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Helicobacter pylori colonization in early life
J E Thomas1, A Dale, M Harding
1Medical Research Council Dunn Nutrition Unit, Cambridge, England.
Insights
Helicobacter pylori infection is common in young Gambian children, with prevalence reaching 84% by 30 months. The 13C-urea breath test is a reliable indicator for early childhood H. pylori colonization.
Area of Science:
- Gastroenterology
- Pediatric Infectious Diseases
- Microbiology
Background:
- Helicobacter pylori infection is a significant global cause of upper gastrointestinal disease.
- Early childhood colonization patterns of H. pylori remain poorly understood, particularly in developing regions.
Purpose of the Study:
- To determine the age of acquisition of H. pylori colonization in Gambian children.
- To evaluate diagnostic methods for H. pylori infection in infants.
Main Methods:
- A cohort of 248 Gambian children (3-45 months) was followed for 2 years.
- The 13C-urea breath test and serology (IgM, IgG) were used for diagnosis.
- Data were collected at 3-month intervals.
Main Results:
- Prevalence of positive breath tests increased from 19% at 3 months to 84% by 30 months.
- Serology showed discrepancies with breath tests, especially in the first year, and was not validated as a reliable diagnostic tool for infants.
- 20% of children experienced transient H. pylori colonization, indicated by negative breath tests and declining antibody levels.
Conclusions:
- H. pylori infection is highly prevalent from an early age in Gambian children.
- The 13C-urea breath test is a reliable indicator of H. pylori colonization in this population.
- Previous studies using serodiagnosis may have underestimated early H. pylori prevalence, suggesting infancy as a key period for interventions.
Abstract:
Helicobacter pylori infection is a major cause of upper gastrointestinal disease throughout the world. Colonization begins in childhood, although little is known about its age of onset, rate, or mode of colonization. Our aim was to identify the age of acquisition of H. pylori colonization in Gambian children. A cohort of 248 Gambian children aged 3 to 45 months was studied at intervals of 3 months for 2 years, using the 13C-urea breath test, specific IgM and specific IgG serology. The prevalence of positive breath tests rose from 19% at 3 months of age to 84% by age 30 months. Elevated specific IgG and IgM antibody levels were associated with positive breath tests, although there was discrepancy between breath test results and serology, particularly IgG serology, during the 1st year of life. Neither IgG nor IgM serology could be validated as reliable diagnostic tools for infant H. pylori colonization compared with the 13C-urea breath test. Reversion to negative breath test, in association with declining specific antibody levels, occurred in 48/248 (20%) of children. On the assumption that the 13C-urea breath test is a reliable index of H. pylori colonization, we conclude that the infection is extremely common from an early age in Gambian children. Transient colonization may occur. Previous studies relying on serodiagnosis may have significantly underestimated the true early prevalence of colonization in the developing world, where the target age for intervention studies is probably early infancy.