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Helicobacter pylori Infection: Genetic and Environmental Influences: A Study of Twins

Hoda M. Malaty, MD, PhD; Lars Engstrand, MD; Nancy L. Pedersen, PhD; and David Y. Graham, MD
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From the Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas; University Hospital, Uppsala, Sweden; Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden. Requests for Reprints: Hoda M. Malaty, MD, PhD, Veterans Affairs Medical Center (111D), 2002 Holcombe Boulevard, Houston, TX 77030. Acknowledgments: The Swedish Adoption/Twin Study of Aging is an ongoing study conducted at the Department of Epidemiology within the Institute for Environmental Medicine of the Karolinska Institute in Stockholm in collaboration with the Center for Developmental and Health Genetics at the Pennsylvania State University. The investigators acknowledge the Swedish Medical Research Council and the Swedish Society of Medicine. Grant Support: In part by grants from the U.S. National Institute of Aging (AG-04563, AG-10175); by the Research Network on Successful Aging of John D. and Catherine T. MacArthur Foundation; by the Department of Veterans Affairs; and by the generous support of Hilda Schwartz.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1994;120(12):982-986. doi:10.7326/0003-4819-120-12-199406150-00002
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Objective: To investigate the importance of genetic effects for acquiring Helicobacter pylori infection.

Design: Cross-sectional study on monozygotic and dizygotic twins, reared apart and reared together.

Setting: Twins from a subregistry of the Swedish Twin Registry, which includes entries for about 25 000 twin pairs who were born in Sweden.

Measurements: Helicobacter pylori status was assessed as the presence of anti-H. pylori IgG in 269 pairs of twins, including 36 monozygotic twin pairs reared apart, 64 monozygotic twin pairs reared together, 88 dizygotic twin pairs reared apart, and 81 dizygotic twin pairs reared together.

Results: The probandwise concordance rate for H. pylori infection was higher in monozygotic twin pairs (81%) than in dizygotic twin pairs (63%) (P = 0.001). Probandwise concordance rates for H. pylori infection among 124 pairs of twins reared apart were 82% and 66% for monozygotic and dizygotic twins, respectively (P = 0.003). The correlation coefficient was 0.66 for monozygotic twins reared apart, and it provides the best single estimate of the relative importance of genetic effects (heritability) for variation in the acquisition of H. pylori infection. The heritability estimate from model-fitting analyses was 0.57, a similar result. The remaining variance was accounted for by shared rearing environmental (20%) and nonshared environmental factors (23%). The latter contribute to differences, not similarities, among family members.

Conclusion: This twin study showed that genetic effects influence the acquisition of H. pylori infection because of greater similarities within the monozygotic twin pairs. Further, sharing the same rearing environment also contributes to the familial tendency for acquiring H. pylori infection.

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