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[Helicobacter pylori infection in pediatrics. Present knowledge and practical problems]
1Cattedra di Gastroenterologia, Università degli Studi, Torino. rinaldo_pellican@hotmail.com
Insights
Helicobacter pylori (H. pylori) infection is common in childhood, especially in developing nations. Early diagnosis and treatment are crucial for preventing long-term health issues like gastric cancer.
Area of Science:
- Pediatrics
- Infectious Diseases
- Gastroenterology
Background:
- Helicobacter pylori (H. pylori) infection is prevalent globally, acquired in childhood, with higher rates in developing countries (70%) versus developed nations (5-15%).
- The exact transmission routes (oral-oral, fecal-oral, gastro-oral) remain undetermined.
- H. pylori infection is linked to recurrent abdominal pain in children with gastritis or ulcers.
Purpose of the Study:
- To review the epidemiology, diagnosis, and clinical manifestations of H. pylori infection in children.
- To discuss the potential long-term consequences and future eradication strategies.
Main Methods:
- Diagnosis involves invasive endoscopic tests or non-invasive methods like serum IgG antibody measurement or the 13C-urea breath test.
- Endoscopy with biopsy is standard for assessing gastritis/ulcer severity but challenging in children.
- Non-invasive tests are suitable for pediatric H. pylori diagnosis.
Main Results:
- H. pylori infection is associated with gastritis, ulcers, and potentially extraintestinal issues like anemia and growth retardation in children, though the latter are debated.
- Early childhood infection may lead to chronic atrophic gastritis and gastric cancer later in life.
Conclusions:
- Non-invasive diagnostic methods are preferred for H. pylori detection in children.
- Future strategies may involve widespread eradication and immunization programs.
- Standard eradication regimens include acid secretion inhibitors and two antibiotics for 7-10 days.
Abstract:
Helicobacter pylori (H. pylori) infection is acquired in childhood, earlier in developing countries, as a consequence the prevalence of infection is higher in developing countries (70%) than in developed countries (5-15%). H. pylori infection spreads from person-to-person, however the precise mode of transmission (oral-oral, fecal-oral or gastro-oral routes) is as yet, not known. Diagnosis of H. pylori infection can be performed with both invasive endoscopic-based tests, or non-invasive tests, mainly by measurement of IgG antibodies against the bacterium in serum samples or by measurement of 13CO2 in expired air (13C-urea breath test). In clinical practice endoscopy and biopsy is recommended before treatment to determine the presence and the degree of gastritis or ulcer. However, endoscopy is a complicated procedure in children and diagnosis of infection can be based on a non-invasive test. The association of H. pylori infection with recurrent abdominal pain seems evident in a subgroup of children with endoscopic features of gastritis, ulcer or hemorrhage. There is an increasing interest in the extraintestinal manifestations of H. pylori infection in children, i.e. iron-deficiency anemia, growth retardation and migraine, but this domain remains controversial. Since infection at a young age is believed to result in chronic atrophic gastritis and gastric cancer in adult life, it is logical to consider a future massive programme of eradication and immunization. Regimens suggested for H. pylori eradication are a combination of inhibitors of gastric acid secretion plus two antibiotics for 7-10 days.