Helicobacter Pylori Infection In Children Research Articles

Recent Changes in the Treatment of Helicobacter pylori Infection in Children and Adolescents

Treatments aimed at eradicating Helicobacter pylori (H. pylori) infections in children and adolescents should be clearly beneficial. According to the updated guidelines, a 14-day triple therapy or bismuth-based triple therapy is the first choice for treatment of children based on the results of antimicrobial sensitivity testing. Though culturing H. pylori using biopsy specimens is not always feasible, it should be performed for establishing empirical rescue therapy for patients not responding to first-line eradication therapy. The European and North American therapeutic strategies for children and adolescents with H. pylori infections may not be appropriate for treating children and adolescents in other countries owing to regional differences in epidemiological characteristics of H. pylori. The existence of clarithromycin-resistant H. pylori is an important factor involved in eradication failure. The development of new treatment-related allergies, treatment failure, side effects, and alteration of the gut microbiome have been highlighted as factors potentially outweighing the possible benefit of preventing future peptic ulcers or gastric cancer. Drug compliance can be improved by providing a detailed explanation of the reason for therapy, duration, and routes of drug administration. Physicians should understand the mechanisms underlying eradication treatment and explain drug prescriptions in detail to both parents and children to increase compliance. Herein, we reviewed the indications for and various modalities of eradication treatment in children with H. pylori infections in accordance with a review of recently published articles.

Helicobacter Pylori Infection in Children with Idiopathic Thrombocytopenic Purpura

Background: Today Helicobacter pylori is the most common bacterial infection worldwide and is associated with some extra-gastrointestinal diseases such as blood disorders including idiopathic thrombocytopenic purpura (ITP). Therefore, this study was designed and performed to determine the status of Helicobacter pylori infection in children with idiopathic thrombocytopenic purpura referred to Dr. Mohammad Kermanshahi Hospital in 2019. Materials and Methods: In this cross-sectional study, 68 children with ITP were evaluated for Helicobacter pylori infection using stool antigen test. Information on Helicobacter pylori was collected using a checklist along with data on gender, age, type of ITP (acute / chronic), primary platelet counts, duration of ITP, and history of receiving treatment for H. pylori infection. Data were analyzed by SPSS-20 using descriptive statistics and the Chi-square test. Results: The mean age of all subjects was 6.35 ± 3.44 years with an age range of 1 to 13 years. The mean duration of the disease was 9.73. ± 9.04 months. Among patients, 63.24% (43 patients) were boys. Regarding the type of ITP, the highest percentage was the Acute type of disease (72/06%). Also, based on the analytical results, there was no significant relationship between Helicobacter pylori infection and gender, mean duration of infection and type of ITP (p <0.05). Conclusion: According to the results of this study, half of the ITP patients had Helicobacter pylori infection, but there was no significant relationship between the type of ITP and its duration with Helicobacter pylori infection. Therefore, it is recommended to conduct similar studies with a larger sample size and perform follow-ups to achieve more accurate results

Helicobacter pylori Infection in Children with Phenylketonuria Does Not Depend on Metabolic Control and Is Not More Frequent Than in Healthy Subjects-A Cross-Sectional Study.

In a small preliminary study, phenylketonuria and poor metabolic control were suggested as risk factors for Helicobacter pylori infection in children as detected with an antigen stool test. We aimed to determine Helicobacter pylori prevalence in an adequately sized group of individuals with phenylketonuria and healthy subjects using the standard gold test (urea breath test). Further, we correlated Helicobacter pylori infection with metabolic control. The study comprised 103 individuals with phenylketonuria and 103 healthy subjects on whom a 13C urea breath test was performed. Blood phenylalanine levels in the preceding year were analysed. The infection rate did not differ between individuals with phenylketonuria and healthy subjects (10.7% vs 15.5%; p = 0.41). The frequency of testing and phenylalanine concentrations of Helicobacter pylori-positive and Helicobacter pylori-negative patients with phenylketonuria did not differ (p = 0.92 and p = 0.54, respectively). No associations were detected for body mass index or metabolic control. Forward stepwise regression models revealed that age (p = 0.0009–0.0016) was the only independent correlate of Helicobacter pylori infection with a relatively low fraction of the variability of the condition being explained (adjR2 = 0.0721–0.0754; model p = 0.020–0.023). In conclusion, Helicobacter pylori infection in phenylketonuria is not more frequent than in the general population. Moreover, it does not depend on metabolic control.

Prevalence of helicobacter pylori infection in children with Vitamin B12 Deficiency - A cross-sectional observational study

Background: Vitamin B12 deficiency is common in children but under diagnosed disorder. Helicobacter pylori infection plays an important role in the development of atrophic gastritis and related malabsorption. There may be a relationship between H.Pylori infection and vitamin B12 deficiency.&#x0D; Aims and Objective: To find out prevalence of Helicobacter pylori infection by endoscopic and histopathological findings, in children aged 2-18 years, with vitamin B12 deficiency.&#x0D; Materials and Methods: Seventy-eight patients with deficient serum vitamin B12 levels were evaluated. Upper GI Endoscopy was performed in all cases and gastric biopsies were obtained for histopathological examination and evidence of H. pylori infection.&#x0D; Results: Tissue biopsy revealed chronic atrophic gastritis in 09 patients and chronic antral gastritis in 52 patients. H. pylori infection by histology was positive in 45(57.70%) patients. We found significant correlation between atrophic gastritis and H. pylori infection, as well as between H. pylori infection and B12 deficiency.&#x0D; Conclusion: H.pylori has an effect on gastric mucosa, which affects the absorption of vitamin B12. Thus individuals with B12 deficiency should be subjected for diagnostic evaluation of H.pylori infection so that appropriate therapy can be initiated.

Manejo de la infección por Helicobacter pylori en la edad pediátrica

The management of Helicobacter pylori infection in children is a consistent problem in clinical practice. Over the years, many questions have been raised regarding symptoms associated with the infection, the diagnostic methods and type of treatment. What is most controversial is determining the criteria that enable us to initiate and carry out the study in children.In the last 10 years, pediatricians have followed the joint ESPGHAN/NASPGHAN guidelines published in 2011 and updated in 2017 in the management of H.pylori in children.This document aims to unify the study indication criteria as well as the diagnosis and treatment recommendations for H.pylori infection in children and adolescents, so they can be used in both Primary and Hospital care.

Risk factors of Helicobacter pylori infection in children: a cross-sectional study in Chenani

Background: H. pylori infections generally occur early in childhood and continue to cause gastric diseases later in life. Epidemiological studies suggest its transmission through fecal to oral and oral to oral routes. Several factors control this transmission including socioeconomic status, quality of drinking water, personal and environmental hygiene, contamination of food, overcrowding and density of population.Methods: A cross-sectional study, involving 100 children aged 1 to 15 years, presenting gastrointestinal complaints was conducted in the department of medicine, district hospital, Udhampur, Jammu, Jammu and Kashmir, India from October 2019 to March 2020. Children with the pathology of central nervous system or with any other known pathology were excluded.Results: Majority of children belonged to the group &gt;6, ≤11 years age (41%), 89% of children were school-going and 78% of participants belonged to the rural areas. Major economic activity of the participants came out to be business and trading (31%), as much as 62% of households were having a size of &gt;4 persons per unit. As many as 24 children were found positive for antigen test upon stool sample examination. The infection rate was significantly higher among children having unsafe source of drinking water (14/24, 58.3%) and poor sanitation facilities (18/24, 66.7%). Overcrowding at home due to bigger household size was found to be a major risk factor among children.Conclusions: The prevalence of H. pylori among children was quite high. Major risk factors included sanitation and drinking water facilities at home and at schools.

Risk Factors Associated with Helicobacter Pylori Infection in Children with Gastrointestinal Symptoms

Background: The main cause of peptic ulcer disease in children is H. pylori, which has also been proven as a carcinogen in human. With an estimated high prevalence and its chronic nature, it is important to determine the risk factors for H. pylori infection. Studies in adults have shown association of H. pylori infection with several risk factors, but research in children is still scarce. Objective: To determine the risk factors associated with H. pylori infection in children with gastrointestinal symptoms. Methods: This was a case-control study in children with gastrointestinal symptoms treated at H. Adam Malik General Hospital in Medan from September 2019 - June 2020. Diagnosis of H. pylori infection was made if one of the diagnostic tests was positive. Data was then collected from parents with a questionnaire guidance and was analysed to determine the association between the risk factors with the incidence of H. pylori infection. Result: A total of 68 children (34 cases and 34 controls) met the criteria as sample. Age range of subjects was between 2-17 years with a median of 12.5 years. Routine hand washing (before eating, after defecation, and when hands were dirty) decreases the risk of H. pylori infection (P = 0.040; OR 0.2; 95%CI 0.4-1.04). History of bottle feeding until more than 2 years old increases the risk of H. pylori infection (P = 0.041; OR 3.59; 95% CI 1.01-12.73). Conclusion: Routine hand washing and a history of bottle feeding until more than 2 years old were associated with the incidence of H. pylori infection.

Low Titer Tissue Transglutaminase Antibodies: A Link to Helicobacter pylori Infection?

Introduction: Low serum titer of anti-tissue transglutaminase (tTG) has been described in various conditions without any evidence of celiac disease (CD). Infectious agents have been suggested to trigger autoimmunity and promote the production of anti-tTG. The aim of this study was to investigate if there is a link between a positive celiac serology and concomitant Helicobacter pylori infection in children. Methods: The data of 178 pediatric patients who underwent upper gastrointestinal endoscopy due to positive celiac serology were compiled. The patients whose histopathologic findings were not consistent with CD were followed on gluten-containing diet. The changes in the serum level of anti-tTG IgA on the follow-up were compared between H. pylori-infected and noninfected patients after the eradication of H. pylori. Results: Of 155 patients who met the inclusion criteria, 119 (group 1) were diagnosed as CD, and duodenal histopathology of the remaining 36 children (group 2) was not compatible with CD. In group 2, 11 out of 36 (30.5%) patients were infected with H. pylori. After the eradication of H. pylori, anti-tTG IgA level either decreased or dropped below cutoff value in 9/11 (81%) patients while it was 20% in those who were not infected with H. pylori in the 6th month of the follow-up (p = 0.001). Conclusion: Our results suggest that H. pylori infection may be the cause of false or transient positive celiac serology. Thus, a positive celiac serology should be carefully interpreted in the presence of H. pylori infection before confirming the diagnosis of this life-long disease.

Importance of Delta Over Baseline Values in Predicting the Severity of Helicobacter pylori Infection in Children

Introduction:Although severe forms of the disease are seen in adults, the Helicobacter pylori (H. pylori) infection is usually acquired during childhood. Therefore, prompt diagnosis of H. pylori infection in childhood is of prime importance. In the present study, we aimed to identify the sensitivity and specificity of 13C urea breath test (UBT) in the diagnosis of H. pylori infection and to assess the severity of the disease with delta over baseline (DOB) values. Materials and Methods: UBT was administered to 200 children who presented with epigastric pain and/or nausea. Esophagogastroduodenoscopy (EGD) was performed in patients. UBT results were compared with histopathological findings. In the Area Under the ROC Curve analysis, a cutoff DOB value was found for the severity of H. pylori infection. Results: 193 children with a mean age of 13.50±2.98 years were included in the analysis. Of these, 71 (36.8%) patients had a positive UBT and 122 (63.2%) had a negative UBT. EGD was performed in 60 out of 71 patients with positive UBT and in 30 out of 122 patients with negative UBT. The sensitivity and specificity of UBT were 85.1% and 100%. DOB was found to be a significant predictor of moderate/marked H. pylori density at a cutoff value of 6%. Conclusions: The positive correlation detected between the level of DOB values and the density of H. pylori and inflammatory activity can be an advantage for detecting the severity of disease

Comparison of clinical outcomes and FOXP3, IL-17A responses in Helicobacter pylori infection in children versus adults.

The purpose of this study was to compare the clinical symptoms and pathological consequences of Helicobacter pylori (H.pylori) infection between children and adults and determine the levels of expression of FOX3P and IL-17A to examine the Th17/Treg balance. Forty pediatric and 40 adult patients who were followed up at the Pediatric Gastroenterology and Internal Medicine Gastroenterology Departments were enrolled in the study. In our case-control study, gastric tissue specimens were evaluated using the updated Sydney system, and the number of cells expressing FOXP3/IL-17A (Treg and Th17 cell markers) was analyzed immunohistochemically. In addition, each case was evaluated using a clinical follow-up questionnaire. Clinical signs and symptoms of children and adults were similar. IL-17A and FOXP3 levels were significantly higher in children and adults with H.pylori (+) than in those without H.pylori (-) (p<.001). In patients with H.pylori (+), the mean FOXP3 level was significantly higher, whereas the mean IL-17A level was significantly lower in children than in adults (p<0001 for both groups). In children with H.pylori (+), bacterial density was negatively correlated with IL-17A level and positively correlated with FOXP3 level. In adults with H.pylori (+), there was a statistically significant, highly positive correlation between bacterial density and levels of IL-17A and FOXP3. Treg cells are suggested to more predominant in children than in adults, IL-17A levels decrease as H.pylori bacterial density increases. In conclusion, immune responses incline toward Treg , which increases the susceptibility to persistent infections.

Helicobacter pylori Infection in Children with Concurrent Celiac Disease and Type 1 Diabetes Mellitus

Objectives: Data regarding Helicobacter pylori (Hp) infection frequency in concurrent celiac disease (CD) and type 1 diabetes mellitus (T1DM) (CD + T1DM) are anecdotal. This study aimed to evaluate the association between Hp and concomitant CD + T1DM in children. Methods: In this 2-center, case-control study, children who underwent esophago-gastro-duodenoscopy (EGD) were studied. CD diagnosis was established by favorable histology and serology. Hp infection was confirmed by both histology and the rapid urease test. Patients were divided into 3 groups as CD only (CDo), CD + T1DM, and non-CD children who underwent endoscopy as controls. Results: Among the 1,431 EGDs performed, 783 cases were eligible. Overall, 215 cases had CDo (mean age: 9.12 ± 4.18 years, 58.1% girls), 63 cases had CD + T1DM (mean age: 9.29 ± 4.46 years, 50.8% girls), and 505 cases were controls (mean age: 9.69 ± 4.52 years, 56.6% girls). Hp infection rate was significantly lower in CD + T1DM group (controls: 49.7% vs. CDo: 32.1% vs. CD + T1DM: 20.6%, p < 0.01). After adjustment for age, gender, and socioeconomic status, the Hp infection rate was still significantly low (adjusted odds ratio [aOR]: 1.57, 95% confidence interval (CI): 1.35–1.83, p < 0.01). A difference in Hp infection rate between controls and CDo group (aOR: 1.43, 95% CI: 1.09–2.12, p < 0.05), and between CDo and CD + T1DM (aOR: 0.89, 95% CI: 0.65–1.54, p < 0.05) group was significant. The severity of duodenal lesions and the presence of Hp infection were not correlated in all celiac children (r: 0.113, p > 0.05). Conclusion: The frequency of Hp infection was significantly lower in CD + T1DM children, compared to the CDo group and the controls.

Epidemiological Aspects of Helicobacter Pylori Infection in Children in Brazzaville

Epidemiological Aspects of Helicobacter Pylori Infection in Children in Brazzaville

The Relationship Between Recurrent Abdominal Pain and Helicobacter Pylori Infection in Children

This study aimed to determine the relationship between recurrent abdominal pain and Helicobacter pylori infection in children. The cross sectional study was conducted 56 children. Subjects were children between aged 2-18 years with complaints of abdominal pain based on the Rome IV criteria according to the inclusion and exclusion criteria. Interview was carried out to establish the diagnosis of recurrent abdominal pain. Helicobacter pylori infection was determined based on Helicobacter Pylori Stool Antigen (HPSA) test measurements.From 56 samples, there were 36 children with positive HPSA and 20 children with negative HPSA. Symptoms of abdominal pain occurred in 16 children (44.4%) in the HPSA positive group, while in the HPSA negative group all had abdominal pain. There was a significant association between abdominal pain symptoms and H. pylori infection (p <0.001).

Review: Helicobacter pylori infection in children

Helicobacter pylori infection in children and adolescents differs in comparison to adults with respect to epidemiology, host responses, and disease manifestations. Furthermore, treatment options are limited in this population and antibiotic resistance rates continue to increase. Therefore, ongoing research is vital to understand disease pathogenesis and provide optimal management of children with infection. This review summarizes relevant publications from April 2019 to March 2020. Similar to adults, recent studies show a decreasing prevalence of infection in the pediatric population. Studies of pathogenesis investigated serum immune responses and the potential inverse association of infection and allergy. Several studies investigated the effect of Hpylori and related inflammation on the gut microbiome. The recommendation of endoscopy-based testing to identify the cause of symptoms and not just Hpylori, reserving noninvasive UBT or stool antigen tests for post-eradication follow-up, was supported by the current literature.

Treatment of Helicobacter pylori infection in children: A systematic review

Treatment of <i>Helicobacter pylori</i> infection in children: A systematic review

Changing prevalence of Helicobacter pylori infection in children and adolescents.

Helicobacter pylori infection has declined over recent decades. However, its prevalence remains high, and nearly 50% of the global population has been infected. In Korea, seroprevalence has steadily decreased in adults, but the status of H. pylori infection in children is unknown. The current status or trend of H. pylori infection in children is important because it can help estimate H. pylori-related diseases including gastric cancer in later life. In this review, the authors discuss the change in H. pylori infection rate among children and adolescents based on literature reviews and our research.

Polyacrylamide Gel Electrophoresis of Proteins Method versus Enzyme-Linked Immunosorbent Assay and Immunochromatography with Monoclonal Antibodies in Pediatric Infection with Helicobacter Pylori

The current methods for the diagnosis of Helicobacter pylori infection in children include invasive (direct) methods, that enable the detection of the bacteria or the bacterial urease in gastric biopsies, or noninvasive (indirect) methods, which consist of researching specific antibodies, antigens and urease in other different samples (serum, saliva, urine, stool, exhaled air). The urease functions in H. pylori infection is to neutralize gastric acid by producing NH3 through the hydrolysis of urea. Monochloramine, a NH3-derived compounds has cytotoxic effects on host cells. The Western Blot method refers to the extraction of a a sodium dodecyl sulphate from a Helicobacter pylori strain followed by a separation of the solubilised protein using discontinous polyacrylamide gel electrophoresis according to molecular mass and transfer of the separated proteins to nitrocellulose. The ELISA (enzyme-linked immunosorbent assay) technique refers to the detection of Anti-Helicobacter pylori antibodies type Ig G. We also used an immunochromatographic system with the lateral leakage test strip based on the principle of the sandwich technique with monoclonal antibodies. As a result, more than two types of reactions can be detected on a single assay device by the combination of colloidal gold �labelled antibodies and complementary oligonucleotide-labelled immobilized at different places on a nitrocellulose membrane. Our study aims to assess the performances of the Western Blot method for determining anti-Helicobacter pylori Ig A and Ig G antibodies in correlation with clinical data and other available diagnosis methods. For validation purposes, the results were compared to those obtained using the enzyme-linked immunosorbent assay technique, gastric biopsy and immunochromatography.

Helicobacter pylori Prevalence and Impact: A Histology-Based Report About Children from an Endemic Country.

BackgroundHelicobacter pylori is spreading worldwide with a high prevalence rate in the developing countries. Our primary goal was to measure the histology-based prevalence of Helicobacter pylori infection in children and to quantify its impact on the gastric inflammation and anemia. Our secondary goal was to study possible predictors for the presence of Helicobacter pylori in this cohort.MethodsA retrospective chart review was performed for children who underwent Esophago-gastro-duodenoscopy at Jordan university hospital in Jordan from 2008 to 2016. Data collected included epidemiological data, indication for endoscopy, endoscopic findings, and laboratory data. The gastric biopsies were re-examined by a pathologist to check for the presence of Helicobacter pylori, the presence of gastritis, and to grade gastritis according to the updated Sydney criteria.ResultsA total of 98 children (53 girls–54%) underwent Esophago-gastro-duodenoscopy. The average age was 11.7 years ± 4.7 years. Of them, 53 patients (29 boys–55%) had Helicobacter pylori identified in the gastric biopsy. The histology-based prevalence rate of Helicobacter pylori was 54%. The most common indication for endoscopy was abdominal pain (53%) followed by vomiting (18%). Nodular gastric mucosa was present in 43% of the Helicobacter pylori-positive group, and in only 11% of the Helicobacter pylori-negative group (P-value <0.0.5). Moderate to severe chronic gastritis was seen in 59% of the biopsies of Helicobacter pylori-positive group, compared to 31% in the Helicobacter pylori-negative group (p value <0.05). Presence of anemia was not different between the two groups (p value > 0.05). Presence of endoscopic nodularity, active gastritis by histology, and moderate to severe gastritis by histology were positive predicators for the presence of Helicobacter pylori. (p value <0.05).ConclusionHelicobacter pylori infection in this study cohort of Jordanian children is common, with a histology-based prevalence rate of 54%. Nodularity of the stomach is the most common positive endoscopic feature, and its presence predicts the presence of Helicobacter pylori. Moderate to severe active gastritis is associated with Helicobacter pylori. The presence of Helicobacter pylori does not affect anemia status in this cohort of Jordanian children.

H. pylori infection and antral nodular gastritis in children

Objectives: The aim of the study was to determine the prevalence of antral nodularity and establish its association with Helicobacter pylori infection in children. Methods: A total of 358 children (mean age: 10.35±3.15 years, M/F:0.95) who had upper gastrointestinal endoscopy were evaluated retrospectively in terms of clinical, endoscopic and histological findings. The association between antral nodularity and H. pylori infection was determined. Results: Antral nodularity was observed in 158 (44.1%) patients. H. pylori was detected in 138 (83.4%) of those patients with antral nodularity. Infected children with H. pylori compared to non-infected group were older (p= 0.0001). The antral nodularity was observed significantly higher in H. pylori-positive patients than in H. pylori-negative cases (p=0.0001). The sensitivity was 52%, specificity 78%, positive predictive value 87% and negative predictive value was 37%. Lymphoid follicle and aggregates formation was observed higher in patients with antral nodularity than patients without (p=0.0001 and p=0.017, respectively). Statistically significant difference was observed between antral nodularity and the grades of H.pylori density (p=0.0001). Conclusions: Children with antral nodularity were more likely to have H. pylori gastritis compared to children without. The parameters associated significantly with antral nodularity were older age, H. pylori infection and H. pylori density.

Ethical Aspects in the Management of Helicobacter Pylori Infection in Children

Ethical Aspects in the Management of Helicobacter Pylori Infection in Children