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Helicobacter pylori infection in children: potential clues to pathogenesis
H M Mitchell1, T D Bohane, V Tobias
1School of Microbiology and Immunology, University of New South Wales, Kensington, Australia.
Insights
Helicobacter pylori infection is present in 14.1% of children with upper gastrointestinal symptoms. Antral nodularity is common in infected children, but peptic ulcer disease is rare and less associated with H. pylori than in adults.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Gastrointestinal Endoscopy
Background:
- Helicobacter pylori (H. pylori) infection is a common cause of upper gastrointestinal symptoms.
- Antral nodularity and peptic ulceration are potential histological findings associated with H. pylori.
- Understanding H. pylori's impact in children is crucial for diagnosis and treatment.
Purpose of the Study:
- To investigate the prevalence of H. pylori infection in children with upper gastrointestinal symptoms.
- To assess the histological response, antral nodularity, and peptic ulceration in infected children.
- To compare findings in children with those in symptomatic adults.
Main Methods:
- Children (n=227) and adults (n=258) with gastrointestinal symptoms underwent endoscopy.
- Histological examination was performed to detect H. pylori infection.
- Antral nodularity and peptic ulceration were recorded.
Main Results:
- H. pylori was detected in 14.1% of children and 15.8% of H. pylori-positive adults showed nodularity.
- 50% of infected children had antral nodular gastritis; the histological response was minimal.
- Peptic ulcer disease occurred in 5.3% of children, with H. pylori associated in 33% of duodenal ulcers.
Conclusions:
- Antral nodularity is not exclusive to childhood but occurs more frequently in infected children.
- The inflammatory response to H. pylori in children is less pronounced than in adults.
- Peptic ulcer disease is uncommon in children and appears less frequently linked to H. pylori compared to adults.
Abstract:
Children (227) undergoing endoscopy for upper gastrointestinal symptoms were investigated for the presence of Helicobacter pylori infection. The histological response to H. pylori infection and the presence of antral nodularity and peptic ulceration were noted. Symptomatic adults (258) undergoing endoscopy were also investigated for the presence of nodularity. H. pylori infection was detected histologically in 32 of 227 (14.1%) children. Of those children infected with H. pylori, half (50%) had antral nodular gastritis. Of 139 H. pylori-positive adults 22 (15.8%) showed nodularity. The active component of the histological response was found to be minimal or lacking in the majority of children infected with H. pylori. Twelve of the 227 children (5.3%) had peptic ulcer disease. Of these, nine were duodenal and three gastric ulcers. Of the nine children with duodenal ulceration three (33%) were infected with H. pylori. As a result of this study we conclude that (a) although antral nodularity occurs more frequently in children it is not exclusive to childhood, (b) the polymorphonuclear response in children is less than that reported in adults, and (c) peptic ulcer disease is rare in children and the present study would suggest that in children it is less frequently associated with H. pylori infection than in adults.