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Helicobacter pylori infection in childhood: risk factors and effect on growth
P Patel1, M A Mendall, S Khulusi
1Division of Biochemical Medicine, St George's Hospital Medical School, London.
Insights
Helicobacter pylori infection is prevalent in 11% of children, linked to socioeconomic factors and reduced growth, especially in girls. Community environment plays a key role in H. pylori acquisition.
Area of Science:
- Pediatric infectious diseases
- Epidemiology
- Child growth and development
Background:
- Helicobacter pylori (H. pylori) infection is a significant global health concern with established links to gastrointestinal diseases.
- Understanding the prevalence, risk factors, and long-term effects of H. pylori in children is crucial for public health interventions.
Purpose of the Study:
- To determine the current prevalence of H. pylori infection in preadolescent schoolchildren.
- To identify socioeconomic and environmental risk factors associated with H. pylori acquisition in childhood.
- To assess the impact of H. pylori infection on the growth trajectory of children.
Main Methods:
- A population-based cohort study followed 554 schoolchildren from Edinburgh from age 7 to 11.
- Risk factors for infection were collected at age 7.
- H. pylori infection at age 11 was diagnosed using a newly developed salivary IgG enzyme-linked immunosorbent assay (ELISA).
- Child height was measured at ages 7 and 11.
Main Results:
- H. pylori infection was detected in 11% (62/554) of the children.
- Independent risk factors included single-parent families, crowded housing conditions, and living in areas with predominantly rented housing.
- Infected children experienced a mean reduction in height growth of 1.1 cm over four years, with a more pronounced effect observed in girls.
- The study highlights the importance of community-level factors over parental social class in H. pylori acquisition.
Conclusions:
- Community characteristics, such as housing and neighborhood type, are significant factors in childhood H. pylori infection acquisition.
- The observed diminished growth in infected children, particularly girls, suggests a potential impact on pubertal growth spurt.
- Salivary ELISA is a viable method for epidemiological studies of H. pylori infection.
Objective:
To investigate the current prevalence of Helicobacter pylori infection in childhood, the risk factors for infection, and the effect of infection on growth in preadolescent schoolchildren.
Design:
Population based sample of 7 year old schoolchildren followed up at age 11; data on risk factors for infection collected at age 7; presence of infection at age 11 determined by measurement of salivary IgG against H pylori by a newly developed enzyme linked immunosorbent assay (ELISA). Height was measured at 7 and 11 years of age.
Subjects:
554 schoolchildren from Edinburgh.
Results:
62 (11%) children had H pylori infection. Independent risk factors for infection were single parent families (adjusted odds ratio = 2.5; 95% confidence interval 1.1 to 5.7), the 10% most crowded homes (3.1; 1.3 to 7.2), and schools serving predominantly rented housing estates (2.5; 1.0 to 6.5). School catchment area was more important than parental social class or housing tenure. Growth in height between 7 and 11 was diminished in infected children by a mean of 1.1 cm (0.3 to 2.0 cm) over four years. This growth reduction was largely confined to girls (1.6 cm over four years), among whom it correlated with salivary IgG (P = 0.015).
Conclusion:
Data from salivary assay to investigate the epidemiology of H pylori suggest that factors relating to the type of community in which the child lives may now be as important for acquisition of this infection as features of the family home. The greater reduction of growth among infected girls raises the possibility that H pylori infection may delay or diminish the pubertal growth spurt.