Related Experiment Videos
Endoscopic, histologic and microbiologic evaluation of upper abdominal pain with special reference to Helicobacter
M Kumar1, S K Yachha, A Khanduri
1Department of Gastroenterology (Pediatric GE), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow.
Insights
Children with upper abdominal pain often have gastritis. Helicobacter pylori (HP) infection requires triple therapy, while HP-negative gastritis responds to H2-receptor antagonists, leading to sustained symptom relief.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Gastrointestinal Endoscopy
Background:
- Unexplained upper abdominal pain is common in children.
- Inflammatory esophago-gastro-duodenal lesions and Helicobacter pylori (HP) infection are potential causes.
- Effective diagnosis and treatment strategies are needed for pediatric abdominal pain.
Purpose of the Study:
- To investigate the link between upper abdominal pain, gastrointestinal inflammation, and HP infection in children.
- To evaluate the efficacy of specific therapies for HP-related and HP-negative gastritis in pediatric patients.
Main Methods:
- A prospective study involving 33 children with significant upper abdominal pain.
- Endoscopy with biopsies for HP detection (rapid urease test, histology, culture).
- HP-positive patients received triple therapy; HP-negative patients received ranitidine, with follow-up assessments.
Main Results:
- Antral gastritis was found in 85% of patients; HP infection was present in 43% of those with gastritis.
- Triple therapy achieved symptomatic improvement in 83% of HP-positive patients.
- Ranitidine improved symptoms in 75% of HP-negative patients, with no relapses observed.
Conclusions:
- HP-related gastritis in children with abdominal pain warrants triple therapy for eradication.
- HP-negative gastritis can be effectively managed with H2-receptor antagonists.
- Specific targeted therapies lead to sustained symptom resolution in pediatric patients.
Objective:
To study children with significant upper abdominal pain of unidentifiable etiology and evaluate: (a) the relationship of pain to inflammatory esophago-gastro-duodenal lesions and Helicobacter pylori (HP) infection, and (b) the response to specific therapy.
Design:
Prospective study.
Setting:
Pediatric section of a tertiary referral gastroenterology center.
Subjects:
Thirty three consecutive children with significant upper abdominal pain [mean age 9.9 +/- 2.7, range 4-15 years; 20 males] were subjected to upper gastrointestinal tract endoscopy and antral mucosal biopsies obtained for rapid urease test (RUT), Gram's staining of impression/crush smears and culture for HP and histologic examination. Patients with HP gastritis were treated with triple therapy, colloidal bismuth subcitrate, amoxycillin and metronidazole, for two weeks. At 8 weeks from the initiation of therapy, patients were re-evaluated for symptoms and HP eradication by repeat endoscopy and antral biopsies. Patients with esophagitis, gastritis and duodenitis without HP infection were treated with ranitidine for 6 weeks. All the patients were followed up for 6 months.
Results:
Histology revealed antral gastritis in 28/33 (85%) patients. HP infection was present in 12/28 (43%) patients with antral gastritis. Symptomatic improvement with triple therapy was observed in 10/12 (83%) patients with HP gastritis and eradication of HP in 5/7. Improvement on ranitidine therapy was observed in 12/16 (75%) patients with HP negative gastritis. On follow-up, no patient with initial improvement with therapy had relapse of symptoms.
Conclusion:
Symptomatic children with HP related gastritis should be treated with triple therapy and HP negative gastritis with H2-receptor antagonist.