Temporal trends and correlates of Helicobacter pylori prevalence in children undergoing upper gastrointestinal...

This study aims to evaluate temporal trends in Helicobacter pylori prevalence in symptomatic children undergoing upper gastrointestinal endoscopy and to identify demographic, clinical, endoscopic, and histopathological factors associated with H. pylori infection. We retrospectively evaluated children aged 0-18 years who underwent upper gastrointestinal endoscopy for various gastrointestinal symptoms with histopathological examination and rapid urease testing between 2010 and 2020. Patients with concordant diagnostic results were included. Demographic characteristics, symptoms, endoscopic and histopathological features were analyzed. Temporal trends in H. pylori prevalence were assessed, and factors associated with H. pylori were evaluated using multivariate logistic regression analyses. Among 1300 eligible patients, 335 (25.8%) were H. pylori-positive. The prevalence of H. pylori declined significantly over the study period, decreasing from 47.9% in 2010 to 23.4% in 2020. H. pylori positivity was associated with older age and lower height Z-score. Dyspepsia and refractory iron deficiency anemia, endoscopically antral nodularity, pangastritis, and duodenal ulcer were more frequent in H. pylori-positive patients and remained independently associated with H. pylori infection. Although H. pylori infection was more frequent in patients with glandular atrophy and intestinal metaplasia, no independent association was found between the lesions and H. pylori after multivariate adjustment.

In symptomatic children who underwent endoscopy, a nearly 50% decline in H. pylori prevalence was observed over a 10-year period. The infection was associated with impaired linear growth, refractory iron deficiency anemia, dyspeptic symptoms, and characteristic endoscopic findings; this underlines the continued clinical importance of H. pylori infection in pediatric practice.

• Helicobacter pylori infection is commonly acquired in childhood. • The decline in H. pylori prevalence in children is less consistent compared to adults, and its clinical associations remain controversial.

• We observed a nearly 50% decline in H. pylori prevalence over a 10-year period, from 47.9% in 2010 to 23.4% in 2020 among symptomatic children, with the most pronounced decline in school-aged children and adolescents. • In this cohort, precancerous lesions were uncommon (gastric atrophy 2.3%, intestinal metaplasia 1.38%) and, although H. pylori infection was nearly twofold higher in children with these lesions, they were not independently associated with H. pylori infection.