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: 1.93). 04/2006; 100(3):227-33. DOI: 10.1016/j.trstmh.2005.03.009
Source: PubMed

ABSTRACT 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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    ABSTRACT: Objective: Triple therapy is the preferred regimen for H. pylori eradication in children. Levofloxacin included regimens are one of the treatment choices for adult patients in whom the first line triple therapy has failed.However, limited data is available for children. Methods: This is a prospective, open-label, follow-up study to evaluate the efficacy of different therapeutic regimen for H. pylori infected children. The primary end point was to determine the rate of treatment failure of H. pylori infected children with first (ACL; amoxicillin, lansoprozole, clarithromycin) and second (MDBL; metranidazole, doxycycline, bismuth subcitrate, lansoprozole) line therapy regimens. The secondary end point was to evaluate the eradication rate and safety of levofloxacin based regimen (LML, including levofloxacin, metronidazole, lansoprozole) in H. pylori infected children who were non-responders to first or second line regimens. Results: 61 symptomatic children who were infected with H. pylori were treated with ACL protocol and 36 (59%) were cured. Fifteen (60%) of the remaining 25 patients were cured with MDBL protocol. All the remaining patients in whom therapy had failed (n=10) were successfully treated with a third line therapy of LML protocol. No side effects were observed during treatment and follow up period. Conclusion: Levofloxacin based triple therapy seems safe and effective as a third line rescue therapy in H. pylori infected children who failed to respond to triple or quadruple therapies. Further larger randomized controlled trials are needed to test the potential clinical efficacy and also safety of levofloxacin based regimens in H. pylori infected children.
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