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Julie Parsonnet, MD; Haim Shmuely, MD; Thomas Haggerty, BS

JAMA. 1999;282:2240-2245.

Context  Helicobacter pylori commonly infects humans; however, its mode of transmission remains unknown.

Objective  To determine how humans—the primary host for H pylori—shed the organism into the environment.

Design  Controlled clinical experimental study conducted from February through December 1998.

Setting  Clinical research unit of a hospital in northern California.

Patients  Sixteen asymptomatic H pylori–infected and 10 uninfected adults.

Intervention  A cathartic (sodium phosphate) and an emetic (ipecac) were given to all infected subjects and an emetic was given to 1 uninfected subject.

Main Outcome Measure  Confirmed H pylori isolates cultured from stool, air, or saliva before and after catharsis and emesis and from vomitus during emesis. Isolates were fingerprinted using repetitive extragenic palindromic (REP) polymerase chain reaction and species identity was confirmed by sequencing the 16s ribosomal RNA gene.

Results  All vomitus samples from infected subjects grew H pylori, often in high quantities. Air sampled during vomiting grew H pylori from 6 (37.5%) of the 16 subjects. Saliva before and after emesis grew low quantities of H pylori in 3 (18.8%) and 9 (56.3%) subjects, respectively. No normal stools and only 22 (21.8%) of 101 induced stools grew the organism, although 7 (50.0%) of 14 subjects had at least 1 positive culture (2 stool culture samples were contaminated by fungus and were not included). Fingerprints of isolates within subjects were identical to one another but differed among subjects. No samples from uninfected subjects yielded H pylori.

Conclusions  Helicobacter pylori can be cultivated uniformly from vomitus and, occasionally, from saliva and cathartic stools. The organism is potentially transmissible during episodes of gastrointestinal tract illness, particularly with vomiting.

Author Affiliations: Division of Infectious Diseases and Geographic Medicine, Department of Medicine, School of Medicine (Drs Parsonnet and Shmuely and Mr Haggerty), and the Division of Epidemiology, Department of Health Research and Policy (Dr Parsonnet), Stanford University, Stanford, Calif.

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