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Helicobacter pylori infection in recurrent abdominal pain in children--a prospective study
1Department of Pediatrics, Municipal Yang-Ming Hospital, 105, Yu-Sheng St., Taipei, Taiwan.
Insights
Helicobacter pylori infection may contribute to chronic gastritis in some children with recurrent abdominal pain (RAP). However, routine screening for H. pylori in children with RAP is not recommended due to insufficient evidence of a significant association.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Recurrent abdominal pain syndrome (RAP) is a common condition in children.
- Helicobacter pylori (H. pylori) infection is a known cause of gastritis.
- The role of H. pylori in pediatric RAP remains debated.
Purpose of the Study:
- To investigate the prevalence and role of H. pylori infection in children diagnosed with recurrent abdominal pain syndrome.
- To correlate H. pylori infection with histologic findings of gastritis and endoscopic features.
Main Methods:
- A cohort of 40 children with RAP was studied.
- H. pylori infection was assessed using serology (anti-H. pylori IgG) and rapid urease testing.
- Gastritis was evaluated through histologic examination of gastric biopsies.
- Endoscopic findings, including antral nodular gastropathy, were recorded.
Main Results:
- H. pylori infection was confirmed in 17.5% of children with RAP.
- H. pylori-positive children showed active chronic gastritis (p < 0.0001).
- Antral nodular gastropathy was a specific endoscopic finding in H. pylori-infected children (p = 0.004).
- Rapid urease test demonstrated higher sensitivity (86%) and specificity (100%) compared to serum assay (71% and 85%).
Conclusions:
- H. pylori-related chronic gastritis may be implicated in a subset of pediatric RAP cases.
- The study did not find compelling data to support routine H. pylori screening for all children with RAP.
- Further research is needed to clarify the etiological significance of H. pylori in pediatric RAP.
Abstract:
A total of 40 children was recruited to assess the role of Helicobacter pylori infection in children with recurrent abdominal pain syndrome. Among 40 children, seven (17.5%) cases were confirmed to have H. pylori infection. All H. pylori-positive patients had active chronic gastritis histologic findings (p < 0.0001); however, the majority of the H. pylori-negative patients had minimal to mild gastritis histologic findings (p = 0.001). Grossly, chronic gastritis picture was present in all children infected with H. pylori and antral nodular gastropathy present in 43%. 71% of H. pylori-positive patients had elevated anti-H. pylori IgG titer; however, 15% in H. pylori-negative patients (p = 0.006). Serum H. pylori assay had a sensitivity of 71% and specificity of 85%; however, sensitivity and specificity of rapid urease test were 86% and 100% respectively. Antral nodularity is a specific, peculiar endoscopic finding of children infected with H. pylori (p = 0.004). Although the present study suggests that H. pylori-related chronic gastritis may play an etiological role in a subgroup of children with RAP syndrome, but the routine screening of H. pylori infection in children with RAP is not recommended, since no compelling data support the significant association between H. pylori infection and RAP syndrome.