Evaluating the Potential for a Helicobacter pylori Drinking Water Guideline

Michael Ryan, Kerry Hamilton, Michael Hamilton, Charles N. Haas

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Helicobacter pylori is a microaerophilic, gram-negative bacterium that is linked to adverse health effects including ulcers and gastrointestinal cancers. The goal of this analysis is to develop the necessary inputs for a quantitative microbial risk assessment (QMRA) needed to develop a potential guideline for drinking water at the point of ingestion (e.g., a maximum contaminant level, or MCL) that would be protective of human health to an acceptable level of risk while considering sources of uncertainty. Using infection and gastric cancer as two discrete endpoints, and calculating dose-response relationships from experimental data on humans and monkeys, we perform both a forward and reverse risk assessment to determine the risk from current reported surface water concentrations of H. pylori and an acceptable concentration of H. pylori at the point of ingestion. This approach represents a synthesis of available information on human exposure to H. pylori via drinking water. A lifetime risk of cancer model suggests that a MCL be set at <1 organism/L given a 5-log removal treatment because we cannot exclude the possibility that current levels of H. pylori in environmental source waters pose a potential public health risk. Research gaps include pathogen occurrence in source and finished water, treatment removal rates, and determination of H. pylori risks from other water sources such as groundwater and recreational water.

Original languageEnglish (US)
Pages (from-to)1651-1662
Number of pages12
JournalRisk Analysis
Issue number9
StatePublished - Sep 1 2014
Externally publishedYes


  • Dose-response
  • Gastric cancer
  • Helicobacter pylori
  • Maximum contaminant level (MCL)
  • Monte Carlo
  • Quantitative microbial risk assessment (QMRA)

ASJC Scopus subject areas

  • Safety, Risk, Reliability and Quality
  • Physiology (medical)


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