Helicobacter pylori stool antigen test

Objective :Helicobacter pylori (H.pylori) infection is usually acquired in early childhood. Invasive techniques used for diagnosis ofH.pylori infection require endoscopic examination which is expensive and inconvenient and may cause complications. the aim of this study was to evaluate the performance of a new noninvasive diagnostic method, stool antigen test forH.pylori in untreated children with recurrent abdominal pain.Methods: Eighty children (35 female, 45 male) who have undergone upper gastrointestinal endoscopy due to recurrent abdominal pain were included in the study. theH.pylori stool antigen test (HpSA) is based on a sandwich enzyme immunoassay with antigen detection. HpSA sensitivity, specificity, and positive and negative predictive values were determined with reference to the results of both histology and rapid urease test as a gold standard (H. pylori status).Results: While 49 of the 80 children (61%) tested were positive forH.pylori according to the results of both histology and rapid urease test, 28 children had negativeH.pylori status. Among those 49 children, 48 were found to be positive by HpSA. Of 28 patients with negativeH.pylori status, 28 were H.py/ori-negative also in the stool test. the sensitivity, specificity, and positive and negative predictive values of HpSA were found to be 98%, 100%, 100%, and 96.5%, respectively.Conclusion: these findings have demonstrated that HpSA as a relatively simple, inexpensive and time saving noninvasive test is a reliable method for detection ofH.pylori infections in children.     

Consideration of Helicobacter pylori infection in childhood: Immune response,endoscopic and morphological findings

Seventy-five children (aged 9–14 years) infected with Helicobacter pylori were studied endoscopically and morphologically for the signs of infection and immune response by ELISA technique (total IgE and specific IgG against H. pylori); a control group of 36 children (not infected with H. pylori) were studied simultaneously. Helicobacter pylori positive children examined endoscopically revealed a number of mucous membrane changes including erythema, erosions, lymphoid nodular hyperplasia and ulcers. Gastritis was confirmed by histology in 58 children; 6% were termed ‘active’, others were ‘non-active’. When studying the concentrations of anti-H. pylori IgG in children from the control group they were considered to be seronegative but in children infected with H. pylori a considerable increase was noted. An evaluation of the interaction between anti-H. pylori IgG titers and age, endoscopic signs and histology was carried out. Suppositions were made about the presence of links between these characteristics. Children with H. pylori infection showed a considerable increase of total IgE titers in comparison with the control group. The role of IgG and IgE in the development of chronic gastroduodenal diseases associated with H. pylori is discussed.     

Recurrent abdominal pain of gastro-intestinal origin

A consecutive series of 71 children (mean age 8.6 years) with recurrent abdominal pain underwent endoscopic oesophageal, gastric and duodenal biopsy in order to determine whether the pain was of gastro-intestinal origin. Of these 71 children, 27 (38%) showed oesophagitis, 14 (20%) cardiac gastritis, 29 (41%) body gastritis, 38 (54%) antral gastritis, and 29 (41%) duodenitis. Thus, 66 of the 71 children studied had an inflammatory lesion explaining their complaints. One of the patients had a gastric ulcer.Helicobacter pylori colonisation was found in 5 of the children: One hadH. pylori associated antral and body gastritis and 4H. pylori associated antral gastritis only. Body gastritis withoutH. pylori was present in three of these four children. Our data do not support the widespread assumption that recurrent abdominal pain for which no medical cause can be found, is psychogenic; neither do they establish an association betweenH. pylori antral gastritis and recurrent abdominal pain. However, our data provide strong evidence that there is a gastro-intestinal origin of these patients' complaints.Presented in part at the Second Pan Pacific Congress of Paediatric Gastroenterology and Nutrition and First Oceanic Symposium on Paediatric Liver Transplantation. Cairns, Queensland, Australia, 24 August, 1990     

Migraine of gastrointestinal origin

A consecutive series of 31 children (median age 12 years) suffering from migraine with (n=21) or without (n=10) aura underwent endoscopic oesophageal, gastric and duodenal biopsy in order to determine whether the complaints were of gastro-intestinal origin. Of these 31 children, 13 (41.9%) showed oesophagitis, 16 (51.6%) gastritis of corpus, 12 (38.7%) antral gastritis and 27 (87.1%) duodenitis. Thus, 29 of the 31 children studied had an underlying inflammatory lesion explaining their complaints.Helicobacter pylori colonization was found in 7 of the children: one hadH. pylori associated antral and corporal gastritis and 6H. pylori associated antral gastritis only. Gastritis of corpus withoutH. pylori was present in all these 6 children. Our data do not support thatH. pylori is a primary pathogen of inflammatory changes seen in children studied, neither do they establish an association betweenH. pylori, antral gastritis and migraine. However, our data strongly suggest that there is a gastro-intestinal origin of these patients' complaints.Conclusion Our findings provide further evidence that recurrent abdominal pain is an early expression of migraine and strongly support a causal link between recurrent abdominal pain and migraine.     

Microarray analysis of gastric mucosa among children with Helicobacter pylori infection

Background: Although initial infection with Helicobacter pylori may occur before 5 years of age, the pediatric mucosal immune response against H. pylori is not clear. The aim of the present study was to evaluate immune responses in the H. pylori‐infected gastric mucosa of children using microarray and real‐time polymerase chain reaction (PCR) analysis of pediatric gastric samples. Methods: Gastric samples were obtained from 12 patients undergoing routine endoscopy of chronic abdominal complaints. Six patients (three boys, three girls) aged 10.1–14.6 years had evidence of H. pylori infection, and the remaining six (three boys, three girls) aged 10.3–15.5 years had no evidence of infection and presented no histological changes associated with gastritis. Microarray and real‐time PCR analyses were performed, and the changes in gene expression‐related immune response were also analyzed. Results: Using microarray analysis, the total number of significantly upregulated and downregulated genes (fold change >5, P < 0.01) was 21 in the antrum and 16 in the corpus when comparing patients with or without infection. Using real‐time PCR, the expression of lipocalin‐2 (Lcn2), C‐C motif chemokine ligand (CCL) 18, C‐X‐C motif chemokine ligand (CXCL) 9 and CXCL11 was upregulated, while the expression of pepsinogen (PG) I and PGII was downregulated when comparing patients with or without infection. Conclusions: Lcn2, CCL18, CXCL9, CXCL11, PGI and PGII play important roles in childhood H. pylori infection.     

Diagnosis ofHelicobacter Pylori

In view of its potential risk for the development of gastrointestinal disease or even gastric cancer at a later age, the study ofHelicobacter pylori infection in childhood is gaining increasing importance andH. pylori infection is being considered a major issue of public health.H. pylori infection can be detected by a variety of methods. Because of its easy use, affordability, and overall availability, serology is the preferred diagnostic test, especially for large epidemiological studies. Based on our results, one might consider treating a child with recurrent abdominal pain and positive serology forH. pylori without further work-up, and only perform additional investigations when an anti-W.pylori therapy fails to resolve the complaints. According to this proposition, endoscopy of the upper gastrointestinal tract remains indicated in children if the noninvastive tests forHelicobacter pylori are negative in the absence of a diagnosis, or if symptomatology persists despite treatment.     

Iron deficiency and Helicobacter pylori infection in children

Aim: To examine the relationship between iron deficiency (ID) and Helicobacter pylori infection in school‐aged children. Methods: Altogether 363 children from ambulatory admission were consecutively enrolled in the study. Haemoglobin (Hb), soluble transferrin receptor (sTfR), IgG against H. pylori and IgA against tissue transglutaminase were measured. The criteria for ID were sTfR > 5.7 mg/L in children aged 7–12 years and sTfR > 4.5 mg/L in older children, for anaemia Hb < 115 g/L in the younger group and Hb < 130 g/L for older boys and Hb < 120 g/L for girls. Results: Iron deficiency was found in 17% of the children, 5% had also anaemia. H. pylori colonization was detected in 27% and serum markers for coeliac disease in 0.6% of the children. The prevalence of ID and H. pylori seropositivity was higher in older children (23% and 29%, vs 9% and 22%, respectively). Children with H. pylori were significantly shorter [length SDS 1.0 (0.98–1.01) vs 0.98 (0.97–0.99)]. Older children had risk for ID (OR 1.1, 95% CI 1.0–1.3, p = 0.03). Although the prevalence of H. pylori seropositivity was higher in the ID group, it was not significantly associated with ID in multivariate analysis. Conclusion: Helicobacter pylori seropositivity was not associated with ID. The associated factor for ID was age.     

儿童新诊断免疫性血小板减少症与幽门螺杆菌感染的相关性研究

目的明确幽门螺杆菌(H.pylori)感染对儿童新诊断免疫性血小板减少症(ITP)的影响。方法选取2011年1月至2013年12月间首次住院并新诊断为ITP的495例患儿为病例组;随机选取无血小板减少及其他血液系统疾病的普通呼吸道感染住院患儿123例作为对照组。依据年龄将两组患儿分为1岁组(n=219)、1岁~组(n=161)、3岁~组(n=76)和7~14岁组(n=39)。回顾性分析各年龄段患儿H.pylori感染率,以及H.pylori感染阳性及阴性ITP患儿经过相同治疗后的预后情况。结果病例组中H.pylori感染率随着ITP患儿年龄的增长而增加,与对照组各年龄段H.pylori感染率比较差异均无统计学意义(均P0.05)。H.pylori感染阳性ITP患儿均未接受针对H.pylori的相关治疗,而针对血小板减少经丙种球蛋白和/或激素治疗后缓解率随着年龄的增长而呈现逐渐下降趋势,与各年龄段H.pylori阴性的ITP患儿治疗后缓解率比较差异均无统计学意义(均P0.05)。结论 H.pylori感染可能不是ITP患儿发病的一个主要致病因素;是否治疗H.pylori并不影响儿童急性ITP的治疗效果。     

Growth in children with Helicobacter pylori infection and dyspepsia

Aims: To compare the height, weight, and body mass index (BMI) of children presenting with dyspeptic symptoms and Helicobacter pylori infection, to those with dyspepsia but without the infection. Methods: A retrospective chart review of 257 children was performed. ¹³C urea breath test was performed to detect H pylori infection; weight and height were recorded and BMI was calculated. Weight, height, and BMI SD scores were determined using the 1990 UK normative data. The Index of Multiple Deprivation 2004 (IMD 2004) scores, which measure deprivation at small area level, were calculated from the patients'' postcodes. Results: Ninety seven of the 257 children were H pylori positive. The mean age at diagnosis and presenting symptoms of H pylori positive and negative patients were similar. The mean IMD 2004 scores for children with H pylori infection were significantly higher compared to H pylori negative patients, suggesting that children with the infection came from relatively more deprived areas. The mean weight and height SD score were significantly lower for children with H pylori infection compared to those without. However, this difference was no longer significant after adjusting for socioeconomic deprivation and ethnic differences between the groups. Conclusion: Children with dyspepsia and H pylori infection were shorter and lighter than patients with similar symptoms but no infection. The differences in anthropometry may be due to socioeconomic and ethnic factors rather than H pylori infection.     

Helicobacter pylori colonization in children with gastritis and peptic ulcer. I. The colonization rate and effects of colonization on mucin content and mucosal inflammation in the antrum

The incidence of Helicobacter pylori infection and effects of H. pylori colonization on mucin content and mucosal inflammation of the antral mucosa were studied quantitatively in 55 Japanese children with suspected gastritis and peptic ulcers (aged 6–16 years, mean 12.3 years). H. pylori was detected, using Warthin-Starry stain, in nine of the 22 cases (41%) with antral histological gastritis, but in none of the 33 histologically normal cases. Five out of seven duodenal ulcer cases showed histological gastritis, and all five cases were H. pylori positive. Severity of gastritis, evaluated by means of gastritis score, was significantly higher in H. pylori positive gastritis cases than in H. pylori negative gastritis cases (5.4 ± 1.0 vs 3.1 ± 0.3, P< 0.001). A PAS-AB index, a proportion of the periodic acid Schiff-alcian blue (PAS-AB) positive mucin area to the total epithelial area, was significantly lower in H. pylori positive cases than in H. pylori negative cases, irrespective of the existence of histological gastritis (23.5±7.6% vs 40.4±5.5%, 43.5±4.2%, P< 0.001). The decreased mucin content of gastric mucosa is likely to lead to weakening of an important defensive factor of gastric mucosa. These findings suggest that H. pylori plays an important role in gastritis and peptic ulcers in children, especially in cases with duodenal ulcer.     

Growth parameters in children with dyspepsia symptoms and Helicobacter pylori infection

Controversy exists about relationship of H. pylori infection and somatic growth retardation of children. The aim of this study was to evaluate the relationship between H. pylori infection and growth parameters in children. 113 children with dyspepsia (4–18 years) were enrolled. C₁₃ urea breath test was performed for determination of H.pylori infection. Height, weight, body mass index (BMI) and standard deviation score (SDS) was calculated and growth parameters were compared between two groups of H.pylori positive and those with negative results. The prevalence of H.pylori infection was 52.2%. There was no meaningful relation between calculated SDS (for height and BMI) and H.pylori infection.     

Effect of Helicobacter pylori eradication on the natural history of duodenal ulcer disease

BACKGROUND—Duodenal ulcer disease is strongly associated with Helicobacter pylori infection of the gastric mucosa. Eradication of H pylori from the gastric mucosa in adults is associated with long term healing of ulcers.AIMS—To follow a cohort of children with duodenal ulcer disease for a minimum of two years after the eradication of H pylori.PATIENTS AND METHODS—Over a three year period, all children diagnosed with duodenal ulcer disease had their symptoms documented and their H pylori status evaluated. The histories of these children were carefully screened to determine previous symptoms and to document previous treatment regimens.RESULTS—Sixteen children were diagnosed with ulcers and 15 were available for treatment and long term follow up. The median age at which symptoms first occurred was 10.5 years (range, 6-14) and the median duration of symptoms was 24 months (range, 2-60). Ten of the children had been treated with H₂ receptor antagonists for a median of 3.5 months (range, 1-60). Duodenal ulcers healed in all children after eradication of H pylori and all children have remained asymptomatic for a median of 37 months (range, 26-62). No child has required subsequent admission to hospital.CONCLUSION—Eradication of H pylori is very effective in the long term healing of duodenal ulcer disease. H pylori eradication should be the standard treatment for all infected children who present with duodenal ulcer disease.     

Reinfection Rate after Successful Helicobacter pylori Eradication in Children

Objective

Reinfection rate of Helicobacter pylori after successful eradication is low in developed countries. This study was performed to determine the reinfection rate of H. pylori during a follow up period of 12 months in Iranian children.

Methods

In this prospective study, children with H. pylori infection were treated with triple omeprazole based regimen. Patients with negative ¹³C urea breath test (UBT) performed after 8 weeks of therapy, were followed up by the same test after 1 year.

Findings

Thirty seven patients, aged 5 to 17 years, were studied. Among them 25 (67.5%) were boys. After eradication therapy of H. pylori, 34 patients had negative ¹³C UBT. Reinfection occurred in 5 (14.7%) patients. Reappearance or continuing symptoms after treatment were associated with higher rate of recurrence (P=0.042).

Conclusion

Recurrence rate of H. pylori was high in our children. Successful eradication significantly decreased complaints and further symptoms. Follow up and reevaluation of patients is necessary especially when there are symptoms after eradication.     

Gastric lymphoma in an 11-year-old boy: A case report

A child with prolonged abdominal symptoms was shown to have a concomitant gastric non-Hodgkin lymphoma and gastritis caused by Helicobacter pylori infection. After a course of antibiotics and 6 months of chemotherapy, the patient is disease free. The relationship of the microbial infection and tumor development is discussed. The case supports a hypothesis that local H. pylori infection may be a predisposing factor for gastric lymphoma. © 1994 Wiley-Liss, Inc.     

Helicobacter pylori infection and growth delay in older children

Accepted 18 March 1997
It is thought that Helicobacter pylori infection may influence growth rate in children. The aim of this study was to evaluate the prevalence of H pylori infection in healthy Italian children, and to look for differences in height between infected and non-infected subjects. Two hundred and sixteen children, aged 3 to 14 years, were tested for H pylori infection by ¹³C-urea breath test. Centile values for height were calculated. Composite indices for socioeconomic class and household crowding were also determined. Forty nine of 216 children (22.7%) were H pylori positive. The prevalence of infection increased with age. Eight of 49 H pylori positive children (16.3%) were below the 25th centile for height, compared with 13 of 167 H pylori negative children (7.8%). This difference became significant in children aged 8.5 to 14 years; in this group (n = 127), eight of 31 infected children (25.8%) were below the 25th centile for height, compared with eight of 96 non-infected children (8.3%). A significant correlation was found between socioeconomic conditions, household crowding, and H pylori status. By using stepwise logistic regression, only the centile value for height was significantly related to H pylori status in older children. Thus H pylori infection was associated with growth delay in older children, poor socioeconomic conditions, and household overcrowding. This finding is consistent with the hypothesis that H pylori infection is one of the environmental factors capable of affecting growth.

     

Helicobacter pylori infection in children: population‐based age‐specific prevalence and risk factors in a developing country

Aim: We estimated the prevalence, age of acquisition and risk factors for Helicobacter pylori (H. pylori) seroprevalence in children aged 1–15 years. Methods: Exposure was assessed using ELISA. Parents responded to a questionnaire regarding number of individuals sharing house, rooms, water source, latrines, housing and assessment of socioeconomic status (SES) by Hollingshead Index. Results: Serum of 1976 children was tested. Helicobacter pylori seropositivity in children aged 11–15 years was 53.5% (OR: 2.0, 95% CI: 1.58–2.5). It increased with moderate crowding index (CRI) of 2–4 to 45.9% (OR: 1.23, 95% CI: 0.92–1.63) and to 51.2% with CRI >4 (OR: 1.52, 95% CI: 1.12–2.06). In middle SES, seropositivity was 50.5% (331/655) (OR: 1.7, 95% CI: 1.29–2.35), whereas in lower SES, it was 47.1% (500/1062) (OR: 1.5, 95% CI: 1.1–2.0). Multivariate analysis showed that Helicobacter pylori seroprevalence was high in children aged 6–10 and 11–15 years (OR: 1.5, 95% CI: 1.2–1.9 and OR: 1.9, 95% CI: 1.56–2.47 respectively), in lower‐middle SES (OR: 1.6, 95% CI: 1.2–2.1 and OR: 1.5, 95% CI: 1.10–2.0 respectively) and in uneducated fathers (OR: 1.58, 95% CI: 1.27–1.95). Conclusion: Helicobacter pylori seropositivity increases with age, in low‐middle SES and is related to father’s educational status. Reducing H. pylori seroprevalence will require improvement in sanitary conditions and educational status of the population.     

Is peptic ulcer a common cause of upper gastrointestinal symptoms?

 The aim of the study was to investigate retrospectively a cohort of children with peptic ulcer disease during a period that covers the recent changes in diagnosis and management of the disease. Over a period of 9 years, 2550 children underwent upper gastrointestinal endoscopy for various reasons. All children, in whom a diagnosis of primary peptic ulcer was established, were included in the study. Previous and current medical history, family history, endoscopic and histological outcome were evaluated and the children were regularly followed-up on an out-patient basis. Primary peptic ulcer was diagnosed in 52 (10 gastric and 42 duodenal, 2%) out of 2550 children. The median age of children with gastric ulcer was 6.5 years, whereas of those with duodenal ulcer was 10.5 years (P=0.04). With regard to clinical symptoms no significant difference was found between children with and without ulcer. The prevalence of Helicobacter pylori infection was significantly higher in children with duodenal ulcer (62%) compared to those with gastric ulcer (20%; P<0.001). At first follow-up visit, 1 month after the end of treatment, 19 symptomatic children underwent a repeat endoscopy, which showed ulcer healing in 95% and failure in H. pylori eradication in 27%. During the long-term follow-up (median 3.5 years), six children became symptomatic. Two of them had duodenal ulcer associated with positive H. pylori. Conclusion Peptic ulcer disease is an uncommon disorder in childhood with non specific clinical features; it seems that efficient treatment and successful Helicobacter pylori eradication result in clinical improvement and cure as well as in long-term healing of ulcers. Received: 25 September 2000 and in revised form: 22 February and 28 March 2001 / Accepted: 29 March 2001     

Severe iron‐deficiency anaemia in adolescents: Consider Helicobacter pylori infection

Aim: This article describes the association of severe iron‐deficiency anaemia with Helicobacter pylori gastritis. Results: We report three children who had symptomatic iron‐deficiency anaemia with no obvious clinical cause and refractory to iron replacement therapy. All three underwent a diagnostic endoscopy and were found to have H. pylori gastritis. Histopathology confirmed inflammatory changes consisting of dense bands of clusters of plasma cells within the lamina propria and two of the three adolescents were noted to have numerous H. pylori in gastric crypts and glands. Two of the three cases had a urease positive test. Iron deficiency was successfully corrected following antibiotic eradication of H. pylori infection. Conclusions: This case series highlights the importance of considering H. pylori infection as a cause of refractory iron‐deficiency anaemia in adolescents, even in the absence of gastrointestinal symptoms.     

儿童幽门螺杆菌感染的新思考

幽门螺杆菌（Hp）是具有高感染率的慢性感染性致病菌。Hp 感染了全球半数以上的人口,大部分成人Hp 感染在儿童期获得。虽然儿童患消化性溃疡并不多见,但是Hp 感染是儿童消化性溃疡的主要病因,并与儿童慢性胃炎、消化不良、慢性腹泻和复发性腹痛等的发病密切相关。Hp 感染还可能参与某些胃肠外的疾病,如儿童营养性缺铁性贫血、生长发育迟缓、营养不良、特发性自体免疫性血小板减少性紫癜、慢性荨麻疹等的发生、发展过程,并与成年后的动脉粥样硬化相关心脑血管疾病、某些神经系统疾病等有关。Hp 感染可给儿童一生的健康带来极大的危害,也会带来许多经济社会问题。该文针对儿童Hp 感染流行病学、胃Hp 感染与口腔Hp 的相关性、Hp 感染的检测方法及Hp 预防与治疗等的进展予以综述。     

Diagnostic de l’infection à Helicobacter pylori chez l’enfant : quoi de neuf en 2003 ?Helicobacter pylori (H. pylori) infection in childhood: what is new in 2003?

A high prevalence and early colonization of Helicobacter pylori (H. pylori) infection in childhood characterizes the developing countries in contrast to developed ones. Upper gastrointestinal endoscopy including gastric biopsies is the diagnostic gold standard method. Non invasive tests can be used in children, including serology, ¹³C-urea breath test and immunoassay enzyme stool antigen test (HpSA). They present good performance in adults, but less in children under 6 years of age. They can be used for screening, epidemiological studies. Only the ¹³C-urea breath test and the immunoassay enzyme stool antigen test (HpSA) are recommended for the control of eradication. The infection remains often asymptomatic in children and the role of this bacterium in clinical manifestations is the subject of conflicting reports. The treatment of H. pylori infection is influenced by the resistance to the antibiotics used. We suggest that eradication of H. pylori infection should take place only after susceptibility testing since the resistance rate for the metronidazole is of 43% and for the clarithromycine 21% in France. The association of proton pump inhibitor and two antibiotics for 1–2 weeks seems to give the best eradication rates. The crucial question is whether asymptomatic children should be treated to prevent cancer in the future.