The role of Helicobacter pylori infection in the development and course of allergic diseases in children with gastroesophageal reflux disease

Abstract

Objective — to improve the prevention and treatment of esophageal lesions in children based on the study of Helicobacter pylori infection in pediatric patients with allergic diseases.
 Materials and methods. Examination involved 256 children aged 6 to 18 years, from them 118 children without allergic pathology were included in the control group. The diagnosis was verified according to the unified clinical protocols of primary and secondary medical care. H. pylori was determined with biopsy urease test or histologically. Video esophagogastroduodenoscopy with endoscopic determination of pH was used to assess the condition of mucosa of the upper gastrointestinal parts. The results were processed using the methods of non‑parametric statistics.
 Results. Helicobacter pylori infection occurred more often in children with atopic dermatitis (32%), less often and equally often (24%) at bronchial asthma and allergic rhinitis and in 16% of patients with a combination of allergic diseases. Only 2 (1.4%) patients had H. pylori‑associated chronic urticaria, which was related to the specificity of the hospital department. Helicobacter infection was observed more often in patients with allergic rhinitis and atopic dermatitis without atopic changes. When comparing the Helicobacter association in children with allergic diseases depending on age, a significant difference was established in the group of children aged 6—12 years with allergic rhinitis and mainly with atopy. Endoscopic changes in the esophageal mucosa and esophageal motility disorders in association with Helicobacter pylori more often diagnosed in patients with atopic dermatitis (10.3%), less often and equally often in patients with bronchial asthma and allergic rhinitis (7.7%), the lowest frequency of Helicobacter pylori infection was found in patients with combined allergic pathology (5.1%) and no association in patients with urticaria. Endoscopic signs of esophageal inflammation were more often detected in patients with atopic dermatitis who had Helicobacter pylori infection and esophageal motility disorders. Most often, inflammatory changes in esophageal mucosa were found in patients with allergies developed in the presence of motor disorders, the risk of their development increased in case of Helicobacter infection. It has not been proven that the presence of atopy affected the development of inflammation in the esophagus.
 Conclusions. Among allergic diseases, Helicobacter pylori infection was more often revealed in patients with atopic dermatitis (32%), allergic rhinitis (24%) and bronchial asthma (24%) without statistical significance. A significant difference in H. pylori contamination depending on age was found only in patients with allergic rhinitis (H. pylori was determined more often in elementary school age), in the rest of the patients and in the control group, no significant differences were found. Endoscopic lesions of the esophagus were more often detected in atopic dermatitis, in particular esophagitis (in 17.9%), it was Helicobacter‑associated in 10.3% of cases and was combined with moderate motor disorders in 10.3% of observations. Allergic rhinitis (15.4%) was also associated with Helicobacter pylori infection (7.7%) and was accompanied by motility disorders in 15.4% of cases. Motor disorders, which were registered both in patients with allergic diseases and in patients without allergies, played an important role in the esophagus inflammation and formation of gastroesophageal reflux disease.