Helicobacter pylori infection in Indian children

Current epidemiological scenario of Hp in India does not very clearly predict the natural history of this infection in children as they grow old. Positive serology does not seem to be of much clinical significance. Colonization by Hp in the stomach or duodenum per se does not predict a potential ulcer disease in all the cases. Most case control studies from India do not suggest any significant relationship of Helicobacter pylori (Hp) infection and recurrent abdominal pain. A significant relationship has been observed between Hp infection and antral gastritis and duodenitis. Hp related gastric or duodenal ulcers are infrequently reported in children probably because children between 12-18 years of age are not included in most of these studies. Scarce information is available regarding the relationship of Hp infection with failure to thrive, persistent diarrhea, disabled and neurodevelopmentally retarded children and the implications of acquiring infection in infancy. There is an urgent need to have guidelines for management of children with variable spectrum of gastroduodenal disease who are detected to have Hp colonization without any evidence of mucosal inflammation. Since a large number of children fall in this group, treating all of them in the absence of knowing their PCR amplified DNA sequence in Hp genome is impractical and may not be necessary. The ones detected to have evidence of mucosal inflammation attributed to Hp infection may need to be treated since it is not justified to leave these children untreated even after making a definite diagnosis. Secondly, eradication therapy may provide them the much desired symptomatic relief which is the patient's primary concern. For older children with peptic ulcer disease, using adult model for clinical significance and therapeutic options is justified. However, at present, there are no definite guidelines regarding the combinations and duration of antibacterial therapy for children in our setting due to lack of available data.