P0945 HELICOBACTER PYLORI INFECTION IN THE NEONATAL PERIOD AND COW MILK PROTEIN INTOLERANCE: IS THERE A RELATION?

Abstract

Introduction: H. pylori is one of the most common infections worldwide, and especially in developing countries. It is generally accepted that H. pylori is most often acquired in childhood. However, under one year of age, infants rarely become infected with H. pylori, even when they are exposed to infected mothers. Many groups have reported a maternal transfer of H. pylori-specific IgG antibodies to the fetus. Spontaneous clearance followed by subsequent reacquisition of infection in young children also has been reported. Methods: The aim of this study is the retrospective analysis of 3 cases of H. pylori infection in neonates between 2001 and 2003, and to discuss the associated clinical presentation along with the need of eradication therapy in this age group. Results: The patients had 15, 17 and 18 days respectively. The first patient presented with excessive crying. The two others had symptoms of gastric outlet syndrome, with poor weight gain and malaise. Treatment for GERD (prokinetics and anti-acids) was initiated in patients 1 and 3, and patient 2 received only prokinetic therapy with hydrolysate formula, then amino-acid formula, with no clinical improvement in all patients. GI endoscopy revealed signs of congestive and edematous gastritis in patients 2 and 3, and hemorrhagic esogastroduodenitis in patient 1. Pathology confirmed this active gastritis with presence of H. pylori bodies. All patients were kept on anti-acids and prokinetics, and formula was changed to a hydrolysate one in patients 1 and 3. Patient 2 was kept on amino-acid formula, and was given antibiotic therapy (amoxicillin and clarithromycin). Significant improvement and resolution of all symptoms was obtained in all patients. Conclusion: H. pylori infection in neonates is very rare, and clinical presentation can vary from signs of minimal GER to those of gastritis and esophagitis. The role of H. pylori infection on the genesis of CMP intolerance has been reported, but there is no clear consensus on eradication treatment of HP in this age group. We think that combination therapy for both GERD and CMPA should be given when no clinical improvement is rapidly obtained, before deciding on eradication of H. pylori.