Helicobacter pylori and infantile hypertrophic pyloric stenosis: is there a possible relationship?
Ahmed Dahshan1, Kevin G Donovan, Issam M Halabi
1Division of Pediatric GI and Nutrition, University of Oklahoma Health Sciences Center-Tulsa, Tulsa, Oklahoma 4135, USA. adahshan@pol.net
Insights
Helicobacter pylori was not found in infants with infantile hypertrophic pyloric stenosis (IHPS). However, findings of chronic active gastritis suggest a possible infectious cause for IHPS.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Emerging evidence suggests Helicobacter pylori may contribute to infantile hypertrophic pyloric stenosis (IHPS).
- Epidemiological and clinical observations prompted further investigation into this potential association.
Purpose of the Study:
- To investigate the potential relationship between H. pylori infection and IHPS in infants.
- To determine the prevalence of H. pylori in infants diagnosed with IHPS.
Main Methods:
- Upper gastrointestinal endoscopy with biopsy was performed on infants diagnosed with IHPS before surgical intervention.
- Endoscopic findings were documented to confirm IHPS characteristics.
- Biopsies were analyzed for H. pylori presence using histology, immunohistochemical staining, and rapid urease testing.
Main Results:
- Sixteen infants (15 male, 14 white, mean age 42 days) with IHPS were studied.
- H. pylori was not detected in any patient via histology or immunohistochemistry.
- While most patients showed normal or mild gastritis, the index case had chronic active gastritis with H. pylori-like organisms; four others had chronic active gastritis.
Conclusions:
- H. pylori was not specifically identified as a causative agent in this cohort of IHPS infants.
- The presence of H. pylori-like organisms and chronic active gastritis suggests a potential acquired infectious etiology for IHPS.
- Further research is warranted to explore infectious agents in the pathogenesis of IHPS.
Background:
Recently, it has been suggested that Helicobacter pylori might be a cause of some cases of infantile hypertrophic pyloric stenosis (IHPS) in infancy on the basis of its epidemiologic and clinical features. We performed this study to evaluate the possible relationship between IHPS and H. pylori.
Design:
In consecutive infants with IHPS, we performed upper gastrointestinal endoscopy with biopsy before pyloromyotomy. The endoscopic appearance of the pylorus was noted to validate endoscopic features of IHPS.
Results:
Sixteen infants, 15 male, 14 white, mean age 42 days, range 21 to 104 days, were studied. The index case had chronic active gastritis on biopsy with organisms suspicious for H. pylori. Four others had chronic active gastritis, six more had focal or mild chronic gastritis, five were normal, and none had H. pylori on histology or immune histochemical staining in selected cases. All patients had negative rapid urease test. Most common endoscopic findings of IHPS were thickened prominent asymmetric pyloric folds and pin-hole pylorus that could not be intubated by the pediatric endoscope.
Conclusion:
H. pylori was not specifically identified in our patients with IHPS. The presence of H. pylori-like organisms in the gastric mucosa in our index case and finding of chronic active gastritis in several others may indicate the possibility of an acquired infectious etiology for IHPS.
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