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Quantitative Polymerase Chain Reaction (qPCR)-Based Rapid Diagnosis of Helicobacter pylori Infection and Antibiotic Resistance
Published on: July 28, 2023
Appropriate strategies for testing and treating Helicobacter pylori in children: when and how?
1Department of Pediatrics and Microbiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Childhood Helicobacter pylori infection poses long-term health risks, including peptic ulcers and gastric cancer. Early detection and treatment are crucial for preventing serious complications in children.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Helicobacter pylori infection is common in childhood, with high prevalence in developing countries and varied rates in the U.S.
- Transmission occurs through person-to-person contact (fecal-oral, oral-oral) and potentially contaminated water.
- Childhood risk factors include family infection, multiple siblings, crowding, lower socioeconomic status, and daycare attendance.
Purpose of the Study:
- To review the epidemiology, transmission, risk factors, natural history, and management of Helicobacter pylori infection in children.
- To highlight the long-term health implications of childhood H. pylori infection, such as peptic ulcer disease and gastric cancer.
- To discuss the diagnostic challenges and treatment recommendations for H. pylori in pediatric populations.
Main Methods:
- Review of existing literature on Helicobacter pylori infection in children.
- Analysis of epidemiological data, transmission routes, and risk factors.
- Evaluation of diagnostic methods and treatment guidelines for pediatric H. pylori.
Main Results:
- Childhood H. pylori infection increases lifetime risk for peptic ulcer, gastric adenocarcinoma, and lymphoma.
- Curing H. pylori infection in those with peptic ulcers significantly reduces recurrence rates.
- Current serology and whole blood tests for H. pylori in children are unreliable; breath and stool tests require further study.
Conclusions:
- Children with H. pylori-related peptic ulcer disease, iron-deficiency anemia, or a family history of gastric cancer require treatment.
- Treatment involves 10- to 14-day triple therapy regimens as recommended by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
- Further research is needed to establish optimal H. pylori detection methods in children.
Abstract:
Helicobacter pylori infection is acquired primarily during childhood and carries a significant lifetime risk for morbidity. In developing countries, approximately 70% of children are infected with the bacterium by their 15th birthday. In the United States, the rate of H pylori infection among children varies widely--approximately 10% of all 10-year-olds are infected; however, this figure is substantially higher among populations of immigrant children and children born of recent immigrants to the United States. H pylori transmission is primarily "person-to-person" via fecal-oral, gastric-oral, or oral-oral routes, with evidence suggesting contaminated water as a potential source of infection. Risk factors for infection in childhood include an infected family member, having > or =2 siblings, crowded living conditions, lower socioeconomic means, and attendance at a daycare facility. The natural history of H pylori infection includes an increased lifetime risk for peptic ulcer and gastric adenocarcinoma or lymphoma. In children and adults who develop H pylori-related peptic ulcer, cure of the infection is associated with a <5% rate of ulcer recurrence. The ideal mode of H pylori detection among children is unclear--currently available serology and whole blood tests are unreliable, while the urea breath test and stool antigen tests have not been studied adequately. Children with confirmed H pylori-related peptic ulcer disease, iron-deficiency (sideropenic) anemia, or a first-degree relative with gastric cancer should be treated for the infection using 1 of 3 available 10- to 14-day triple therapy regimens recommended by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
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