Helicobacter pylori Infection and Various Upper Gastrointestinal Diseases in Children with Abdominal Complaints

Kim, Hyun Young; Chung, Ki Sup

Abstract

PURPOSE
The purpose of this study was to research the incidence of H. pylori infection in children with upper gastrointestinal complaints according to age, sex, and diseases diagnosed by endoscopy. This study was also aimed at evaluating the usefullness of diagnostic methods, and to assess the effectiveness of treatment.
METHODS
Upper gastrointestinal endoscopy and gastric mucosal biopsy were performed on 178 children who visited the OPD or were admitted to the Department of Pediatrics, Yonsei University College of Medicine between Aug. 1992 and Jul. 1994 due to abdominal pain and upper gastrointestinal bleeding. With biopsied specimens, CLO test (rapid urease test) and Warthin-Starry stain were performed, and the ELISA test was done with their serum at the same time. Patients with any positive results for H. pylori were treated with DeNol and amoxicillin for 4-6weeks. Endoscopic re-evaluation and the CLO test or the Warthin-Starry stain on biopsy specimens were performed in 10 follow-up patients.
RESULTS
1) The prevalence of H. pylori infection in children presenting with abdominal complaints was 25.3%. No sexual predominance was observed. 2) In the endoscopically normal group (61 cases), the prevalence of H. pylori infection was 11.5%, and showed no significant difference with advancing age. In the endoscopically abnormal group (117 cases), prevalence appeared to increase with advancing age (9.1% in the age group under 5 years, 16.1% in the age group 5 to 10 years, 42.3% in the age group over 10 years). Average prevalence was 32.5% for all patients. 3) The freqeuncy of H. pylori infection included chronic nodular gastritis in 61.3% (19 of 31 cases), duodenal ulcer in 53.8% (7 of 13 caes), gastric ulcer in 22.5%, superficial gastritis in 14.6% and erosive gastritis in 10%. 4) The frequency of H. pylori infection increased with advancing age in chronic nodular gastritis, duodenal ulcer, and gastric ulcer, and their infection rate in patients over 10 years of age was 70.8%, 54.5% and 50.0% respectively. There were no significant differences of prevalence rate related to age in the other remaining diseases. 5) When the Warthin-Starry stain was considered as the gold standard, the sensitivity and specificity of CLO test for H. pylori were 100%, 92%, and those of the ELISA test were 69.2%, 81.8% respectively. 6) Children with any positive results for H. pylori infection were treated with DeNol and amoxicillin for 4-6 weeks. In 5 of 10 children who could be followed up for endoscopy and gastric biopsy after treatment, H. pylori was eradicated with a negative conversion rate of 50%.
CONCLUSIONS
The prevalence of H. pylori in children with abdominal complaints was 23.5%, indicating that H. pylori infection might be the cause of abdominal complaints in some children with presumed functional abdominal pain. A high prevalence rate of H. pylori infection which increased with advancing age, was noted in patients with chronic nodular gastritis or duodenal ulcer. Antral nodularity was the characteristic endoscopic finding of children infected with H. pylori. We suggest that an early detection of H. pylori infection using upper gastrointestinal endoscopy and CLO testing and proper treatment for children with abdominal complaints might lower the incidence of peptic ulcer diseases or gastric cancer with advancing age.