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Helicobacter pylori infection in children with recurrent abdominal pain
V Wewer1, K M Christiansen, L P Andersen
1Department of Paediatrics, Gentofte Hospital, University of Copenhagen, Denmark.
Insights
Helicobacter pylori (H. pylori) infection was found in 16% of children with recurrent abdominal pain. Diagnosis requires biopsies due to discrepancies between endoscopy, histology, and culture findings.
Area of Science:
- Pediatric Gastroenterology
- Microbiology
Background:
- Recurrent abdominal pain (RAP) is a common pediatric complaint.
- The role of Helicobacter pylori (H. pylori) in pediatric RAP requires further investigation.
Purpose of the Study:
- To investigate the prevalence of H. pylori and associated gastrointestinal findings in children with RAP.
- To evaluate the diagnostic utility of endoscopy, histology, and serology in these children.
Main Methods:
- Culture and serology for H. pylori were performed on 37 children with RAP.
- Upper gastrointestinal endoscopy with biopsies was conducted.
- Histological examination of biopsies was performed.
Main Results:
- H. pylori/Helicobacter-like organisms (HLO) were detected in 6 (16%) children, with histological inflammation in 5.
- No endoscopic changes were observed in H. pylori-positive children.
- H. pylori/HLO-negative children also showed significant histological (26%) and endoscopic (16%) abnormalities.
- Metronidazole resistance was observed in three H. pylori-positive cases.
Conclusions:
- Pathological findings are frequent in children with recurrent abdominal pain.
- Discrepancies between endoscopic, histological, and culture results highlight the importance of biopsies for accurate diagnosis.
- H. pylori diagnosis and treatment in pediatric RAP warrant further study, especially concerning antibiotic resistance.
Abstract:
Helicobacter pylori was cultured and Helicobacter-like organisms (HLO) were seen in 6 (16%) of 37 children with recurrent abdominal pain. Five children had concomitant histological inflammation, but none had endoscopic changes. All 6 children demonstrated positive serology. Compared with the total group, they were more often from developing countries, larger families and lower social groups. Treatment with phenoxymethyl penicillin and colloidal bismuth subcitrate did not result in side effects or elevated serum levels of serum bismuth. Three children demonstrated metronidazole-resistant strains and the treatment of these children remained an unsolved problem. Among the 31 H. pylori/HLO negative children 8 (26%) demonstrated histological changes, 5 (16%) endoscopic changes and 11 (35%) had positive serology. In conclusion, pathological findings at upper gastrointestinal endoscopy are common in children with recurrent abdominal pain. Because of disconcordance between endoscopy, histology and culture, we recommend that biopsies should always be taken to clarify the diagnosis.