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Treatment of Helicobacter pylori in children with recurrent abdominal pain
V Wewer1, L P Andersen, A Paerregaard
1Department of Pediatrics H, Odense University Hospital, Odense, Denmark.
Insights
Eradicating Helicobacter pylori in children with recurrent abdominal pain (RAP) did not significantly reduce symptoms. This study found no causal link between H. pylori infection and RAP, suggesting other factors may be involved.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
Background:
- The role of Helicobacter pylori (H. pylori) in pediatric recurrent abdominal pain (RAP) is not well-defined.
- Investigating H. pylori eradication's impact on RAP symptoms in children is crucial for understanding its potential role.
Purpose of the Study:
- To determine if H. pylori eradication alleviates recurrent abdominal pain in infected children.
- To investigate the correlation between H. pylori eradication and symptom resolution in pediatric RAP.
Main Methods:
- A double-blind treatment study involving 37 H. pylori-infected children with RAP.
- H. pylori identification via histology and culture, followed by amoxicillin and metronidazole treatment.
- Re-endoscopy, serology, and symptom assessment at 3 and 6 months post-treatment, with blinded and open-label observations.
Main Results:
- Successful H. pylori eradication was achieved in 81% of children.
- Significant decrease in H. pylori IgG antibodies observed post-eradication.
- While overall well-being improved in 95% of children, no correlation was found between H. pylori eradication and the disappearance of RAP symptoms.
Conclusions:
- The study provides no evidence for a causal relationship between H. pylori infection and recurrent abdominal pain in children.
- Findings suggest that H. pylori eradication alone may not resolve RAP in pediatric patients.
Background:
The role of Helicobacter pylori remains unclear in children with recurrent abdominal pain (RAP). In this study children with RAP were included in a double blind treatment study to elucidate whether symptoms disappear in children with a H. pylori infection and RAP, if the bacteria are eradicated.
Methods:
Thirty-seven H. pylori-infected children aged 4.9-14.5 years (median 9.8 years) with RAP were included. H. pylori was identified by histology and culture. The children were treated with amoxicillin and metronidazole for 14 days. A re-endoscopy including biopsies for histology and culture was done at least one month after the end of treatment. Simple questions for symptoms were asked and blood for serology was repeated 3 and 6 months after the end of treatment. During the observation period the results of the re-endoscopy and the serology 3 and 6 months after the re-endoscopy were blinded for 23 patients and opened to 14 of the patients according to the choice of the families.
Results:
The eradication rates were 81% (30/37) in the total group and 74% (17/23) in the blinded group. The IgG antibodies to H. pylori decreased significantly 3 (p =.03) as well as 6 months after end of treatment (p <.001) in children with successful eradication. The number of children with RAP decreased after examination and treatment and the well-being improved after 6 months in almost 95% of the children. However, no correlation was seen between eradication of H. pylori and disappearance of RAP, neither after 3 nor after 6 months' observation in the total group of patients (p =.94 and p =.90) or in the blinded group (p =.42 and p =.65).
Conclusions:
These results do not provide evidence for a causal relationship between RAP and H. pylori.
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