A Review of the Risk Factors for, Consequences, Diagnosis, and Management of Helicobacter pylori in Adults with Intellectual Disabilities

  This paper reviews the epidemiology of Helicobacter pylori ( H. Pylori ) in adults with intellectual disability (ID) including clinical presentation, risk factors for infection and diseases, and assesses the best options for testing and treatment. It was observed that particular groups of adults with ID have significantly higher rates of H. pylori infection, and possibly disease consequences including peptic ulcer disease and gastric cancer, when compared to the general population, although the presentation with typical dyspepsia in people with ID is rare. Identified independent risk factors for infection include a history of institutionalization, lower ability, higher levels of behavior problems, and living with flatmates with oral hypersalivation or fecal incontinence. The presence of ID and the associated biopsychosocial factors necessitate development of adaptations to the usual testing and treatment methods as part of a preventive health strategy in order to relieve occult symptoms, and prevent disease development. Among the available tests, the fecal antigen or serology tests are equally acceptable to adults with ID regardless of their level of disability or behaviors, although only those who function more normally can perform the urea breath test. The H. pylori eradication rate is lower, with treatment side‐effect and recurrence rates higher, compared to the general population; but, given the evidence that patients with ID carry the infection and associated pathology for long periods, testing and treating those with at‐risk is recommended. While not recommending screening all adults with ID for H. pylori infection, the authors provide an overall evidence‐based position statement on whom to test and treat, and how to diagnose and manage this infection, an important cause of preventable disease.