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.
    Full-text · Article · Mar 2010 · Arab Journal of Gastroenterology
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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.
    Full-text · Article · Nov 2006 · Helicobacter
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    ABSTRACT: We aimed to evaluate seroprevalence of Helicobacter pylori ( H. pylori ) IgG antibodies in children with Juvenile rheumatoid arthritis (JRA) and to assess the effect of its eradication treatment on various symptoms and inflammatory indices, to find out whether there is a possible link between this bacterium and disease severity. This study included 21 children with JRA (10 males and 11 females) with a mean age (10.5±4.5 years). Eighteen healthy children matched in age and sex were used as a control group. All subjects had undergone full clinical examination and laboratory investigations including complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor, anti-nuclear antibodies, serum albumin, α1-globulin, α2-globulin, β-globulin and γ-globulin. H. pylori IgG antibodies detection was done by ELISA technique. We found that 61.9% of patients with JRA were seropositive for H. pylori IgG, whereas only 27.8% of the healthy children were seropositive (p< 0.05). Red cell indices and albumin were statistically significantly higher in healthy children than JRA patients (p< 0.05). ESR was statistically significantly higher in JRA patients than controls (p< 0.05). The number of swollen joints correlated positively with β-globulin, ESR and CRP (r = 0.43, p = 0.048; r = 0.67, p = 0.001 and r = 0.54, p = 0.01, respectively). Comparison between H. pylori seropositive and seronegative JRA patients revealed that ESR and CRP were statistically significantly higher in H. pylori seropositive JRA patients than seronegative patients (p< 0.05). Gastrointestinal symptoms were significantly more obvious in the former subgroup (p< 0.05). Hemoglobin level, hematocrite and serum albumin were statistically significantly lower in H. pylori seropositive than seronegative JRA patients (p< 0.05), while α1-globulin, α2-globulin, β-globulin and γ-globulin showed no significant differences between both subgroups (p>0.05). Six months after starting H. pylori eradication treatment; the clinical parameters of JRA and ESR were statistically significantly lower in H. pylori seropositive JRA patients than the base line values (p< 0.05). They showed progressive improvement of all clinical parameters over time. In conclusion: H. pylori seroprevalence is more frequent in JRA patients than healthy children. It might have a role in the pathogenesis of JRA and might be implicated in aggravating severity of symptoms since treatment for its eradication might induce progressive and considerable improvement of both clinical symptoms and laboratory investigations.
    Full-text · Article · May 2007 · Journal of Medical Sciences(Faisalabad)
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