P0522 H. PYLORI INFECTION IN INTERNATIONALLY ADOPTED CHILDREN

Abstract

Introduction: When children presenting with gastrointestinal symptoms, H. pylori infection should be considered in the differential diagnosis although the prevalence is low in developed countries, internationally adopted children from developing countries may have an increased rate of H. pylori infection. AIM: The aim of the study is to determine if there is increased rate of H. pylori infection in internationally adopted children. Although American Academy of Pediatrics has guidelines for assessing other gastrointestinal parasitic infections in this particular group of patients, it does not highlight the increase incidence of H. pylori infection in this group. Methods: Retrospective chart review was performed over the past two years on internationally adopted children who presented to our clinic with gastrointestinal complaints and eventually diagnosed with H. pylori infection. Results: Three patients, 1 male and 2 female, age range from 4–6 years, mean age 5 years, adopted from orphanages in Romania and Russia, presented to our clinic with symptoms including vomiting, diarrhea, abdominal pain, poor weight gain, and feeding aversion. Patients had undergone studies, including complete blood count, H. pylori serology, upper GI small-bowel-follow-through, and stool studies for enteric pathogen. They all underwent upper endoscopy, which revealed antral gastritis. Biopsies revealed chronic gastritis with evidence of H. pylori infection. CLO test was positive in all three patients. H. pylori serology was drawn in two out of three patients. Only one patient was H. pylori serology positive. All three patients underwent repeat upper endoscopy after being treated for H. pylori infection. Two patients had complete resolution of symptoms, and repeat endoscopy was normal with normal biopsies and negative CLO test. One patient stayed symptomatic, and repeat endoscopy, after eight weeks, showed persistence of H. pylori gastritis. He received another course of antibiotics and PPI. His symptoms resolved, and histological improvement was documented on repeat endoscopy. Patients were followed up for one year with no recurrence of symptoms. Conclusion: There is an increase prevalence of H. pylori infection among internationally adopted children. H. pylori should be considered in those children presenting with abdominal pain, vomiting, diarrhea, feeding aversion, and poor weight gain. Treatment of H. pylori led to healing of chronic gastritis and significant improvement of symptoms.