Pylori In Children Research Articles

Histopathological frequency of Helicobacter pylori in children between 1-18 ages in the Erzurum province

Histopathological frequency of Helicobacter pylori in children between 1-18 ages in the Erzurum province

Eradication of Helicobacter pylori in Children by Triple Therapy Regimens of Amoxicillin, Omeprazole, and Clarithromycin or Azithromycin.

Background and Objectives:The present study aimed to evaluate the effect of classical and azithromycin-containing triple therapy eradication regimen against H. Pylori in children, and to determine the level of patients’ tolerance.Patients and Methods:This single clinical trial was performed in 2014 on 2 to 15 years old children. All children, in whom H. Pylori infection was confirmed through multiple biopsies of the stomach and required treatment, were enrolled in the study. H. Pylori-positive patients were treated alternately with two different drug regimens; Group OCA received clarithromycin 7.5 mg/kg/day every 12 hours for 10 days, amoxicillin 50 mg/kg/day every 12 hours for 10 days, and omeprazole 1 mg/kg/day every 12 hours for two weeks, and Group OAA received azithromycin 10 mg/kg/day once a day (before meal) for 6 days along with amoxicillin and omeprazole. Four to six weeks after completion of treatment, patients’ stool was tested for H. Pylori through the monoclonal method using the Helicobacter antigen quick kit.Results:There were no significant differences between the two groups regarding gender and age of patients. Based on ITT analysis, the therapeutic response in the OAA and OCA groups were 56.2% and 62.5%, respectively (P = 0.40). Drug adverse effects were 15.6% in the OCA and 3.1% in the OAA group (P = 0.19).Conclusions:The therapeutic response was seen in more than half of the patients treated with triple therapy of H. Pylori eradication regimen including azithromycin or clarithromycin, and there was no significant difference between the two treatment groups.

To culture on not to culture? That is the question for the primary care physician

In spite of the increase in number of non-invasive diagnostic tools for Helicobacter pylori in children, the ultimate solution (gold standard) has not yet been discovered. This reality is not unexpected, considering the various factors that may affect the accuracy rate of any diagnostic tool. Those factors include the prevalence of the disease in the tested community, the number of infected children included in the study, the demographic data of the children involved (young vs. older age, race and ethnicity), the commercial availability of the tested tool, its reliable cut-off value for the pediatric age group, and more. It is thus understandable, why different expert committees from Europe and North America are “chasing” the published data every so often, and revising their recommendations accordingly [1–3]. In this issue of Journal of Pediatric Infectious Diseases, Argentieri et al. [4] reported the accuracy of various invasive and non-invasive diagnostic tools for detection of H. pylori infection in Italian children. In this presumed retrospective study, 215 children were evaluated for H. pylori infection by invasive [tissue biopsy, rapid urease test (RUT), and culture], and noninvasive (stool antigen) methods. The authors chose

Prevalence of Helicobacter pylori in children in eastern Turkey and molecular typing of isolates.

The objectives of the present study were to determine Helicobacter pylori via culture, polymerase chain reaction and histopathological diagnosis in 101 children ranging in age from 4 to 18 years, to identify the association among restriction fragment length polymorphism types and clinical disease and to investigate the relationships among different isolates of H. pylori in different age groups. We observed a high prevalence of H. pylori infections in children between the ages of 13 and 18 (75.8%), while children aged 4 to 6 years had the lowest prevalence of infection (40%). H. pylori was detected in 30.7% (31 of 101), 66.3% (67 of 101) and 63.2% (60 of 95) of children as determined by culture methods, PCR and histological examination, respectively. H. pylori isolates with RFLP types I and III were the most common among children with antral nodularity, whereas RFLP types II and IV were the least detected types. Interestingly, all isolates from peptic ulcer patients were type III. Although our results show a high prevalence of H. pylori infections in the pediatric population in eastern Turkey, no association was identified between H. pylori infection with antral nodularity and recurring abdominal pain. In addition, we found low genetic variation among H. pylori isolates from children and no association between RFLP types and antral nodularity (p > 0.05). Additionally, we found that H. pylori isolates with specific RFLP types were predominant in different age groups.

Helicobacter pylori Infection in Early Childhood and Growth at School Age.

There are conflicting results regarding the role of H. pylori in children's growth. We examined differences in growth indices at school age according to H. pylori infection acquisition in preschool age. A prospective study was undertaken between 2004 and 2009, in which of healthy children (N = 139, ages 3-5 years at baseline) were tested for the presence of H. pylori antigen in their stool using enzyme-linked immunoassay and followed-up till age 6-9 years (median follow-up time 45 months). Height, weight, and hemoglobin levels were measured, and socioeconomic data were obtained. Z scores of height for age, weight for age, and body mass index for age at baseline and follow-up were calculated using the 2000 Center for Disease Control and Prevention growth reference curves. Growth velocity (cm/month) between preschool and school age was compared between H. pylori-infected and uninfected children using mixed models. Fifty-three percent of the children were H. pylori positive at baseline, and all except one child tested positive at follow-up. The adjusted mean Z score of height for age at follow-up was significantly lower among H. pylori-infected children than uninfected ones: 0.15 (95% confidence intervals (CIs) 0.02, 0.29) and 0.45 (95% CI 0.29, 0.60), respectively (p = .002). Growth velocity was slower in the former group -0.0264 cm/month (95% CI -0.047, -0.005) (p = .014), after adjusting for baseline height and age. H. pylori infection was not associated with body weight. Helicobacter pylori infection acquired in early childhood may have long-term adverse influence on linear growth at school age.

Description of methods for the detection of Helicobacter pylori in children with chronic gastroduodenal pathology

Description of methods for the detection of Helicobacter pylori in children with chronic gastroduodenal pathology

THE EFFECT OF TOXIGENIC STRAINS OF HELICOBACTER PYLORI ON CLINICAL AND MORPHOLOGICAL MANIFESTATIONS OF CHRONIC GASTRODUODENAL PATHOLOGY IN CHILDREN

Objective: to study the incidence rate of different genotypes of Helicobacter pylori in children with erosive and ulcerative changes in gastric and duodenum mucosa, as well as to evaluate the effect of toxigenic strains on the morphological changes of the mucosa. Material of study. 230 children aged from 8 to 17 with chronic gastroduodenal pathology associated with Helicobacter pylori were examined. Results. The examined patients revealed the heterogeneity of Helicobacter pylori genome. The persistence of toxigenic strains of Helicobacter pylori is associated with the expressed morphological changes in the mucous membrane. Conclusion. The development of the erosive and ulcerative processes in the stomach and duodenum mucosa in children is associated with the persistence of virulent strains of Helicobacter pylori infection with cagA+vacAs1/m1 or cagA+vacAs1s2/m1m2 genotypes.

Seroprevalence of Helicobacter pylori in children in a rural area

Seroprevalence of Helicobacter pylori in children in a rural area

English

Helicobacter pylori is a spiral gram negative bacterium that normally grows in the stomach, and is the main causal agent of gastritis and peptic ulcers. In 1994, The International Agency for Research on Cancer recognized H. pylori as a carcinogenic factor for stomach cancer. The oral cavity has been proposed as a reservoir for H. pylori and several authors have demonstrated the presence in adult patients of the organism in saliva and dental plaque. However, isolation of H. pylori in children is still questionable. Several investigators have reported the presence of H. pylori in the dental plaque of children, sometimes associated with gastro-esophageal reflux. These isolations has been realized by polymerase chain reaction were gold standard is the culture. On the other hand, many authors have failed to isolate H. pylori by culture in samples obtained from the saliva or dental plaque. We performed an extensive review of the literature to facilitate future research in this controversial topic. Key words: Helicobacter pylori, children, dental plaque, polymerase chain reaction, urease breathe test.

Is Helicobacter pylori Always a "Bad Guy"?

Various clinical presentations have been ascribed to Helicobacter (H.) pylori. Most importantly, H. pylori is considered the leading cause of gastric cancer worldwide and because of that, in adult population, it is listed as a number one carcinogen. However, children are less prone to develop H. pylori related serious diseases such as peptic ulcer disease (PUD) and cases of malignancy are only sporadically reported. On the other hand, there is an increasing level of evidence suggesting that H. pylori in children could also have a beneficial effect. Recently, several data confirmed previously described inverse relationship of H. pylori infection and gastroesophageal reflux disease. Furthermore, it has been hypothesized that an increased prevalence of allergic diseases could be, at least partially, explained by the decreased incidence of H. pylori infection. H. pylori can, to some degree, influence immunological response. It has an ability to promote high proinflammatory cytokine expression in the gastric mucosa shifting immunity towards Th1 response, which could be a plausible explanation for the down-regulated clinical expression of allergies (including asthma) in patients with H. pylori gastritis. Based on these findings the aim of this review is to present "pros and cons" for H. pylori eradication in children.

Treatment of Helicobacter Pylori in Children

Childrenwith Helicobacter infection need treatment. The aim of treatment is elimination of H.Pylori. Most patients with this infection are asymptomatic and without peptic disease. Treatment and management of these patients are controversy. Conventional Treatment: The best treatment for H. pylori eradication regimens should have cure rates of at least 80%, be without major side effects, and induce minimal bacterial resistance. Antibiotics alone have not achieved this. Luminal acidity influences both the effectiveness of some antimicrobial agents and the survival of the bacteri; thus antibiotics have been combined with acid suppression such as proton pump inhibitors (PPIs), bismuth, or H2 antagonists. The “classic” regimen is treatment twice daily for 7 days with a PPI and clarithromycin plus either amoxicillin or metronidazole Bismuth has been used in the treatment of peptic ulcer disease and 1 part o quadruple therapy for H.Pylori but compliance of children for it is low. Sequential Therapy Sequential therapyinvolves dual therapy with a PPI and amoxicillin for 5 days followed sequentially by clarithromycin, Tinidazole and omeperazole for 5 days or other triple therapy for 7 days. This treatment has had 97% efficacy. Adjunctive Therapies A number of studies have showed the potential benefits of probiotic therapy in H. pylori treatment regimens.Consumption of these drugs accompanied with other medications increase H.Pylori eradication.

Antibiotics resistance ofHelicobacter pyloriand treatment modalities in children withH. pyloriinfection

Pediatric infection with Helicobacter pylori may occur early in childhood and persist lifelong. Global pediatric clinical studies have reported a decreasing tendency in the overall rate of H. pylori eradication. In pediatric patients with H. pylori infection, pediatric patients with peptic ulcer, and the first-degree relatives of patients with a history of gastric cancer, it is commonly recommended that H. pylori strains be eradicated. Antibiotic drug resistance to H. pylori, which has been reported to vary widely between geographic regions, is mainly associated with treatment failure in these patients. It is therefore imperative that the antibiotic resistance rates of H. pylori in children and adolescents be meticulously monitored across countries and throughout geographic regions. This paper particularly focuses on the antibiotic drug resistance of H. pylori and the thearpy of pediatric H. pylori infection cases.

Use of the noninvasive entero-test in the detection of Helicobacter pylori in children in an endemic area in Colombia.

Gastric infection with Helicobacter pylori (H pylori), a strong risk factor for gastric cancer, is highly prevalent in children residing in the Colombian Andes. We aimed to validate the use of the Entero-test to culture and genotype H pylori strains from asymptomatic Colombian children. Children (ages 10-15 years, n = 110, 80 of which were H pylori positive by the urea breath test [UBT]) were subjected to the Entero-test, and strings were cultured and/or used for DNA extraction for polymerase chain reaction (PCR). These children had been treated for H pylori in 2007. A second population of children (ages 10-15 years, n = 95),which had not been previously treated, was also subjected to the Entero-test. Of UBT-positive children in the treated group, 29 of 80 (36%) Entero-test samples were H pylori culture positive; 29 additional string extracts were tested by PCR for the H pylori virulence factors cagA and vacA. PCR from cultures and extracts yielded a sensitivity of 74% and specificity of 87%. In the untreated group, 16 of 94 UBT-positive children (17%) produced Entero-tests that were culture positive. Fifty-eight of 94 (62%) string extracts were PCR positive for cagA and/or vacA. In previously treated children, H pylori strains were more often the less virulent vacA s2 (P = 0.001), m2 (P = 0.006), and i2 genotypes (P = 0.039). The Entero-test may be used as a noninvasive test to detect H pylori in asymptomatic children residing in high-risk areas for gastric cancer. Treatment of H pylori in children was associated with less virulent genotypes.

Clinical significance of Helicobacter pylori in children with idiopathic thrombocytopenic purpura

This study was aimed to investigate the clinic significance of helicobacter pylori (HP) in children with idiopathic thrombocytopenic purpura (ITP). The infection of HP in 92 ITP children was determined by (13) C-Urea Breath Test, the same test was also performed on 66 healthy children. The 68 children infected with HP were randomly divided into 2 groups: single drug group treated only with corticosteroid and; combined drug group treated with corticosteroid and anti-helicobacter pylori treatment. The results showed that 68 patients infected with HP were found in 92 ITP children (74.7%), 26 patients infected with HP were observed in 66 healthy children (39.4%), which was lower than that in ITP children (74.7%, P < 0.05). After anti-helicobacter pylori therapy, the total effective rate and cure rate of ITP patients increased respectively from 73.5% to 94.1%, and the total recurrence rate (17.0%) was much lower than single drug group (47.1%, P < 0.05). Otherwise, after therapy the platelet count in both two groups increased continuously, and at the same time point, the platelet count in anti-helicobacter pylori group was higher than that in the single drug group (P < 0.05). It is concluded that the ITP children have a higher infection rate of HP, which may be involved in the pathogenesis of ITP. Anti-helicobacter pylori therapy would help to improve the therapeutic efficacy and reduce the recurrence of ITP children.

Ефективність використання бактеріологічного та імунохроматографічного методів виявлення бактерій Helіcobacter pylori серед дітей шкільного віку

Detection of Helicobacter pylori bacteria in school age children is an actual problem. Most methods of Helicobacter infection diagnostics are not fully reliable. During 2009–2012, H. pylori bacteria was found in 77 children with gastroduodenal diseases by using immunochromatographic, serologic, bacterioscopic, and cultural methods. It was established that positive result of bacteria H. pylori detection depends on applied method: bacteria presence was found by the immunochromatographic method in 80.5%, serologic method – 44.1%, bacterioscopic method – 42.8% and cultural method – in 96.1% patients. A comparison of sensitivity and specificity of the immunochromatographic me­thod demonstrated its high informativity. Restrictions of using all methods of detection of H. pylori in children are noted. It was shown that it is necessary to focuse at the purpose of study and reliability of the method chosen. If depth analysis is necessary, for characteristics of isolated bacteria several methods should by simultaneously used. However, primary diagnosis of H. pylori infection in school children, immunochromatographic method is approp­riate, since it is simple in execution, sensitive, specific, and does not require fibrogastroduodenascopia or taking biopsies as opposed to the invasive methods. Keywords: Helicobacter pylori, helicobacter infection, immunochromatographic and bacteriologic methods, sensitivity, specificity.

Comparison of Sequential and Standard Therapy for Helicobacter pylori Eradication in Children and Investigation of Clarithromycin Resistance

The aim of the present study was to compare the efficacy of sequential and standard triple-drug regimen for Helicobacter pylori (H pylori) eradication in children and to determine the primary resistance rate to clarithromycin. Children with H pylori infection randomized to receive either standard regimen (n = 28) consisting of lansoprazole for 30 days, amoxicillin and clarithromycin for 14 days or sequential regimen (n = 16) consisting of lansoprazole for 30 days, amoxicillin for 7 days, followed by clarithromycin and metronidazole for the next 7 days. Clarithromycin susceptibility of H pylori was assessed with fluorescence in-situ hybridization technique. Eradication was controlled by C urea breath test or monoclonal stool antigen test 4 weeks after the end of the therapy. H pylori eradication rate was higher in the sequential therapy group (93.7%), compared with the standard therapy group (46.4%) (P = 0.002). There was no difference in adverse drug reactions and in compliance to the treatment between the groups. Primary clarithromycin resistance rate for H pylori was found as 25.7% (n = 9). All of the patients having clarithromycin resistance were coincidentally in the standard therapy group. After the exclusion of these 9 patients, sequential therapy was again found to be more effective than the standard therapy (P = 0.02). Sequential therapy seems highly effective for eradicating H pylori in children; however, the difference between 2 groups in resistant strains was the limitation of the study. Our country needs to reassess the effectiveness of standard triple therapy regimen for H pylori eradication.

Detection of Clarithromycin‐Resistant Helicobacter pylori by Stool PCR in Children: A Comprehensive Review of Literature

Helicobacter pylori infection is acquired mainly during childhood. To eradicate H. pylori, clarithromycin-based triple therapy has been recommended in children and adults by the latest Maastricht Consensus. However, the prevalence of clarithromycin-resistant H. pylori was higher in children than that in adults. Therefore, rapid, reliable and noninvasive methods for detecting clarithromycin-resistant H. pylori strains should be developed for children. Studies on evaluating stool PCR in detecting clarithromycin-resistant H. pylori and epidemiological surveys of the prevalence of clarithromycin-resistant H. pylori in children were searched in PubMed (from 1966 to December, 2011) for reviewing. The average rates of primary clarithromycin-resistant H. pylori ranged from less than 10% to more than 40% in different regions. The rates of secondary resistance to clarithromycin were higher than primary resistance in the same population. In H. pylori isolated from children, the frequent point mutations that are responsible for the clarithromycin resistance included A2143G, A2142G, A2142C and A2144G, and they varied geographically. Comparing with culture-based susceptibility tests, stool PCR performed excellently for their rapidity, independence of bacterial growth, reproducibility and easy standardization. However, stool PCR showed lower sensitivity but perfect specificity in detection of clarithromycin-resistant H. pylori in children. Methodology and mixed infections of resistant H. pylori strains might contribute to the considerable discrepancies of stool PCR results. Detection of clarithromycin-resistant H. pylori by stool PCR for children are reliable, rapid, noninvasive methods that are worthy of further clinical promotion. However, more evaluations of stool PCR in detection of clarithromycin-resistant H. pylori in children need to be conducted.

Monitoring of Antibiotic Resistance Rates of Helicobacter pylori in Austrian Children, 2002–2009

We retrospectively studied antibiotic resistance rates of H. pylori and their temporal changes in children. Resistance rates were 21.6% for both clarithromycin and metronidazole. There was no overall difference between children with or without migrational background. Resistance rates increased over time, and patients without migrational background showed a significant increase in metronidazole resistance. Our study emphasizes antibiotic resistance monitoring of H. pylori in children.

A rare complication of Helicobacter pylori infection in childhood: duodenal stenosis

Helicobacter pylori is a spiral-shaped, flagellated, microaerophilic gram negative bacillus that colonizes esophagus and gastric mucosa. It is one of the important causes of peptic ulcer disease. Duodenal stenosis is one of the rare and important complications of peptic ulcer disease caused by Helicobacter pylori in children. In this article, a patient in whom duodenal stenosis developed due to Helicobacter pylori infection is presented and discussed on the basis of literature knowledge.

Sequential Therapy Versus Tailored Triple Therapies for Helicobacter pylori Infection in Children

The aim of the study was to compare sequential versus tailored triple therapy regimens on Helicobacter pylori (H pylori) eradication rates in children and to assess the effect of antimicrobial susceptibility. Prospective, open-label, multicenter study. Children received randomly either a 10-day sequential treatment comprising omeprazole (OME) with amoxicillin for 5 days and OME, clarithromycin (CLA), and metronidazole (MET) for the remaining 5 days, or a 7-day triple therapy comprising OME with amoxicillin and CLA in cases of a CLA-susceptible strain or MET in cases of CLA-resistant strain. H pylori eradication was assessed by C-urea breath test. One hundred sixty-five children, 95 girls and 70 boys, of median age 10.4 years, were included. The intention-to-treat (ITT) eradication rate was 76.9% (sequential 68/83 = 81.9%, triple therapy 59/82 = 71.9%, ns), and the per-protocol (PP) eradication rate was 84.6% (sequential 68/77 = 88.3%, triple therapy 59/73 = 81.8%, ns). Eradication rates tended to be higher using the sequential treatment, but the difference was only statistically significant for ITT analysis in children harboring both CLA- and MET-susceptible strains (87.8% vs 68.5%, odds ratio [OR] 3.3, P = 0.03). Both ITT and PP eradication rates were significantly lower with sequential treatment in CLA-resistant compared with CLA-susceptible strains (ITT: 56.2% vs 72.7%, OR 5.5, P = 0.008; PP 64.3% vs 80.0%, OR 7.9, P = 0.009). Both treatments were well tolerated. Sequential treatment is greatly effective for eradicating H pylori in children except in CLA-resistant strains. Sequential treatment can be used as a first-line therapy, but only in areas with a low CLA resistance rate.