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Helicobacter pylori-associated gastritis in Kuwait: endoscopy-based study in symptomatic and asymptomatic children
S Radhakrishnan1, B al Nakib, M Kalaoui
1Department of Gastroenterology, Al Amiri Hospital, Kuwait City, Kuwait.
Insights
Helicobacter pylori gastritis affects both symptomatic and asymptomatic children similarly. A combination of amoxicillin and tinidazole showed poor efficacy in treating H. pylori infection in Kuwaiti children.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Limited data exists on Helicobacter pylori prevalence in asymptomatic children.
- Helicobacter pylori infection is a significant cause of gastritis globally.
- Understanding prevalence is crucial for effective pediatric healthcare strategies.
Purpose of the Study:
- To determine the prevalence of H. pylori infection and associated gastritis in symptomatic and asymptomatic children.
- To evaluate the efficacy of a specific antibiotic combination for H. pylori eradication in children.
Main Methods:
- Endoscopic antral biopsies were collected from 60 children (aged 9 months-13 years).
- Biopsies were analyzed for gastritis and H. pylori via microscopy and culture.
- A subset of children received amoxicillin and tinidazole for H. pylori treatment.
Main Results:
- H. pylori-associated gastritis prevalence was 31% in children with abdominal pain and 27.7% in asymptomatic children (p > 0.05).
- Culture sensitivity was 85.7%. Six children had H. pylori gastritis, suggesting environmental transmission.
- Treatment with amoxicillin and tinidazole resulted in H. pylori clearance in only 42.3% of cases.
Conclusions:
- H. pylori gastritis demonstrates similar prevalence in symptomatic and asymptomatic children within this population.
- The combination of amoxicillin and tinidazole appears to be an ineffective treatment for H. pylori-associated gastritis in Kuwaiti children.
- Further research is needed to identify optimal treatment regimens for pediatric H. pylori infections.
Abstract:
Information is limited concerning the prevalence of Helicobacter pylori infection in asymptomatic children. Since January 1989, we have endoscoped 60 children for recurrent abdominal pain or for obtaining small-intestinal biopsy (their ages were a mean of 6.6 (range 9 months-13 years); there were 37 boys and 23 girls. Antral biopsies were obtained from all subjects and these were studied for the presence of gastritis and stained for H. pylori using modified Gram's stain. All biopsies were cultured for H. pylori. Children endoscoped for small-intestinal biopsy (n = 18) were used for comparison. Of the 42 children who had abdominal pain, 24 showed histological gastritis and 13 had H. pylori on microscopy (31% H. pylori-associated gastritis). In the compared group, five showed histological gastritis, and all had H. pylori on microscopy (27.7%). Culture was positive in 15; sensitivity was 85.7%. Six children, three pairs of siblings, had H. pylori gastritis supporting environmental etiology. Two had coinfection with intestinal giardiasis. Seven children were treated with daily oral amoxycillin (50 mg/kg) and tinidazole (20 mg/kg) for 6 weeks. In 3 (42.3%) H. pylori colonization cleared with healing of gastritis and resolution of symptoms. These results indicate that H. pylori gastritis is equally prevalent in symptomatic and asymptomatic children (31 and 27.7%, respectively; p > 0.05) in our population. It seems that the combination of oral amoxycillin and tinidazole is a poor choice in the treatment of H. pylori-associated gastritis in Kuwaiti children.