamento de Ciências da Saúde Pública e Forenses e
Educação Médica, Faculdade de Medicina, Universidade
do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto,