Helicobacter pylori infection in children: Prevalence, diagnosis and treatment outcome

Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226 014, India.
Transactions of the Royal Society of Tropical Medicine and Hygiene (Impact Factor: 1.84). 04/2006; 100(3):227-33. DOI: 10.1016/j.trstmh.2005.03.009
Source: PubMed


The clinical significance of Helicobacter pylori infection in children remains largely unknown. The rate of acquisition at different ages has not been ascertained using reliable tests on gastric biopsies. We determined prospectively the prevalence of H. pylori infection in children and its association with gastroduodenal disease. We evaluated 240 children undergoing upper gastrointestinal endoscopy for H. pylori infection by rapid urease test, culture, ureA PCR and histopathology. Group I constituted 58 children with upper abdominal pain (UAP) and group II (controls) of 182 children without UAP who underwent diagnostic or therapeutic endoscopy for other reasons. Helicobacter pylori-positive children with UAP received anti-H. pylori therapy. Helicobacter pylori infection was significantly higher in children with UAP than controls (53.4% vs. 28%; P<0.001) and overall prevalence increased with age. On follow-up endoscopy, H. pylori had been eradicated from 82% of children with UAP; it was eradicated from the remaining 18% after a second regimen. Treated H. pylori-positive children with UAP remained symptom-free for a median of 25 months. Control children remained chronically H. pylori infected. Chronic inflammation was present in all infected children, and active inflammation in 48.8%. The study shows H. pylori infection increases with age and is strongly linked to UAP in children.

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    • "Unlike, the classical recurrent abdominal pain syndrome that present with recurrent central abdominal pain in otherwise healthy children [16] [17], the presence of epigastric pain especially if associated with dyspeptic symptoms is more associated with abnormal gastric pathology. Singh et al. [18] found that H. pylori infection was diagnosed in 53% of 240 Indian children presented with epigastric pain. Therefore , the yield from upper gastrointestinal endoscopy in children with epigastric pain is more revealing. "
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    ABSTRACT: Background and study aims: Helicobacter pylori (H. pylori) infection is common in the Saudi paediatric population. The aim of this study was to describe the clinical presentation, endoscopic abnormalities and associated histopathological changes in a group of Saudi children with H. pylori infection. Patients and methods: This is a chart review of all Saudi children diagnosed at King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia, between September 2001 and July 2005 with H. pylori infection. Results: A total of 230 children were identified. One hundred and thiry six (55%) were females. The mean age was 11 ± 3.9 years (range, 2–17). Thirty-two (14%) were underweight and 12 (5%) were stunted. The main symptom was epigastric pain in 128 (56%). Nodular gastritis was the most frequent endoscopic finding in 94 patients (40%). The histopathological findings in the antrum showed moderate chronic inflammatory activity in 65%, mild glandular atrophy in 14% and intestinal metaplasia in 2%. In the corpus, moderate chronic inflammatory activity was found in more than 50%, glandular atrophy in 7%, and no cases with intestinal metaplasia. The density of H. pylori in the antrum was mild in 67% and moderate in 26% of cases. In the corpus, it was mild in 49% and moderate in 21% of patients.The mean gastritis score was 4.2 ± 1.3 in the antrum and 3.4 ± 1.3 in the corpus. Nodular gastritis was associated with the highest mean gastritis score of 4.9 ± 1.2 in the antrum (ANOVA < 0.001). The severity of gastritis in the antrum and the corpus was associated with higher density of H. pylori (ANOVA < 0.001). Conclusion: Saudi children with H. pylori infection were commonly found to have abnormal endoscopic findings which were associated with significant gastric mucosal inflammation.
    Arab Journal of Gastroenterology 03/2010; 11(1):39–43. DOI:10.1016/j.ajg.2010.01.005
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    ABSTRACT: This review summarizes the literature on Helicobacter pylori infection in childhood between April 2005 and March 2006, and includes guidelines of the Canadian Helicobacter Study Group Consensus Conference, noninvasive tests, optimum therapy regimens and problems with resistance, and reviews on immune mechanisms in the gastric mucosa that may lead to the development of an effective vaccine.
    Helicobacter 11/2006; 11 Suppl 1(s1):40-5. DOI:10.1111/j.1478-405X.2006.00427.x · 4.11 Impact Factor
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    ABSTRACT: The failure rate of Helicobacter pylori (H. pylori) eradication imposes the assessment of new options. A prospective open study was performed in 90 symptomatic children (range 3-18 years) with H. pylori infection, randomized in two groups: control (42 patients) and intervention group (48 patients). Both groups were treated with the standard triple eradication therapy (omeprazole/esomeprazole, amoxicillin and clarithromycin) for 7-10 days. The intervention group was also treated with Saccharomyces boulardii (S. boulardii), 250 mg b.i.d., for 4 weeks. The eradication rate of H. pylori was assessed by the same methods (urease test and histology) 4-6 weeks after treatment. Adverse events and compliance were evaluated after 7 and 28 days of treatment. The Chi-square test was used for statistical evaluation (p < 0.05). H. pylori infection was identified in 90 of 145 children (62%) and it correlated positively with age (p < 0.002) and inversely with socioeconomic status (p < 0.005). All infected children had chronic gastritis, with antral nodularity in 76.7%. Overall, H. pylori eradication rate was 87.7% (control 80.9%, S. boulardii group 93.3%) (p = 0.750). The incidence of side effects was reduced in the S. boulardii group: 30.9% in the control versus 8.3% in the probiotic group (p = 0.047). The addition of S. boulardii to the standard eradication treatment confers a 12% nonsignificant enhanced therapeutic benefit on H. pylori eradication and reduces significantly the incidence of side effects.
    Acta Paediatrica 09/2008; 98(1):127-31. DOI:10.1111/j.1651-2227.2008.00977.x · 1.67 Impact Factor
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