RECURRENT ABDOMINAL PAIN

Abstract

Objective: To assess the association between the Helicobacter Pylori (H.pylori) infection andrecurrent abdominal pain (RAP) by documenting the frequency of Helicobacter pylori infection in children aged 5 to 15years in our setup. Design: A comparative study. Place and Duration of Study: The study was conducted in pediatricunit Military Hospital Rawalpindi over one year period from 1st Apr 200 to 31st Mar 2002. Subject and Methods: Wedivided the patients into two groups; group A or the study group and the group B or the control group. In group A, atotal of 87 Children aged 5 to 15 years presenting with RAP in which no underlying cause was found on initialassessment underwent upper gastrointestinal tract (GIT) endoscopic examination. In group B (control) we included 68children in whom upper GIT endoscopy was done for any reason other than the RAP. In both the groups thegastroduodenal biopsy samples were sent for culture and histological examination for the diagnosis of H. pyloriinfection. The signs and symptoms of these patients were analyzed in detail. Results: In group A, out of 87 patientswho were endoscoped there were 44 female and 43 male. 54(62%) were found positive and 33(38%) were foundnegative for H.pylori on histopathology and culture examination of biopsy samples. In the control group (B) thefrequency of H.pylori infection was 35% (24 of 68) which was significantly lower than the study group (p-value .001).The frequency of H.pylori increased significantly with advancement in age (p-value .003) and lowering of thesocioeconomic status (p-value.002). The commonest endoscopic finding was antral gastritis (31 of 87; 35.6%). Antralnodularity was observed in 8(26%) out of 36 cases of antral gastritis and in 23(74%) cases there was antral erythemawithout nodularity. The remaining endoscopic findings were pan-gastritis (14 of 87;16%), duodenal ulcer (10 of87;11.5%), duodenitis (4 of 87;4.6%) and gastric ulcer (2 of 87;2.3%). The less frequent findings were gastric andduodenal erosions and esophagitis (about 1% each).Their was no abnormal finding in 22(25.3%) cases. Childrenpredominantly (52%) had the symptoms characteristics of ulcer-like dyspepsia. Recurrent epigastric pain wassignificantly more common in the H.pylori positive than the H. pylori negative children (44 of 87 vs 16 of 33 [p-value.001]). There was no difference for other symptom characteristics when comparing infected with non-infected children.Conclusion: The frequency of H.pylori infection is high in children with recurrent abdominal pain and there is a high degree of association between recurrent abdominal pain, endoscopic findings (chronic gastritis, duodenitis, gastric andduodenal ulcer) and the H. pylori infection.