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Helicobacter pylori infection, serum pepsinogens, and pediatric abdominal pain: a pilot study
Eias Kassem1, Medhat Naamna2, Kadri Mawassy1
1Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel.
Insights
High serum PGII levels, indicating gastritis, are linked to increased risk of abdominal pain in children. Serum pepsinogens (PGs) offer a valuable non-invasive tool for diagnosing pediatric abdominal pain of unknown origin.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Biomarker Research
Background:
- Helicobacter pylori (H. pylori) infection's role in pediatric abdominal pain is debated.
- Serum pepsinogens (PGs) are non-invasive markers of gastritis, but their utility in pediatric cases is understudied.
- Previous research has not fully explored the association between H. pylori, PGs, and unexplained pediatric abdominal pain.
Purpose of the Study:
- To investigate the association between H. pylori infection, serum pepsinogen levels (PGI and PGII), and pediatric abdominal pain.
- To evaluate serum PGs as non-invasive biomarkers for gastritis in children with abdominal pain.
- To determine if H. pylori infection or gastritis markers are more significantly associated with abdominal pain in children.
Main Methods:
- A case-control study involving 99 children (5-17 years) with abdominal pain and 179 controls.
- Serum samples analyzed for anti-H. pylori IgG antibodies and PGI/PGII levels using ELISA.
- Multivariable analysis conducted to adjust for potential confounding factors.
Main Results:
- H. pylori sero-positivity rates were similar between cases (34.3%) and controls (36.3%).
- Children with H. pylori infection showed higher PGI/PGII levels and lower ratios, suggesting gastritis.
- Elevated serum PGII levels (≥7.5 μg/L), indicative of antral inflammation, were significantly higher in cases (58.6%) than controls (44.7%) and associated with increased abdominal pain risk (aPR 1.73).
Conclusions:
- Increased serum PGII levels, a marker of gastritis, are associated with a higher likelihood of pediatric abdominal pain.
- Serum PGs serve as a valuable non-invasive biomarker for gastritis in evaluating children with severe, unexplained abdominal pain.
- Gastritis, indicated by elevated PGII, appears to be a more significant factor than H. pylori infection itself in pediatric abdominal pain.
Abstract:
The significance of Helicobacter pylori (H. pylori) infection in pediatric abdominal pain remains poorly recognized. We examined associations of H. pylori infection and serum pepsinogens (PGs), as non-invasive markers of gastritis, with pediatric abdominal pain. A case-control study was conducted among 99 children aged 5-17 years admitted to one hospital for abdominal pain (cases) without an apparent organic reason. Using enzyme-linked immunosorbent assays, sera were tested and compared with 179 controls for anti-H. pylori immunoglobulin G (IgG) antibodies and PGI and PGII levels. Multivariable analysis was performed to adjust for potential confounders. H. pylori IgG sero-positivity was 34.3 and 36.3% in cases and controls, respectively, P = 0.7. H. pylori-infected children had higher median PGI and PGII levels and a lower PGI/PGII ratio than uninfected children. Cases infected with H. pylori had a higher median PGII level (P < 0.001) and lower PGI/PGII ratio (P = 0.036) than controls infected with H. pylori. The percentage of cases with PGII ≥7.5 μg/L, as indication for antral inflammation, was higher than in controls: 58.6 versus 44.7%, P = 0.027. Children with PGII levels ≥7.5 μg/L had increased risk for abdominal pain: adjusted prevalence ratio 1.73 [95% confidence intervals 1.02, 2.93], P = 0.039.
Conclusion:
Children with increased serum PGII levels, as an indication of gastritis, are more likely to have abdominal pain. Serum PGs can be a useful non-invasive marker for gastritis, in evaluating children with severe abdominal pain with no apparent organic reason. What is Known: • The significance of Helicobacter pylori infection in pediatric abdominal pain remains debated. • Serum pepsinogens (PGs), non-invasive markers of gastric inflammation, were rarely utilized in assessing the association between H. pylori in pediatric abdominal pain of unknown origin. What is New: • High serum PGII level, as an indication of gastritis, rather than H. pylori infection itself, was associated with increased risk for abdominal pain. • Serum PGs can be a useful biomarker for gastritis in evaluating children with severe abdominal pain with no apparent organic reason.
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