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Author Spotlight: Detection and Treatment of Helicobacter pylori Infection
Published on: July 28, 2023
Helicobacter pylori Found Incidentally During Upper Endoscopy Performed for Diagnosis of Common Pediatric
Yael Dolstra1, Michal Kori1,2,3
1From the Department of Pediatrics, Kaplan Medical Center, Rehovot, Israel.
Insights
Helicobacter pylori (H. pylori) gastritis is frequently found incidentally in children undergoing endoscopy for other gastrointestinal conditions. Treatment is recommended for ulcers, erosions, and in certain patient groups, though indications require further study.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Gastrointestinal Endoscopy
Background:
- Helicobacter pylori (H. pylori) gastritis can be an incidental finding during upper endoscopy.
- Endoscopies are often performed to diagnose conditions like celiac disease (CeD), inflammatory bowel disease (IBD), and eosinophilic esophagitis (EoE) in children.
Purpose of the Study:
- To determine the incidence of H. pylori in children undergoing endoscopy for CeD, IBD, and EoE.
- To identify the indications for H. pylori treatment in this pediatric population.
Main Methods:
- A retrospective, single-center study reviewed endoscopy reports of pediatric patients diagnosed with CeD, IBD, or EoE between January 2017 and December 2021.
- Data included patient demographics, endoscopic and histologic findings, H. pylori culture results, and treatment information.
Main Results:
- H. pylori gastritis was diagnosed in 21.5% of 558 children. Incidence was similar across CeD (21.5%), IBD (23.9%), and EoE (14.6%) groups.
- Treatment was primarily indicated for ulcers (3.3%) and erosions (14.2%). Eradication treatment was recommended in 18.3% of patients, with higher rates in IBD and EoE.
- Predictors for treatment included age over 10, nodular gastritis, erosions, and ulcers. Celiac disease was a negative predictor for treatment.
Conclusions:
- H. pylori gastritis is a common incidental finding in pediatric endoscopy.
- Current indications for H. pylori treatment in these cases are not well-defined and warrant further investigation.
Background:
Helicobacter pylori ( H. pylori ) gastritis may be an incidental finding during upper endoscopy performed to diagnose celiac disease (CeD), inflammatory bowel disease (IBD) and eosinophilic esophagitis (EoE). We aimed to describe the incidence of H. pylori in children undergoing endoscopy for CeD, IBD and EoE and determine the indications for treatment.
Methods:
A retrospective, single-center study based on the review of endoscopy reports of pediatric patients, diagnosed with CeD, IBD and EoE, between January 2017 and December 2021. Data collected included; age, gender, hematologic parameters, endoscopic, histologic and H. pylori culture results, and information on eradication treatment.
Results:
H. pylori gastritis was diagnosed in 120 of 558 (21.5%) children [72 (60%) female, mean age 10.6 years] during gastroscopy performed for the diagnosis of other GI diseases. H. pylori was present in 87 of 404 (21.5%) CeD, 27 of 113 (23.9%) IBD and 6 of 41 (14.6%) EOE patients ( P = 0.46). The main indication for treatment was the presence of ulcers, in 4 of 120 (3.3%), and erosions in 17 of 120 (14.2%). Eradication treatment was recommended in 22 of 120 (18.3%) patients, 8 of 87 (9.2%) CeD, 10 of 27 (37%) IBD and 4 of 6 (66.7%) EoE patients, P < 0.001. Four independent positive treatment predictors were identified; age above 10 years {odds ratio (OR) = 10.57 [95% confidence interval (CI) 1.88-59.36], P = 0.007} the presence of nodular gastritis (OR = 5.03 [95% CI 1.09-23.15], P = 0.38), erosions [OR = 49.21 (95% CI 8.19-295.83), P < 0.000] and ulcers [OR = 22.69 (95% CI 1.25-410.22), P = 0.035]. CeD was a strong negative predictor for treatment [OR = 0.23 (95% CI 0.002-0.241), P = 0.002].
Conclusions:
H. pylori gastritis is a common incidental finding during endoscopy. The indications for treatment are not well defined and should be further investigated.
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