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Esophagitis and Helicobacter pylori in children: incidence and therapeutic implications
C Rosioru1, M S Glassman, M S Halata
1Department of Pediatrics, New York Medical College, Valhalla.
Insights
Helicobacter pylori (H. pylori) infection did not affect esophagitis in children. Most children improved with acid-reducing medication, but some H. pylori-positive patients needed antibiotics for gastritis.
Area of Science:
- Pediatric Gastroenterology
- Microbiology
- Clinical Medicine
Background:
- Esophagitis is common in children presenting with abdominal pain and vomiting.
- The role of Helicobacter pylori (H. pylori) in pediatric esophagitis is not well-defined.
- Understanding H. pylori's impact is crucial for effective treatment strategies.
Purpose of the Study:
- To investigate the association between H. pylori colonization and esophagitis in children.
- To evaluate the treatment response in pediatric esophagitis based on H. pylori status.
- To determine optimal therapeutic approaches for pediatric esophagitis.
Main Methods:
- A cohort of 457 children undergoing endoscopy for abdominal pain/vomiting were studied.
- Esophageal biopsies were analyzed histologically for esophagitis.
- Antral biopsies were tested for H. pylori using microbiological and histochemical methods.
Main Results:
- The incidence of esophagitis was similar in H. pylori-positive and negative children.
- Clinical improvement with H2-receptor antagonists was independent of H. pylori status.
- H. pylori-positive children with esophagitis and gastroduodenal inflammation responded to amoxicillin and bismuth subsalicylate.
Conclusions:
- Primary treatment for pediatric esophagitis should involve antisecretory agents, irrespective of H. pylori status.
- Antibacterial therapy may be necessary for H. pylori-positive children with esophagitis and concurrent gastroduodenal inflammation.
- H. pylori screening is recommended for pediatric patients undergoing upper endoscopy.
Abstract:
The relationship between gastric Helicobacter pylori colonization and esophagitis was determined in 457 children undergoing endoscopic evaluation of abdominal pain and/or vomiting. In all patients, biopsies of the esophagus were examined histologically, and two antral biopsies were analyzed for the presence of H. pylori, using standard microbiological and histochemical techniques. The incidence of biopsy-proven esophagitis was similar in H. pylori-positive (15/56 patients) and -negative (94/401; p = NS) groups. Clinical improvement, after 2 months of antisecretory therapy with H2-receptor antagonists, was independent of H. pylori status (11/15 vs. 68/94 responders; p = NS). All 26 H. pylori-negative nonresponders became asymptomatic with a second course of H2-blockers. The 4/15 H. pylori-positive patients (all of whom had associated gastritis/duodenitis) who failed antisecretory therapy responded clinically to treatment with amoxicillin plus bismuth subsalicylate. These data indicate that primary treatment of biopsy-confirmed esophagitis in children should include anti-secretory agents, regardless of H. pylori status. A small percentage of H. pylori-positive patients with esophagitis and concomitant gastroduodenal inflammation may require additional antibacterial therapy, suggesting that presence of the organism should be assessed in all pediatric patients undergoing upper endoscopic evaluation.