Prevalence and specificity of antigastric autoantibodies in adolescents infected with Helicobacter pylori

OBJECTIVES: Antigastric autoantibodies (AGA) can be detected in as many as 50% of adults infected with Helicobacter pylori. We investigated H pylori -associated antigastric autoimmunity in children and adolescents. STUDY DESIGN: Patients with dyspepsia (n = 78; mean age 10.9 years, range 2-21 years, SE 0.46 years) underwent gastroscopy. H pylori infection was determined by serologic and histologic features and breath tests. AGA were detected by immunohistochemistry and were characterized by immunoprecipitation with the gastric hydrogen ion, potassium ion, adenosine triphosphatase (H(+),K(+)-ATPase). In absorption assays, antibodies against H pylori were removed to determine the role of molecular mimicry. RESULTS: AGA were detected in 9 (18%) of the 51 infected patients and in 1 (4 %) of the 27 noninfected patients (P =.08; nonsignificant) and could not be absorbed to H pylori. Children with AGA were significantly older (P =.01). AGA in H pylori gastritis reacted against the gastric H(+),K(+)-ATPase in 3 (33%) of the 9 patients. CONCLUSIONS: The age of the patient or the duration of gastritis seem to be relevant factors for the formation of antigastric autoimmunity. The gastric H(+),K(+)-ATPase represents an autoantigen as early as childhood. No evidence for a role of molecular mimicry between H pylori and the host at this young age could be found.     

Endoscopic nodular gastritis: an endoscopic indicator of high-grade bacterial colonization and severe gastritis in children with Helicobacter pylori

OBJECTIVE: To investigate the significance of endoscopic nodular gastritis associated with Helicobacter pylori infection. METHODS: This prospective study included 185 children (50.8% boys) aged 1 to 12 years (mean, 6.9 +/- 3.0 years) who underwent upper intestinal endoscopy during evaluation of chronic abdominal pain. The authors assessed the endoscopic appearance of the stomach, noting those patients with endoscopic nodular gastritis. Urease activity of gastric mucosal biopsies was measured. With histologic examination, the presence and density of H. pylori organisms, the presence of follicular gastritis, the nature of inflammation, and the gastritis activity grade and overall gastritis score were assessed. RESULTS: H. pylori infection was identified in 50 children (27%). Endoscopic nodular gastritis was significantly associated with active chronic gastritis and follicular gastritis. Nodularity in the stomach showed a high specificity (98.5%) and positive predictive value (91.7%) for the diagnosis of H. pylori infection and was observed in 22 of 50 (44%) H. pylori-positive patients and in 2 of 135 (1.5%) H. pylori-negative patients. A significant association was observed between older age and the prevalence of this finding (P< 0.001). There was a significant increase in endoscopic nodular gastritis with increased H. pylori density and a positive correlation (Pearson coefficient = 0.97) with increased gastritis score on histologic examination. Increase in gastritis score was dependent on increased H. pylori density in patients with gastric nodularity; this finding was independent of age. CONCLUSIONS: Endoscopic findings of antral nodularity in children suggest the presence of H. pylori infection and follicular gastritis and may identify cases of severe gastritis and marked bacterial colonization.     

Helicobacter pylori infection in pediatrics. Present knowledge and practical problems

Helicobacter pylori (H. pylori) infection is acquired in childhood, earlier in developing countries, as a consequence the prevalence of infection is higher in developing countries (70%) than in developed countries (5-15%). H. pylori infection spreads from person-to-person, however the precise mode of transmission (oral-oral, fecal-oral or gastro-oral routes) is as yet, not known. Diagnosis of H. pylori infection can be performed with both invasive endoscopic-based tests, or non-invasive tests, mainly by measurement of IgG antibodies against the bacterium in serum samples or by measurement of 13CO2 in expired air (13C-urea breath test). In clinical practice endoscopy and biopsy is recommended before treatment to determine the presence and the degree of gastritis or ulcer. However, endoscopy is a complicated procedure in children and diagnosis of infection can be based on a non-invasive test. The association of H. pylori infection with recurrent abdominal pain seems evident in a subgroup of children with endoscopic features of gastritis, ulcer or hemorrhage. There is an increasing interest in the extraintestinal manifestations of H. pylori infection in children, i.e. iron-deficiency anemia, growth retardation and migraine, but this domain remains controversial. Since infection at a young age is believed to result in chronic atrophic gastritis and gastric cancer in adult life, it is logical to consider a future massive programme of eradication and immunization. Regimens suggested for H. pylori eradication are a combination of inhibitors of gastric acid secretion plus two antibiotics for 7-10 days.     

Helicobacter pylori and specific immunoglobulin E antibodies to food allergens in children

OBJECTIVES: It has been suggested that chronic Helicobacter pylori infection may increase gastric permeability, predisposing infected children for the development of food allergies. We assessed the presence of food-specific immunoglobulin (Ig)E antibodies in H. pylori positive children and controls. METHODS: We measured specific IgE values to six major food allergens (Pharmacia CAP-system) in a group of school-aged Caucasian (n = 36) and non-Caucasian (n = 38) children with a known H. pylori status. All children had undergone upper gastrointestinal endoscopy because of abdominal complaints. RESULTS: Among H. pylori positive children (mean age, 8.8 years; range, 5-15 years, 25 female, 26 male), 33% (17 of 51) had an elevated food-specific IgE level to at least one of the food allergens tested. Unexpectedly, the majority of those with elevated serum food-specific IgE levels (12 of 17) were to cow's milk. Among H. pylori negative children (mean age, 9.3 years; range, 5-15 years, 13 female, 10 male), 26% (6 of 23) of the children had an elevated serum IgE level to at least one of the food allergens tested, and 9% (2 of 23) were positive to cow's milk. The difference in the number of children with an elevated serum IgE level for cow's milk in H. pylori positive and negative children was not significant. The severity of gastritis did not correlate with the presence of food-specific IgEs. CONCLUSIONS: H. pylori infection had no effect on the manifestation of specific IgE to major food allergens in school-aged children. An IgE response to cow's milk was common among these school-aged children.     

Can pre-neoplastic lesions be detected in gastric biopsies of children with Helicobacter pylori infection?

BACKGROUND: Active gastritis, gastric mucosal atrophy and intestinal metaplasia are lesions associated with Helicobacter pylori infection. Atrophy and intestinal metaplasia are only seen in adults. OBJECTIVES: We describe pediatric patients with atrophy and metaplasia, and compare the inflammatory response in these patients to controls. METHODS: As part of a multicenter study of pediatric H. pylori infection, gastric biopsy specimens obtained during diagnostic upper endoscopy of 19 H. pylori-infected children and 45 uninfected controls were reviewed and graded by using the updated Sydney system. The inflammatory response was characterized using immunohistochemistry for T lymphocytes, B lymphocytes, and macrophages, and TUNEL assay for apoptosis. RESULTS: Histology of H. pylori-infected and control biopsy specimens showed active gastritis in 32% and 2% respectively (P = 0.002). Mild intestinal metaplasia was found in 4 H. pylori-infected children, in two of whom it appeared to be accompanied by atrophy. Specimens from patients with H. pylori infection contained increased numbers of B lymphocytes in lymphoid nodules, and apoptosis in the superficial epithelium and inflammatory cells. T lymphocytes and macrophages appeared in similar numbers in specimens from controls and infected patients. CONCLUSIONS: We describe intestinal metaplasia associated with H. pylori infection in children. Since atrophy usually precedes intestinal metaplasia in adults, we suggest that atrophy exists in children. High numbers of B lymphocytes and apoptosis in the surface epithelium are seen in patients with H. pylori infection and may be related to the development of atrophy and intestinal metaplasia.     

Gastric inflammation is enhanced in children with CagA-positive Helicobacter pylori infection

BACKGROUND: Helicobacter pylori infection is likely to be acquired at an early age. The factors leading to active inflammation in childhood, however, are largely unknown. SUBJECTS AND METHODS: We determined the CagA status, the best characterized virulence factor of H. pylori, and serum antibodies of IgG and IgA classes to H. pylori in 39 infected children. RESULTS: Mononuclear cell infiltration in the antrum but not in the gastric body was more intense in CagA-positive children than in CagA-negative children. The degree of polymorphonuclear cell infiltration on the other hand was independent of the CagA status. The antibody titers of IgG and IgA classes to H. pylori were higher in CagA-positive than in CagA-negative infections (P<0.001 and P<0.01, respectively). IgG antibody titers to H. pylori correlated directly with the density of mononuclear and polymorphonuclear cell infiltration in the gastric antrum but not in the gastric body. CONCLUSION: H. pylori-infected children with CagA antibodies seem to have a more severe inflammation in the gastric antrum than CagA-negative children as shown by an increase in the density of antral mononuclear cells. A finding of higher serum antibody titers to H. pylori in CagA-positive children may be related to this enhancement of inflammation.     

Testing for serum IgG antibodies to Helicobacter pylori cytotoxin-associated protein detects children with higher grades of gastric inflammation.

BACKGROUND: Little information is available about the relationships between Helicobacter pylori cytotoxin-associated protein (CagA) and clinicopathologic features in children. The purpose of this study was to test whether determining serum IgG antibodies to CagA is a useful tool for detecting more severe disease. METHODS: One hundred twenty-seven consecutive children (age range, 0.75-17.8 years; median, 9.4 years) referred for gastroscopy were included in the study. Antral and corpus biopsies were taken for gastric histology and H. pylori detection. Major symptoms and endoscopic findings were recorded. A serum sample was drawn from each child and assayed for IgG antibodies CagA by a commercial enzyme-linked immunosorbent assay. RESULTS: Sixty-three (50%) children had no evidence of H. pylori infection, 28 (22%) were H. pylori positive/CagA positive, and 36 (28%) were H. pylori positive/CagA negative. There were no differences in clinical diagnosis and occurrence of any predominant symptom according to H. pylori and CagA status. Findings of antral nodularity were more frequent (p = 0.003) in H. pylori-positive/CagA-positive children than in H. pylori-positive/CagA-negative children. The gastritis score was significantly higher in H. pylori-positive/CagA-positive children than in H. pylori-positive/CagA-negative children (5.7 +/- 1.9 vs. 3.8 +/- 1.6, respectively; p = 0.0003), either in the antral (p = 0.0002) or in the corpus (p = 0.001) mucosa. Inflammation (p = 0.0001) and activity (p = 0.0001) scores were both higher in H. pylori-positive/CagA-positive children than in H. pylori-positive/CagA-negative children, but the H. pylori density score was not significantly different (p = NS). In no case was normal gastric mucosa found in H. pylori-positive/ CagA-positive children. Lymphocytic gastritis (p = 0.0008) and lymphoid follicles (p = 0.000003) were a more frequent finding in H. pylori-positive children than in H. pylori negative children, irrespective of CagA status. CONCLUSION: Testing for serum IgG to CagA detects higher grades of gastric inflammation among children with H. pylori infection. It may be useful in targeting H. pylori-positive/ CagA-positive children for antimicrobial therapy while reducing the need for endoscopy and gastric biopsy.     

Helicobacter pylori and Meckel's diverticula

BACKGROUND: Helicobacter pylori is known to infect only gastric mucosa and is strongly associated with gastroduodenal ulceration. The authors studied whether H. pylori colonizes the gastric mucosa of Meckel's diverticula, and determined its relationship to "gastritis" and bleeding. METHODS: A 10-year retrospective review identified 45 children with Meckel's diverticulum. Hematoxylin-eosin and Diff-Quik stains were used to assess the presence and severity of gastritis, and to highlight organisms in the resected diverticula. Cases with organisms were then studied with antibodies specific for H. pylori using immunoperoxidase methods. RESULTS: Twenty-eight children, 7 months to 12.6 years of age, had lower gastrointestinal hemorrhage caused by Meckel's diverticulum and had positive radionuclide scans. All had acid-secreting mucosa in their diverticula, and ulceration. "Chronic gastritis" and eosinophilia were constant findings; "acute gastritis" was present in four patients. Twenty specimens exhibited lymphoid follicles in the gastric mucosa. Seventeen patients with Meckel's diverticula (age range, 1 month-14.7 years) who presented with acute abdominal pain associated with intussusception were used for comparison. Acid-secreting gastric mucosa was seen in four patients. H. pylori was identified in only one of the 45 patients; this patient had ulceration and moderate "acute gastritis." CONCLUSIONS: H. pylori does not colonize a substantial number of children who have ulcerated and bleeding Meckel's diverticulum in the presence of acid-secreting mucosa. Although H. pylori is a notable cause of ulceration, the authors confirm that ulceration is possible in its absence, and alternative mechanisms of ulceration are important. The presence of lymphoid follicles in Meckel's diverticula, unlike gastric biopsies, is not associated with H. pylori.     

Helicobacter pylori in children: an Indian perspective

Helicobacter pylori is causally associated with peptic ulcer disease and gastric carcinoma. Typically children get infected with this organism during the first decade of life but diseases, associated with H. pylori, are seen mainly in adults. In India, almost 80% of population is infected with H. pylori and most of them by 10 years of age. Hence, it is important for a pediatrician to know when to suspect this infection, how to investigate and how to treat it. Extensive electronic (PubMed) literature search was done for this review and literature (randomized controlled trials, clinical trials, meta-analysis, practice guidelines) related to H. pylori in children were reviewed. Special emphasis was given to Indian studies. From this review we can conclude that H. pylori infection is very common in Indian children especially in the low socioeconomic status but most infected children remain asymptomatic through out their childhood and about 15% develop peptic ulcer disease as young adults and 1% develop gastric cancer in older age. There is no association, what so ever, of H. pylori infection and recurrent abdominal pain (RAP). Endoscopy is the preferred method of investigation in children with upper digestive symptoms suggestive of organic disease. Children with H. pylori related disease (peptic ulcer, primary gastric B-cell lymphoma and atrophic gastritis with intestinal metaplasia) but not mere H. pylori infection should be treated with the triple drug regimen comprising of proton pump inhibitor (PPI) and two antibiotics for two weeks.     

Gastric emptying of solids in children with H. pylori-positive and H. pylori-negative non-ulcer dyspepsia

OBJECTIVE: There is currently no data available in children on possible relationships among Helicobacter pylori, gastric motility and gastric inflammation. This is a prospective study of gastric emptying (GE) in symptomatic children with and without H. pylori who met symptom-based criteria for non-ulcer dyspepsia (NUD). METHODS: 47 consecutive dyspeptic patients (23 males; age range, 7 to 18 years) were enrolled. All patients had extensive negative diagnostic investigations. Scintigraphic solid-phase gastric emptying was assessed. RESULTS: 21 H. pylori-positive and 26 H. pylori-negative patients were identified with non-ulcer dyspepsia. The groups were not different in clinical symptoms except that pain related to feeding was more frequent in infected children (P < 0.03). Nodular antral gastritis was found more frequently in the H. pylori positive group (P < 0.0001). The gastritis score was more severe in H. pylori infected than H. pylori negative patients in both fundic and body mucosa (P < 0.001). Within the H. pylori-positive NUD group, the mean half-time GE of a solid meal was significantly accelerated compared to the non-infected group (P < 0.05). There was no difference in the intragastric food distribution and curves of gastric emptying of both groups. A significant relationship was found between the degree of gastric body inflammation gastric emptying, but not antral inflammation. Gastric emptying rate did not differ by sex or age of the subjects in either group. CONCLUSIONS: In dyspeptic children with H. pylori, gastric emptying of a solid was significantly accelerated compared with symptomatic H. pylori uninfected patients. This suggests that H. pylori is able to induce gastric emptying acceleration. Our findings add more information on H. pylori infection and gastroduodenal disease.     

Helicobacter pylori and nonulcer dyspepsia in childhood: clinical pattern, diagnostic techniques, and bacterial strains

BACKGROUND: This is a report of the results of a multicenter study performed in children with dyspepsia from five pediatric centers in Puglia, a region in southern Italy. In the study, clinical features of Helicobacter pylori infection, the reliability of diagnostic techniques, and the involvement of bacterial strains were examined. METHODS: Fifty-three outpatients with dyspepsia enrolled in our study and compiled a diary recording clinical symptoms in patients before they underwent the following diagnostic techniques: endoscopy, biopsy for histologic analysis, rapid urease test, 13C urea breath test, serology specific for immunoglobulin (Ig)G and anti-CagA and VacA. RESULTS: H. pylori showed a prevalence of 30.2% (n = 16). Histologic positivity was seen in all patients at the antral level (H. pylori-associated chronic gastritis). In the gastric body, bacterial chronic active gastritis was present only in six patients (H. pylori-associated chronic pangastritis). Clinical evaluation showed a significant difference in favor of subjects positive for H. pylori only for epigastric burning and/or pain (p < 0.001). The comparison of results of diagnostic tests, using histology as the gold standard, showed sensitivity and specificity of more than 93% for 13C urea breath test and more than 85% for rapid urease test and serology. Anti-CagA antibodies were found in 64.3% and anti-VacA antibodies in 42.8% of H. pylori-positive patients. CONCLUSIONS: H. pylori prevalence in children with dyspepsia from the geographic area studied is comparable with that found in other developed countries. Approximately 50% of the studied patients were infected by cytotoxic strains. The urea breath test was the most reliable noninvasive diagnostic tool and is suitable for routine use, although endoscopy with histologic assessment remains the definitive investigation and is particularly important in patients with positive serology for CagA and VacA. Finally, the frequency of aggressive strains in our region seems to affect the clinical pattern; this emphasizes the importance of definitive diagnosis in children and offers a new role for serology.     

Characteristics and prevalence of Helicobacter heilmannii infection in children undergoing upper gastrointestinal endoscopy.

BACKGROUND: Helicobacter heilmannii, described in 1983 as a new cause of chronic gastritis, has been reported rarely in children. The purpose of this study was to determine the clinical characteristics and the prevalence of H. heilmannii infection, in comparison with Helicobacter pylori infection in children undergoing upper digestive endoscopy. METHODS: Diagnosis of H. heilmannii was based on its morphologic characteristics in gastric biopsy specimens (two from the antrum, one from the fundus), whereas H. pylori infection was defined by histology and/or culture (one specimen from the antrum, one from the fundus). Respective prevalences of H. heilmannii and H. pylori were calculated in 518 patients studied prospectively who underwent systematic biopsies. RESULTS: The prevalence of H. pylori was 8.9% (46/518) and increased with age (from 2% before 3 years of age to 18% after 10 years). On the contrary, the prevalence of H. heilmannii infection was low, 0.4% (2/518), and no different from that published in adults. After completion of the study period, a third H. heilmannii-infected child was diagnosed. Characteristics of H. heilmannii infection could be studied in these three children 5, 9, and 14 years old. Two of three had abdominal pain and one had dysphagia. Nodular gastritis was observed at endoscopy in two children. H. heilmannii chronic active gastritis (n = 3) was localized in the antrum, associated with an interstitial infiltrate, and could not be distinguished from H. pylori gastritis (n = 46). CONCLUSION: Clinical characteristics, endoscopic features and gastric histopathology did not allow H. heilmannii to be distinguished from H. pylori gastritis in our pediatric population. H. heilmannii infection should be considered and carefully looked for during histologic examination of gastric specimens in cases of H. pylori-negative gastritis.     

Accuracy of serology and 13C-urea breath test for detection of Helicobacter pylori in children

BACKGROUND: Indirect noninvasive methods, such as the 13C-urea breath test and serology, can be useful for the detection of Helicobacter pylori infection in children. We analyzed retrospectively the diagnostic accuracy of these two methods. PATIENTS AND METHODS: Between September, 1989, and October, 1996, H. pylori status was determined in 139 children by means of culture and histologic study of gastric biopsies. We performed 146 13C-urea breath tests and serologic assays (Cobas core; Roche). RESULTS: H. pylori infection was detected in 91 of 139 (65%) children. The 13C-urea breath test was discordant with H. pylori status in 4 of 146 tests; serology was discordant in 24 and indeterminate in 7 of 146. The 13C-urea breath test was more sensitive than serology (98% vs. 79%, P < 0.01) but comparable in specificity (96% vs. 92%). The serology yielded false negative results more often in children younger than 5 years of age (P < 0.05). CONCLUSIONS: The 13C-urea breath test is more reliable than serology for the detection of active H. pylori infection in children. Below 10 years of age serology is insufficiently sensitive for clinical purposes, whereas the 13C-urea breath test remains a reliable test.     

幽门螺杆菌感染与儿童胃炎关系探讨

为进一步研究幽门螺杆菌（Helicobacter pylori,H.pylori)感染与儿童胃炎的关系，对我科1998年至2000年间500例3岁－15岁儿童胃镜活检组织进行组织学和H.pylori观察，按Sydney胃炎标准对病变分级，分析和探讨H.pylori感染与儿童胃炎发展变化的关系。结果表明：40.4%的儿童胃炎与H.pylori感染有关；而且炎症的程度、淋巴滤泡的形成、嗜酸细胞增多及幽门腺萎缩明显高于无H.pylori感染的儿童胃炎。提示上海地区儿童胃炎有很高的H.pylori感染率，H.pylori感染与儿童胃炎关系密切，儿童H.pylori胃炎的胃粘膜病理变化比非H.pylori感染者严重。     

Management and response to treatment of Helicobacter pylori gastritis.

Gastritis associated with Helicobacter pylori was present in gastric biopsies from 24/95 (25%) children and adolescents undergoing endoscopy for recurrent abdominal pain and upper gastrointestinal symptoms. H pylori associated gastritis occurred mainly in older children (8-16 years) and was significantly associated with low socioeconomic class and a family history of peptic ulcer disease. Antral nodularity was a common endoscopic finding in H pylori positive children. Eighteen children, all over 5 years of age, were treated with tripotassium dicitratobismuthate (De-Nol) for two months and ampicillin for two weeks. In 12 children follow up gastric biopsies were obtained six weeks after completion of treatment. In 9/12 (75%) children H pylori was eradicated, and gastritis improved.     

Prevalence of Helicobacter pylori infection detected by serology and 13C-urea breath test in HIV-1 perinatally infected children

BACKGROUND: Conflicting results have been reported in adults with human immunodeficiency virus (HIV-1) who were investigated for Helicobacter pylori infection. Most studies indicate a lower prevalence than is found in the general population. The purposes of this study were to evaluate H. pylori prevalence by noninvasive methods in a population of children perinatally infected with HIV-1 and to correlate H. pylori prevalence with HIV-1-related clinical and immunologic status. METHODS: H. pylori infection was studied in 45 children perinatally infected with HIV-1 by performing serologic testing of anti-H. pylori immunoglobulin G antibodies and the 13C-urea breath test. RESULTS: Eight children with HIV-1 (17.7%) were positive by serology, and nine (20%) were positive by 13C-urea breath test. No significant differences related to age, previous antibiotic treatment, immunoglobulin administration, antiretroviral treatment, abdominal pain, CD4+ cell count, number of HIV-1 RNA copies, and frequency of severe immunodepression were noted between children with positive 13C-urea breath test results and those with negative results. Children with positive results were significantly more likely to have severe clinical manifestations. CONCLUSIONS: The results show, by both serology and 13C-urea breath test, a prevalence of H. pylori infection comparable with the prevalence in the normal population of the same age. H. pylori prevalence has probably been underestimated in patients with HIV. Results of serologic and histologic analyses for H. pylori require cautious interpretation, especially in severely immunodeficient patients.     

幽门螺杆菌相关性胃肠粘膜病患儿血清CagA抗体、VacA抗体检测及其临床意义

为了解幽门螺杆菌（elicobacter pylori,H.pylori)相关性胃肠粘膜病患儿血清中细胞毒素相关基因抗原（CagA)、空泡毒素抗原（VasA)的有无及其临床意义，应用免疫印迹法对46例慢性胃炎和25例消化性溃疡患儿血清CagA抗体、VacA抗体进行了检测。结果：（1）慢性胃炎小儿血清H.Pylori CagA抗体（＋）、VacA抗体（＋）检出率为28．3％，消化性溃疡患儿为64．0％，两组比较差异有显著性（P＜0．05）；（2）对慢性胃炎炎症活动程度进行分组检测，中、重度急性活动性胃炎患儿中H.Pylori CagA抗体（＋）、VacA抗体（＋）检出率为50．0％，与轻症者比较差异有显著性（P＜0．05）。提示H.pylori菌株存在不同致病能力，CagA、VasA是致小儿H.Pylori相关性胃肠粘膜病重要的毒力因素；通过检测CagA、VacA抗体，可及时指导临床治疗。     

�����ݸ˾���Ⱦ���ͯ����θ��θ�Ĥ����仯��ϵ�о�

目的探讨幽门螺杆菌(HP)感染对不同年龄组儿童慢性胃炎胃黏膜病理变化的影响。方法 2007年1月至2010年12月,对上海交通大学医学院附属瑞金医院1634例反复上消化道症状儿童行电子胃镜检查,取胃窦部黏膜组织检测HP,按1996年悉尼标准进行病理评分,分析HP感染与炎症严重程度及活动性的关系。并根据年龄分为4组:<4岁组69例,4～<7岁组313例,7～<11岁组706例,11～18岁组546例,比较各组HP感染率、活动性病变发生率以及淋巴滤泡检出率的差异。结果 1634例患儿中HP阳性524例(32.1%),阳性率随年龄增长而升高。HP阳性患儿活动性炎症、中重度炎症、中性粒细胞浸润、淋巴细胞重度浸润和淋巴滤泡的检出率均高于阴性者(P<0.01)。胃黏膜病理示慢性浅表性胃炎(CSG)中、重度炎症及慢性萎缩性胃炎(CAG)中度炎症的发生率,HP阳性患儿均高于阴性者(P<0.01)。除婴幼儿组外,各年龄组HP感染患儿的活动性病变发生率和淋巴滤泡检出率均显著高于HP阴性者(P<0.05)。结论儿童HP感染率随年龄增长而升高。HP感染与胃黏膜炎症严重程度、活动性炎症发生率以及滤泡样改变均密切相关,与慢性胃炎不同病理类型的严重程度也密切相关。     

Upper gastrointestinal disease, Helicobacter pylori and recurrent abdominal pain

Over a 5-y period, 396 children complaining of recurrent abdominal pain (RAP) underwent upper gastrointestinal endoscopy in order to identify any underlying organic pathology and determine the prevalence of Helicobacter pylori (H. pylori) infection. Histologically confirmed mucosal inflammation was found in 338 out of 396 children (85.4%); in 113 of 396 patients (28.5%), H. pylori was identified on the gastric mucosa. Significant discriminating factors between H. pylori positive and negative children with RAP included age (mean age for positive 11 y vs. 8.1 y for negative, p < 0.01) and gender (male gender predominance in the H. pylori positive, p < 0.001). No significant difference was found between H. pylori positive and negative groups regarding incidence and character of the presenting symptoms. All H. pylori positive children (100%) had abnormal histology compared with 225 out of 283 negative ones (79.5%). Histologically confirmed gastritis was the most prominent finding in H. pylori positive children compared with H. pylori negative (98.2% vs. 19%, p < 0.001). Conversely, oesophagitis was more common in H. pylori negative children (47.7% vs. 27.4%, p < 0.001). The incidence of peptic ulcer was higher in H. pylori infected patients than in the H. pylori negative group (5.3% vs. 1%, p < 0.05). Our data suggest that gastrointestinal pathology is more common than previously thought in children with RAP, while H. pylori infection is a relatively important factor in the etiology of upper gastrointestinal inflammation in RAP syndrome.     

A rapid serologic test and immunoblotting for the detection of Helicobacter pylori infection in children

The gold standard for the diagnosis of Helicobacter pylori infection requires an endoscopic biopsy of gastric mucosa for histological examination, urease test and culture. Noninvasive serological tests are useful as a screening test for H. pylori infection. The aim of this study was to evaluate the performance of a rapid office-based serologic test, using immunochromatography ICM, and the immunoblotting for the diagnosis of H. pylori infection in Thai children. Eighty-two symptomatic children, 30 boys and 52 girls (mean age 9.2+/-3.8 years; range, 1.2-16.0 years) who had no previous treatment for H. pylori underwent upper endoscopy. Biopsies were obtained from the gastric body and antrum for histopathology and rapid urease test. Serum samples collected from all patients were tested for H. pylori IgG antibodies using ICM (Assure H. pylori Rapid Test, Genelabs Diagnostics, Singapore). Immunoblotting (HelicoBlot 2.1, Genelabs Diagnostics, Singapore) was tested in sera of 75 patients to detect antibodies to specific antigens of H. pylori. Positive H. pylori status was defined as positive for both histology and rapid urease test. Of 82 patients, 25 (30.5%) were H. pylori positive, 56 (68.3%) were H. pylori negative and one was equivocal. ICM assay yielded a positive result in 24 of the 25 H. pylori-positive patients (96.0%) and 3 of the 56 H. pylori-negative patients (5.4%). The immunoblotting yielded a positive result in all of 22 H. pylori-positive patients (100%) and in 2 of the 52 H. pylori-negative patients (3.8%). Obtained ICM's sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 96.0, 94.6, 88.9, 98.1 and 95.1%, with immunoblotting 100.0, 96.2, 91.6, 100.0, and 97.3%, respectively. The immunochromatographic and immunoblot tests are non-invasive, reliable and useful for the diagnosis of H. pylori infection in Thai children.