Helicobacter pylori infection in children: prevalence, diagnosis and treatment outcome.
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.Cocuk Enfeksiyon Dergisi 01/2009;
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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; 11:39–43. DOI:10.1016/j.ajg.2010.01.005
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ABSTRACT: To study extra- gastric manifestations of H. pylori infection among children in Egypt. This case-control study in which thirty [corrected] H pylori positive children were compared to thirty [corrected] H pylori negative children was conducted. Full history taking, clinical examination, CBC, serum iron, serum ferritin in addition to H pylori antibody testing were performed. Mean hemoglobin, MCV, MCH, serum iron and serum ferritin were all less in seropositive patients but these were statistically non significant. Iron deficiency (ID) was defined as serum ferritin less than 12 ng/ml; and Iron deficiency anemia (IDA) as hemoglobin less than 11 g/dL in addition to ID. Seropositive patients showed increased frequency of ID and IDA and this was statistically significant (0.003 & 0.000 respectively). There was no statistically significant difference as regards the platelet counts of the two groups or the presence of skin disorders or the gender. There is increased incidence of ID and IDA among H pylori positive children. This needs to be confirmed by larger therapeutic randomized controlled trials. The hematological response to eradication therapy needs to be further studied.The Indian Journal of Pediatrics 12/2010; 78(4):418-22. DOI:10.1007/s12098-010-0308-6 · 0.92 Impact Factor