Pylori-positive Children Research Articles

The Efficacy of Saccharomyces boulardii CNCM I-745 in Addition to Standard Helicobacter pylori Eradication Treatment in Children.

PurposeThis study aims to investigate Saccharomyces boulardii CNCM I-745 during Helicobacter pylori eradication in children.MethodsOne hundred ninety-four H. pylori positive children were randomized in two groups. Therapy (omeprazole+clarithromycin+amoxicillin or omeprazole+clarithromycin+metronidazole in case of penicillin allergy) was given to both groups during two weeks. In the treatment group (n: 102) S. boulardii was added to the triple therapy, while the control group (n: 92) only received triple therapy. The incidence, onset, duration and severity of diarrhea and compliance to the eradication treatment were compared. A 13C urea breath test was done 4 weeks after the end of eradication therapy in two groups of 21 patients aged 12 years and older to test the H. pylori eradication rate.ResultsIn the treatment group, diarrhea occurred in 12 cases (11.76%), starting after 6.25±1.24 days, lasting 3.17±1.08 days, and compliance to eradication treatment was 100%. In the control group, diarrhea occurred in 26 cases (28.26%), starting after 4.05±1.11 days, lasting 4.02±0.87 days, and in six cases eradication treatment was stopped prematurely (p<0.05). The 13C urea breath test showed successful H. pylori eradication in 71.4% of the patients in the treatment and in 61.9 % in the control group (not significant).ConclusionS. boulardii has a beneficial effect on the prevention and treatment of diarrhea during H. pylori eradication in children. Although S. boulardii did only slightly increase H. pylori eradication rate, compliance to eradication treatment was improved.

Occurrence of Helicobacter pylori in saliva from preschool-age children

IntroductionIt is known that initial infection with Helicobacter pylori can occur in children aged 5 years or less, but there have been no studies investigating the period of initial infection. Here, 418 children attending preschool, and their parents, were tested for H. pylori DNA by real-time PCR using saliva samples in order to infer the period of initial infection of H. pylori. MethodsSubjects took samples of their saliva by chewing on a sterile absorbent cotton roll for 2 minutes, and samples were stored at −80̊C until they were examined. DNA was extracted from 100μl of saliva and was tested for H. pylori DNA using the TaqMan method. ResultThe H. pylori DNA detection rate among children was: 4.1% among 3-year-olds, 4.9% among 4-year-olds, 10.0% among 5-year-olds, and 13.3% among 6-year-olds. The detection rate thus increased with age, showing a sharp increase from age 4 to 5 years. The rate of H. pylori detection among mothers of H. pylori-positive children was 56.2%, which was significantly greater than the rate among mothers of H. pylori-negative children (17.2%). ConclusionThese results suggest that initial infection occurs even in children aged under 3 years, and the rise in detection rate between age 4 and 5 years suggests that there is a high risk of H. pylori infection during this period. Furthermore, the finding that the positivity rate was significantly higher among mothers of H. pylori-positive children than mothers of H. pylori-negative children indicates that mother-child infection is the most important route.

Helicobacter pylori infection in Omani children.

Helicobacter pylori (H. pylori) infection is the most common chronic bacterial infection in humans. Its prevalence in Omani adults and children is not known. To report histology-based H. pylori infection prevalence in Omani children. A retrospective study of biopsy proven H. pylori infection in children over a 3 year period in a single center. Age, gender, indication for endoscopy, history of recurrent abdominal pain, and anemia were compared between H. pylori-positive and negative children. Of 143 patients who underwent endoscopy, gastric biopsies were available on 112. The overall prevalence of biopsy proven H. pylori infection was 25%. The prevalence in children with recurrent abdominal pain was 30% compared to 22% in children who underwent endoscopy for other indications (p = .382). The prevalence increased from 7% in children aged <5 years, to 33% in those aged between 5 and 10 years (p = .010). There was no significant difference in the prevalence between the 5-10 years age group (33%) and older age group (29%) (p = .814). There was no significant difference in gender or anemia between the two groups. This study represents the first reported study on the prevalence of biopsy proven H. pylori infection in Omani children. H. pylori infection prevalence is 25%, is lower than regional and many Arab countries. The prevalence appears to increase till age of 5 years. There was no significant association between H. pylori and recurrent abdominal pain, gender, or anemia.

Blood pressure and stature in Helicobacter pylori positive and negative persons.

To evaluate vital signs and body indices in Helicobacter pylori (H. pylori) positive and negative persons. A total of 22 centres entered the study. They were spread over the whole country, corresponding well to the geographical distribution of the Czech population. A total of 1818 subjects (aged 5-98 years) took part in the study, randomly selected out of 38147 subjects. H. pylori infection was investigated by means of a 13C-urea breath test. Data on height, weight, systolic and diastolic blood pressure and heart rate were collected at the clinics of general practitioners. The overall prevalence of H. pylori infection was 30.4% (402/1321) in adults (≥ 18 year-old) and 5.2% (26/497) in children and adolescents (≤ 17 year-old). Once adjusted for age and gender, only a difference in body mass index remained statistically significant with H. pylori positive adults showing an increase of 0.6 kg/m(2) in body mass index. Once adjusted for age and gender, we found a difference in height between H. pylori positive and H. pylori negative children and adolescents. On further adjustment for place of residence, this difference became statistically significant, with H. pylori positive children and adolescents being on average 3.5 cm shorter. H. pylori positive adults were significantly older compared to H. pylori negative subjects. Once adjusted for age and gender, H. pylori infection had no impact on body weight, body mass index and vital signs either in adults or children and adolescents. Chronic H. pylori infection appeared to be associated with short stature in children. H. pylori infection did not influence blood pressure, body weight and body mass index either in adults or children and adolescents.

Helicobacter pylori-associated hypochlorhydria in children, and development of iron deficiency

AimsAcute Helicobacter pylori infection is associated with transient hypochlorhydria. In H pylori-associated atrophy, hypochlorhydria has a role in iron deficiency (ID) through changes in the physiology of iron-complex absorption. The...

Influence ofHelicobacter pyloriinfection on ghrelin levels in children

To compare ghrelin levels in plasma and gastric mucosa before and after Helicobacter pylori (H. pylori) treatment in children with H. pylori-associated functional dyspepsia. Children with H. pylori-associated functional dyspepsia were enrolled in this study. H. pylori infection was confirmed by positive bacterial culture results. All of the children received triple H. pylori eradication therapy (a 2 wk course of omeprazole, amoxicillin, and clarithromycin). The children were divided into two groups based on the success of the H. pylori treatment: group 1 (eradicated) - patients who had a negative 13C-urea breath test 2 mo after the end of therapy; and group 2 (non-eradicated) - patients who had a positive 13C-urea breath test. Plasma ghrelin, gastric ghrelin mRNA, and the body mass index were evaluated in both groups before and after the H. pylori treatment. The plasma ghrelin levels were measured by a radioimmunoassay. The expression of gastric ghrelin mRNA was determined by real-time reverse transcription polymerase chain reaction. A total of 50 children with H. pylori-associated functional dyspepsia were treated with triple H. pylori eradication therapy. The mean age of the children was 5.52 ± 0.83 years, and there were 28 males and 22 females. Among the 50 H. pylori-positive children, 30 successfully achieved eradication, and 20 did not. The mean plasma ghrelin levels of group 1 were 22.17 ± 1.73 ng/L and 26.59 ± 2.05 ng/L before and after the treatment, respectively, which was a significant increase (P = 0.001). However, the mean plasma ghrelin level of group 2 before and after the H. pylori treatment was 21.34 ± 2.40 ng/L and 22.24 ± 2.10 ng/L (P = 0.785). The plasma ghrelin levels increased substantially after treatment in group 1 but showed only minor changes in group 2. Similarly, the gastric ghrelin mRNA expression in group 1 before treatment was 2.84 ± 0.08. After treatment, the level was 3.11 ± 0.65, which was significantly different (P = 0.023). The gastric ghrelin mRNA expression in group 2 did not change significantly during the treatment (2.82 ± 0.44 vs 2.79 ± 0.31, P = 0.875). The plasma ghrelin and gastric ghrelin mRNA levels in group 1 increased substantially after the treatment but did not do so in group 2. In addition, the body mass index the two groups did not differ significantly 2 mo before and after the H. pylori treatment. H. pylori eradication increases the plasma and tissue ghrelin levels in children with H. pylori-associated functional dyspepsia.

Low Prevalence of Helicobacter pylori Among Symptomatic Children from a Hospital in Havana, Cuba

The aims of this study were to assess the prevalence of Helicobacter pylori infection and to introduce a new algorithm to improve its diagnosis in Cuban symptomatic children. One hundred and thirty-three consecutive children with upper gastrointestinal symptoms were studied. Patients were endoscoped and antral biopsies were obtained for rapid urease test (RUT), culture and histology. Prevalence of H. pylori infection was 30.8%. No statistical differences were found concerning demographic, socio-economic factors or chief clinical complaints, between H. pylori-positive and negative children, except for haematemesis, which was significantly higher in infected children (p = 0.003). Histologically, there was statistical association between moderate chronic gastritis in infected children (p = 0.04). Culture and RUT had the highest specificity and sensitivity, respectively. The prevalence of H. pylori infection in Cuban symptomatic children is similar to the one observed in developed countries. Culture and RUT is a useful combination to diagnose H. pylori infection in paediatric patients.

Eosinophil Counts in Upper Digestive Mucosa of Western European Children: Variations With Age, Organs, Symptoms, Helicobacter pylori Status, and Pathological Findings

The aim of the study was to measure the number of eosinophils per high-power field (eos/HPF) according to age, organs, and clinical symptoms and to compare the results to histological characteristics of the upper digestive tract mucosa in children. A systematic prospective assessment of 284 esophagus, 342 antrum, 453 corpus, and 167 duodenum biopsies was carried out in 316 girls and 366 boys referred for endoscopy (median age 9 months), eos/HPF, and histological analysis. Counts (mean-max SD) were as follows: esophagus 1.73 to 50 eos/HPF (5.35), antrum 3.27 to 40 (4.7), corpus 2.11 to 38 (3.76), and duodenum 4.80 to 46 (7.7). Counts >15 eos/HPF were found in 2.8% esophagi, 3.5% corpora, 4.9% antra, and 10.7% duodena. Duodenal eos/HPF were significantly higher than those of esophageal, corporeal, and antral. Mucosal eos/HPF increased with age in esophagus and antrum. The highest esophageal eos/HPF were significantly associated with recurrent abdominal pain, and with anemia in antrum, corpus, and duodenum. Major and/or minor histological features of eosinophilic esophagitis were seen in 9 of 10 esophagi with 5 to 15 eos/HPF and 7 of 8 esophagi with >15 eos/HPF. Eosinophils per high-power field were significantly correlated with histological antral and corporeal gastric inflammation. Helicobacter pylori-positive children had higher eosinophils per high-power field than H pylori negative ones both in esophagus and in antrum. The present study shows that in a western European country mucosal hypereosinophilia is rare. Mucosal eosinophil counts increase from esophagus to duodenum, and also with age in esophagus and antrum. The highest eos/HPF in the esophagus are associated with recurrent abdominal pain and in the corpus, antrum, and duodenum with anemia. Features of eosinophilic esophagitis are rare but detectable in association with counts as low as 6 eos/HPF.

Pediatric Helicobacter pylori Infection and Circulating T-Lymphocyte Activation and Differentiation

In this study, H. pylori-infected and noninfected children with gastritis were compared to a control group with respect to circulating CD4(+) and CD8(+) T lymphocytes expressing activation and differentiation markers. Additionally, the lymphocyte phenotypes of children with gastritis were correlated with the gastric inflammation scores. H. pylori infection status was assessed based on [¹³C]urea breath test, rapid urease test, and histology. Analysis of the lymphocyte surface molecule expression was carried out by triple-color flow cytometry. The group of H. pylori-infected children showed an elevated proportion of peripheral B cells with CD19(low) , along with a twofold increase in the percentage of memory (CD45RO(+)) CD4(+) and CD8(+) T-cell subsets (p < .05). Moreover, a positive correlation between the age and the percentage of these subsets was seen (r = .38, p = .04 and r = .56, p < .01, respectively). Children with gastritis but without infection had a slightly increased percentage of CD8(+) T cells and CD56(+) NK cells, CD3(high) T cells and CD45RO(high) CD4(+) T-cell subsets (p < .05). Both H. pylori-infected and noninfected children with gastritis were characterized by an increased percentage of memory/effector CD4(+) T cells, the presence of NK cells with CD56(high), memory T-cell subset with CD4(high), and naive, memory, memory/effector, and effector T-cell subsets with CD8(high) (p < .05). Gastric inflammation scores correlated positively with the percentage of CD4(+) T lymphocytes in H. pylori-infected children (r = .42, p = .03). In noninfected children, gastric inflammation scores correlated positively with the percentage of B cells (r = .45, p = .04). In H. pylori-negative children, gastritis was associated with an increased percentage of activated NK and T cells, and intermediate-differentiated peripheral blood CD4(+) T cells, which was more pronounced in H. pylori-positive children who also showed an increased B-cell response. However, increased inflammation was only associated with the elevation of CD4(+) T-cell percentage in H. pylori-positive children as well as B-cell percentage in H. pylori-negative children with gastritis.

Effect of Helicobacter pylori Infection on Growth Velocity of School-age Andean Children

Helicobacter pylori infection affects about half of the world's population and is usually acquired in childhood. The infection has been associated with chronic gastritis, peptic ulcer, and stomach cancer in adulthood. Little is known, however, about its consequences on child health. We examined the effect of H. pylori infection on growth among school-age children in the Colombian Andes by comparing growth velocity in the presence and absence of H. pylori infection. Children who were 4-8 years old in 2004 were followed up in a community where infected children received anti-H. pylori treatment (n = 165) and a comparison community (n = 161) for a mean of 2.5 years. Anthropometry measurements were made every 3 months and H. pylori status ascertained by urea breath test every 6 months. Growth velocities (cm/month) were compared across person-time with and without infection, using mixed models for repeated measures. In the untreated community, 83% were H. pylori-positive at baseline and 89% were -positive at study end. The corresponding prevalences were 74% and 46%, respectively, in the treated community. Growth velocity in the pretreatment interval was 0.44 (standard deviation [SD] = 0.13) cm/month. Models that adjusted for age, sex, and height estimated that H. pylori-positive children grew on average 0.022 cm/month (95% confidence interval = 0.008 to 0.035) slower than H. pylori-negative children, a result that was not appreciably altered by adjustment for socioenvironmental covariates. This study suggests that chronic H. pylori infection is accompanied by slowed growth in school-age Andean children.

A Localized Case–Control Study of Extra-Gastric Manifestations of Helicobacter pylori Infection in Children

To study extra- gastric manifestations of H. pylori infection among children in Egypt. This case-control study in which thirty [corrected] H pylori positive children were compared to thirty [corrected] H pylori negative children was conducted. Full history taking, clinical examination, CBC, serum iron, serum ferritin in addition to H pylori antibody testing were performed. Mean hemoglobin, MCV, MCH, serum iron and serum ferritin were all less in seropositive patients but these were statistically non significant. Iron deficiency (ID) was defined as serum ferritin less than 12 ng/ml; and Iron deficiency anemia (IDA) as hemoglobin less than 11 g/dL in addition to ID. Seropositive patients showed increased frequency of ID and IDA and this was statistically significant (0.003 & 0.000 respectively). There was no statistically significant difference as regards the platelet counts of the two groups or the presence of skin disorders or the gender. There is increased incidence of ID and IDA among H pylori positive children. This needs to be confirmed by larger therapeutic randomized controlled trials. The hematological response to eradication therapy needs to be further studied.

PTH-029 Helicobacter pylori-associated hypochlorhydria in children relates to the development of iron deficiency

Introduction Acute H pylori infection is associated with transient hypochlorhydria of variable duration. Hypochlorhydria in H pylori -associated atrophy has a role in iron deficiency (ID) through changes in the physiology of iron absorption. The role of hypochlorhydria in H pylori -associated ID in childhood has not been investigated. The aims were to evaluate the association between H pylori -associated hypochlorhydria and ID in children. Methods A total of 123 children were prospectively enrolled in the study. Any child with peptic ulceration, or who received antacids, PPIs, H2 antagonists, and antibiotics in the previous 4 weeks was excluded. Blood was taken for complete blood count and iron profile. Gastric biopsies were taken for H. pylori determination by histology and rapid urease test. H pylori status was defined as +ve if either test was positive. Gastric juice was obtained at the beginning of the endoscopy avoiding water insufflation. Duodenal biopsies were taken for exclusion of coeliac disease (CD). Stool samples were collected for parasitology/microbiology. Of the 123 children, 2 with CD, 8 with non-specific duodenal inflammation (DI), 5 with lost blood analysis and 9 with parasitic infections (2 with DI) were excluded. Results Of the remaining 101 children 31 were H pylori +ve and 10 were hypochlorhydric (pH>4). There were no differences in demographic characteristics with regard to infection status, or gastric pH. In H pylori +ve children with pH >4 (n=6) serum iron (median (IQR): 60.2 (45–66) μg/dl) and transferrin saturation levels percentage (16.6 (15–19)) were significantly lower (p<0.01) than H pylori positive children (n=25) with pH≤4 (iron 113.2 (91–132); transferrin saturation 32.6 (24–38)). No differences in ferritin or TIBC were observed. In H pylori negative children with pH>4 (n=4) both iron (119 (101–137)), and transferrin saturation (36.4 (31–41)), were not significantly different from children with pH≤4 (n=66) (iron 98.7 (80–122); transferrin saturation 32.2 (25–40)). Conclusion Low serum iron and transferrin in childhood H pylori infection is associated with hypochlorhydria. In uninfected children, hypochlorhydria was not associated with altered serum iron parameters, indicating a combination of H pylori infection and/or inflammation and hypochlorhydria has a role in the aetiology of iron deficiency. Even though H pylori -associated hypochlorhydria may reflect a transient period during acute gastritis, it alters iron homeostasis with clinical impact in developing countries with a high H pylori prevalence. Funded by EU CONTENT Project (INCO-CT-2006-032136) and CONICYT/BM (RUE #29).

Intrafamilial Spread of Helicobacter pylori Infection in Greece

To find out the role of family members in the Helicobacter pylori infection in childhood by investigating the incidence of infection within families of H. pylori-infected children. H. pylori infection is usually acquired in early childhood and possibly family members are the main source of infection. One hundred consecutive children with upper gastrointestinal symptoms, without previous H. pylori eradication treatment were prospectively studied by gastroscopy and C-urea breath test. Simultaneously, all family members were studied by C-urea breath test regardless of earlier eradication treatment for H. pylori infection. The age of children and their parents, socioeconomic status, parents' education, and living conditions were recorded. Forty-four index symptomatic children were infected by H. pylori. No statistical difference was found concerning demographic factors, between H. pylori-positive and H. pylori-negative index children except age, which was higher in the H. pylori-infected children (P=0.009). In all H. pylori-positive and in 71.4% of the negative index children, at least 1 more family member was infected (P<0.001), always including a parent in the H. pylori-positive, compared with 69.6% in the H. pylori-negative group (P<0.001). The percentage of infected siblings, mothers and fathers was higher in H. pylori-infected index children (P<0.001, P=0.001, and P=0.035, respectively). The prevalence of H. pylori infection is significantly higher among families of infected index children. The presence of at least 1 infected family member in all H. pylori-positive index children suggests that the family could be the main source of H. pylori infection in children.

IL2-330G polymorphic allele is associated with decreased risk of Helicobacter pylori infection in adulthood

We evaluated whether polymorphisms in genes coding molecules linked to the innate and adaptive immune response are associated with susceptibility to Helicobacter pylori infection. IL1B-511C → T, IL1B-31 T → C, IL1RN allele 2, IL2-330 T → G, TNFA-307 G → A, TLR2Arg677Trp, TLR2Arg753Gln, TLR4Asp299Gly, and TLR5 392STOP polymorphisms were determined in 541 blood donors. IL2-330 T → G allele carriers had a decreased H. pylori infection risk (OR = 0.63, 95% CI = 0.43–0.93) after adjustment for demographic and environmental factors. Hence, we investigated whether the polymorphism is functional by evaluating IL-2 serum concentration in 150 blood donors and 100 children. IL-2 pro-inflammatory and anti-inflammatory properties were indirectly investigated by determining serum IFN-γ and IL-10/TGF-β levels. The polymorphism was associated with increased mean IL-2 levels in H. pylori-positive adults (2.65 pg/mL vs. 7.78 pg/mL) and children (4.19 pg/mL vs. 8.03 pg/mL). Increased IL-2 was associated with pro-inflammatory activity in adults (IFN-γ = 18.61 pg/mL vs. 25.71 pg/mL), and with anti-inflammatory activity in children (IL-10 = 6.99 vs. 14.17 pg/mL, TGF-β = 45.88 vs. 93.44 pg/mL) ( p < 10 −3 for all). In conclusion, in the context of H. pylori infection, IL2-330 T → G polymorphism is functional and is associated with decreased risk of infection in adults.

Study on the Relationship Between Helicobacter pylori in the Dental Plaque and the Occurrence of Dental Caries or Oral Hygiene Index

The aims of our study were to determine the presence of Helicobacter pylori DNA in the dental plaque of Chinese children aged 3-6 years by nested polymerase chain reaction (PCR) and to investigate the relationship between this infection and the occurrence of dental caries or oral hygiene index. Two hundred and fourteen children from a kindergarten in Guangzhou City of China were evaluated. The children's plaques were assessed by plaque indices of Quigley-Hein. Dental plaque was analyzed using nested PCR for two sets of primers directed to the 860-bp fragment of H. pylori genomic DNA, which have been reported to be highly sensitive and specific by other researchers. H. pylori was detected in dental plaque samples from 126 children, and 70 children with dental caries carried H. pylori in dental plaque. Of these children without infection, only 36 of 88 suffered dental caries. Besides, the average dental plaque index of 126 H. pylori-positive children was higher than that of 88 children without infection. In the present study, there was a significant correlation between H. pylori infection and dental caries or dental hygiene. The oral cavity may be a reservoir for H. pylori infection in children. H. pylori in dental plaque may play a role in the occurrence of dental caries, and poor oral hygiene may represent a risk factor for H. pylori in the oral cavity.

Differences in peripheral blood lymphocyte phenotypes between Helicobacter pylori-positive children and adults with duodenal ulcer

The immunological mechanisms involved in the development of duodenal ulcer, especially in childhood, are unclear. Helicobacter pylori-positive children and adults, with and without duodenal ulcer, were therefore compared with respect to CD4(+) T-cells, and CD8(+) T-cells, B-cells and B1a-cells, as well as cell activation (CD4(+)/HLA-DR(+) and CD8(+)/HLA-DR(+)) and co-stimulatory (CD4(+)/CD28(+) and CD8(+)/CD28(+)) markers, in peripheral blood. Children with and without duodenal ulcer differed significantly. In particular, there was a phenotypic change in CD8(+) T-cells from children with ulcer that involved a 200% increase in the number of CD8(+)/HLA-DR(+) cells/mm(3) and a decrease of 34.2% in the number of CD8(+)/CD28(+) cells/mm(3). This phenotype of chronically activated memory CD8(+) T-cells, which has also been observed in patients with AIDS and tuberculosis, is associated with disease severity and progression. A lower frequency of B1a-cells was also observed in the group of children with ulcer. Conversely, no difference between infected adults with and without ulcer was observed, but the percentage of CD4(+)/HLA-DR(+) cells was lower in adults with ulcer, suggesting that a down-regulated immune response may play a role in the development of duodenal ulcer in adults. Gastric inflammation correlated positively with CD4(+) and chronically activated CD4(+) T-cells in children and adults without duodenal ulcer, respectively. These results suggest that there are differences in the immunophenotyping profile between H. pylori-positive children and adults with duodenal ulcer, indicating the possibility of distinct immune mechanisms in the development of the disease according to age.

Combination of Helicobacter pylori Strain and Tumor Necrosis Factor‐α Polymorphism of the Host Increases the Risk of Peptic Ulcer Disease in Children

Helicobacter pylori infection is probably acquired in childhood and causes a vigorous immune response. It is unclear why only a subgroup of infected children develops peptic ulcer disease. We have previously reported that iceA1 strains tend to be associated with duodenal disease in children. However, the pathogenesis probably does not depend solely on the H pylori strain but also on the variability of the host response. The aim of this study was to assess the significance of tumor necrosis factor-alpha (TNF-alpha) promoter polymorphism in relation to infection with H pylori strains in children. A total of 113 antral biopsies of H pylori-positive children (ages 2-18 years) were analyzed. Of these, 23 had duodenal disease, including erosive duodenitis and/or duodenal ulceration, and 90 had gastritis only. H pylori infection was diagnosed by bacterial culture and histology. Patient genomic DNA extracted from the antral biopsy was used to characterize the genetic polymorphism of TNF-alpha promoter at nucleotide positions -308 and -238 by polymerase chain reaction-based restriction fragment-length polymorphism. All H pylori strains were examined for cytotoxin-associated gene A and induced-by-contact-with-epithelium gene (iceA1). A total of 31% of children with duodenal disease were infected with iceA1 positive strains and had the -238 G to A polymorphism in the TNF-alpha gene vs only 1.6% of children with gastritis alone (P < 0.0005). The combination of bacterial iceA1 and TNF-alpha 238 G to A polymorphism may be a risk factor for peptic ulcer disease in children infected with H pylori. Larger studies are needed to confirm this association.

The association betweenHelicobacter pyloriinfection and height in children from an urban community in north-east Brazil

An association between Helicobacter pylori infection and short stature in children has been described recently. To describe differences in stature between H. pylori-infected and non-infected children in a low-income community in north-east Brazil. H. pylori status was evaluated by 13C-urea-breath test; centile values for weight and height were calculated for each child. The prevalence of H. pyloni was 55.8% (197/353) and increased with age. Of 197 H. pylori-positive children, 62% were below the 25th centile for height compared with 48% of H. pylori-negative children (75/156) [AOR (adjusted odds ratio) 1.61, 95% CI 1.04-2.49, p=0.03] after adjustment for variables with p < 0.25 in univariate analysis (gender, number of residents, of children per household and of persons per bed). These results were significant only when older children were included. Thus, in children aged 8-14 years, 80% (89/111) of H. pylori-positive were <25th centile for height compared with 63% (35/56) of H. pylori-negative children (p=0.01). Compared with children with a height >25th centile, the AOR for H. pylori infection increased from 2.42 in the crude analysis to 6.62 after adjustment (p=0.006). H. pylori is associated with short stature in older children living in a poor urban community in Brazil.

Biochemical Markers of Bone Metabolism in Children with Helicobacter pylori Infection

We investigated the biochemical markers of bone metabolism in children with Helicobacter pylori infection. Biochemical markers of bone metabolism and serum levels of vitamin B12, ferritin and estradiol were measured in 41 H. pylori-positive (+) children (23 girls, 18 boys; aged 11.8+/-3 years). Serum levels of intact parathyroid hormone, ss-collagen I carboxy terminal telopeptide, total alkaline phosphatase (ALP), bone-specific ALP, N-terminal cross-links of human procollagen type I, N-mid-osteocalcin, calcium, phosphate, ferritin, and estradiol did not differ significantly between H. pylori(+) and H. pylori negative (-) children. Vitamin B12 levels were significantly decreased in H. pylori(+) compared to H. pylori(-) children. H. pylori infection was not accompanied by significant changes in markers of bone metabolism in children, although vitamin B12 levels were decreased. Further studies are required to clarify whether H. pylori infection causes time-dependent changes in bone turnover markers during the long course of this inflammatory disease.

Lactobacillus reuteri therapy to reduce side‐effects during anti‐Helicobacter pylori treatment in children: a randomized placebo controlled trial

Helicobacter pylori eradication fails in about 25-30% of children, particularly because of the occurrence of resistance to antibiotics and side-effects. To determine whether adding the Lactobacillus reuteri to an anti-H. pylori regimen could help to prevent or minimize the gastrointestinal side-effects burden in children. Forty H. pylori-positive children (21 males; median age: 12.3 years) were consecutively treated with 10-day sequential therapy [omeprazole + amoxycillin for 5 days, and omeprazole + clarithromycin + tinidazole for other 5 days] and blindly randomized to receive either L. reuteri ATCC 55730 (10(8) CFU) or placebo. All children completed the Gastrointestinal Symptom Rating Scale (GSRS) at entry, during and after treatment. H. pylori status was assessed after 8 weeks by (13)C-urea breath test. Overall, in all probiotic supplemented children when compared with those receiving placebo there was a significant reduction of GSRS score during eradication therapy (4.1 +/- 2 vs. 6.2 +/- 3; P < 0.01) and at the end of follow-up (3.2 +/- 2 vs. 5.8 +/- 3.4; P < 0.009). Overall, children receiving L. reuteri report less symptoms than those receiving placebo. L. reuteri is capable of reducing frequency and intensity of antibiotic-associated side-effects during eradication therapy for H. pylori.