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Helicobacter pylori, gastroduodenal disease, and recurrent abdominal pain in children
C Macarthur1, N Saunders, W Feldman
1Division of General Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Strong evidence links Helicobacter pylori infection to antral gastritis and duodenal ulcers in children. Evidence for gastric ulcers is weak, and for recurrent abdominal pain, it is weak or absent.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Clinical Epidemiology
Background:
- Helicobacter pylori (H pylori) is a bacterium implicated in various gastrointestinal conditions.
- Understanding the causal relationship between H pylori and specific pediatric conditions is crucial for effective treatment and prevention.
Purpose of the Study:
- To evaluate the evidence for a causal link between H pylori infection and antral gastritis, peptic ulcer disease, and recurrent abdominal pain in pediatric populations.
- To assess the strength of evidence using established criteria for causal inference.
Main Methods:
- A comprehensive literature search was conducted using MEDLINE and other specialty journals from January 1983 to July 1994.
- Studies included were limited to those involving children aged 0 to 18 years.
- Hill's criteria for causal inference were applied to analyze the retrieved data from 45 studies.
Main Results:
- A strong association was found between H pylori infection and antral gastritis (rate ratio median 4.6) and duodenal ulcer disease (prevalence median 92%) in children.
- The prevalence of H pylori in children with gastric ulcer was lower (median 25%), and inconsistent for recurrent abdominal pain (median 22%).
- Lower H pylori infection rates (median 6%) were observed in children meeting Apley's criteria for recurrent abdominal pain.
Conclusions:
- There is robust evidence supporting a causal association between H pylori infection and antral gastritis and duodenal ulcers in children.
- Further randomized, double-blind, placebo-controlled trials are needed to confirm these findings.
- The evidence for H pylori's role in gastric ulcers is weak, and its association with recurrent abdominal pain in children is minimal or absent.
Objective:
To assess the evidence for a cause-and-effect relationship between Helicobacter pylori infection and antral gastritis, peptic ulcer disease, and recurrent abdominal pain in children.
Data Sources:
A MEDLINE search from January 1983 through July 1994 was used to identify pertinent English-language publications. Current Contents and selected specialty journals were searched manually. Editorials, reviews, case reports, abstracts, and letters to the editor were excluded.
Study Selection:
All studies in children (ie, 0 to 18 years) were included.
Data Extraction:
Hill's criteria for causal inference were used to determine the strength of the evidence for a causal relationship.
Data Synthesis:
In total, 45 studies (case series, cross-sectional surveys, and treatment trials) were retrieved. The rate ratio of antral gastritis in children with H pylori infection (compared with uninfected children) ranged from 1.9 to 71.0 (median, 4.6). The prevalence of H pylori infection in children with duodenal ulcer was high (range, 33% to 100%; median, 92%) compared with children with gastric ulcer (range, 11% to 75%; median, 25%). Prevalence rates of infection in children with recurrent abdominal pain were inconsistent (range, 0% to 81%; median, 22%), with lower rates in children meeting Apley's criteria (range, 0% to 9%; median, 6%).
Conclusions:
There is strong evidence for an association between H pylori infection and antral gastritis and duodenal ulcer disease in children; however, data from randomized, double-blind, placebo-controlled treatment trials are required. There is weak evidence for an association with gastric ulcer and weak or no evidence for an association with recurrent abdominal pain.