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Upper gastrointestinal disease, Helicobacter pylori and recurrent abdominal pain
E Roma1, J Panayiotou, Y Kafritsa
1Department of Paediatrics, Aghia Sophia Children's Hospital, Athens, Greece.
Insights
Recurrent abdominal pain in children often indicates gastrointestinal pathology. Helicobacter pylori infection is a significant factor in upper gastrointestinal inflammation among these children.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Recurrent abdominal pain (RAP) is a common pediatric complaint.
- The underlying organic pathology and prevalence of Helicobacter pylori (H. pylori) infection in children with RAP require further investigation.
Purpose of the Study:
- To identify organic pathology in children with RAP using upper gastrointestinal endoscopy.
- To determine the prevalence of H. pylori infection in this pediatric population.
Main Methods:
- A 5-year study involving 396 children with RAP who underwent upper gastrointestinal endoscopy.
- Histopathological examination of mucosal biopsies to detect inflammation and H. pylori presence.
Main Results:
- 85.4% of children showed inflammation; H. pylori was found in 28.5% of cases.
- H. pylori positive children were older (11 vs. 8.1 years) and more likely male.
- H. pylori infection was strongly associated with gastritis (98.2%) and peptic ulcers (5.3%), while oesophagitis was more common in H. pylori negative children.
Conclusions:
- Gastrointestinal pathology is highly prevalent in children with RAP.
- H. pylori infection is a significant contributor to upper gastrointestinal inflammation and pathology in children experiencing recurrent abdominal pain.
Abstract:
Over a 5-y period, 396 children complaining of recurrent abdominal pain (RAP) underwent upper gastrointestinal endoscopy in order to identify any underlying organic pathology and determine the prevalence of Helicobacter pylori (H. pylori) infection. Histologically confirmed mucosal inflammation was found in 338 out of 396 children (85.4%); in 113 of 396 patients (28.5%), H. pylori was identified on the gastric mucosa. Significant discriminating factors between H. pylori positive and negative children with RAP included age (mean age for positive 11 y vs. 8.1 y for negative, p < 0.01) and gender (male gender predominance in the H. pylori positive, p < 0.001). No significant difference was found between H. pylori positive and negative groups regarding incidence and character of the presenting symptoms. All H. pylori positive children (100%) had abnormal histology compared with 225 out of 283 negative ones (79.5%). Histologically confirmed gastritis was the most prominent finding in H. pylori positive children compared with H. pylori negative (98.2% vs. 19%, p < 0.001). Conversely, oesophagitis was more common in H. pylori negative children (47.7% vs. 27.4%, p < 0.001). The incidence of peptic ulcer was higher in H. pylori infected patients than in the H. pylori negative group (5.3% vs. 1%, p < 0.05). Our data suggest that gastrointestinal pathology is more common than previously thought in children with RAP, while H. pylori infection is a relatively important factor in the etiology of upper gastrointestinal inflammation in RAP syndrome.