Helicobacter pylori infection in Turkish children with recurrent abdominal pain.

Abstract

To the Editor: We read Frank et al's article (1) with interest. The authors investigated the link between recurrent abdominal pain (RAP) and Helicobacter pylori (Hp) infection in children, and evaluated the efficacy of antimicrobial treatment in patients with Hp infection. Histopathologic diagnosis of Hp infection was found in 29 (40%) of the 73 children with RAP who underwent diagnostic upper endoscopy within 3 years. All but five children with Hp infection were of non-Swiss origin (83%). The mean age of the Hp infected children was 10.8 years. Twenty-two of the 29 patients received a 10-day course of omeprazole (< 10 years of age, 10 mg; and > 10 years of age, 20 mg twice daily), amoxicillin (25 mg/kg twice daily), and clarithromycin (7.5 mg /kg twice daily). Four to 6 weeks after termination of treatment, 19 of the children were evaluated for eradication of Hp infection by 13C-urea breath test (UBT). They all had negative UBT results. Clinical symptoms resolved completely in 15 (79%) of the 19 patients. The authors concluded that Hp infection should be considered a possibility in all patients with RAP, especially in those from countries with a higher prevalence of the infection. In this study, we evaluated the occurrence of Hp infection in children with RAP and evaluated the efficacy of treatment in eradicating the infection and improving clinical symptoms. Between August 1999 and November 2000, 151 children with RAP were investigated. Eighty (53%) of the 151 patients underwent diagnostic upper endoscopy. The decision to perform endoscopy was based on the severity of symptoms reflected by interference with normal daily activity. During endoscopy, antral biopsy specimens were obtained for rapid urease test and histology. Helicobacter pylori infection was diagnosed when the bacterium was present in the antral biopsy specimen and the rapid urease test was positive. Of the 80 patients, 58 (72.5%) were Hp infected. The mean age of the patients (27 males, 46.5%) was 11.8 ± 2.7 years (range 5–16). The mean time of the complaints was 22.6 ± 23 months (range 3–120). Three (5.2%) of the 58 patients had duodenal ulceration. Histologically chronic gastritis was observed in all biopsies. Helicobacter pylori infected children were administered triple therapy with omeprazole (< 10 years of age, 20 mg daily for 4 weeks) or lansoprazole (> 10 years of age, 30 mg daily for 4 weeks), clarithromycin (7.5 mg/kg twice daily for 14 days) and amoxicillin (25 mg/kg three times daily for 14 days). At the end of therapy, clinical symptoms ameliorated in 32 (69.6%) of the 46 patients who were available for clinical evaluation. Helicobacter pylori infection was eradicated in 24 (57.1%) of the 42 patients who had negative UBT results. The role of Hp infection as a cause of RAP in children is controversial. Some studies suggest that there is not an association between Hp infection and RAP in children (2–4). In developing countries, Hp prevalence in children with RAP is as high as 75%(5). Frank et al. (1) also found that the Hp infection rate increased to 83% in children of non-Swiss origin. Similar to both studies (1,5), 72.5% of our patients with RAP were Hp infected. In countries with a higher prevalence of the Hp infection, it should be considered as a possible complication in all patients with RAP. The symptoms in 69% of our patients ameliorated after treatment. In conclusion, our population showed that RAP in children has an important association with Hp infection and appropriate treatment can improve the clinical symptoms. Inci Nur Saltik Nurten Koçak Hasan Özen Aysel Yüce Figen Gürakan Hülya Demir