Helicobacter pylori Chronic Gastritis in Children: To Eradicate or Not to Eradicate?

doi:10.1016/j.jpeds.2011.01.033

The Journal of Pediatrics

Volume 159, Issue 1, July 2011, Pages 50-56

https://doi.org/10.1016/j.jpeds.2011.01.033 Get rights and content

Objective

To evaluate the efficacy of triple eradication therapy versus symptomatic therapy in children with Helicobacter pylori–associated chronic active gastritis (H pylori-ACAG).

Study design

Symptomatic patients with H pylori-ACAG (n = 31) were randomly assigned into two groups: (1) patients infected with H pylori who were treated with triple eradication therapy (n = 16); and (2) patients infected with H pylori who were treated with symptomatic therapy (n = 15).

Results

After 1 year of follow-up, macroscopic appearance was significantly different in group B (P = .023), and chronic inflammation, H Pylori density, and activity were significantly higher in group B than in group A (P = .022, .007, and .002, respectively); however, we did not find a significant difference in the symptoms comparing both groups (P = .287). After 1 year of follow-up, we observed the persistence of the H pylori infection in all children who had not received eradication treatment.

Conclusions

There is no correlation between eradication of H pylori infection and improvement of dyspeptic symptoms. Self-eradication does not occur within 1 year of follow-up. A trend toward a higher rate of chronic inflammation in noneradicated children at 1 year limited the time of our study.

Section snippets

Methods

Children between 3 years and 17 years, 11 months, were consecutively recruited from patients with H pylori gastritis who underwent upper gastrointestinal endoscopy (UGE) from January 2007 to June 2008 at the Endoscopy and Digestive Motility Unit of the Department of Pediatrics, University of Naples “Federico II.”

Exclusion criteria included history of antibiotics (amoxicillin, tetracycline, metronidazole, clarithromycin, azithromycin, or other), antacids, H₂-blockers, proton pump inhibitors,

Results

Forty-two patients were infected with H pylori, based on the presence of H pylori in the gastric mucosa biopsies. Eleven subjects were excluded from the study because the parents of seven refused consent and four had received antibiotics within the previous 4 weeks. One patient was excluded because he showed gastric ulcer. Thirty children were eligible and participated in the study.

Fifteen patients infected with H pylori (group A) (M/F: 7/8; mean age: 121.25 ± 42.27 months; range, 48 to 174)

Discussion

In this prospective, longitudinal study, we found that after 1 year of follow-up, macroscopic appearance in children infected and uninfected with H pylori was not statistically significant different, and a trend toward a higher rate of chronic inflammation was present in noneradicated children.

Ganga-Zandzou et al¹⁵ demonstrated in the 2-year follow-up study a deterioration in the histologic features of the gastric mucosa of 18 infected children despite stable H pylori colonization and the

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: The authors declare no conflicts of interest.

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Original ArticleHelicobacter pylori Chronic Gastritis in Children: To Eradicate or Not to Eradicate?

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Pediatr Gastroenterol Nutr

Gastroenterol Clin North Am

Gastroenterology

J Pediatr

Am J Gastroenterol

Helicobacter pylori occurrence and transmission: a family affair?

Scand J Infect Dis

Acquisition of Helicobacter pylori infection in early childhood: independent contributions of infected mothers, fathers, and siblings

Am J Gastroenterol

Eradication of Helicobacter pylori as a means toward eliminating gastric adenocarcinoma

Gastroenterology

Age at establishment of Helicobacter pylori infection and gastric carcinoma, gastric ulcer and duodenal ulcer risk

Cancer Res

Epidemiology of Helicobacter pylori and gastric cancer

Gastric Cancer

Helicobacter pylori infection in children: recommendation for diagnosis and treatment

J Pediatr Gastroenterol Nutr

Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report

Gut

Maintenance therapy for erosive esophagitis in children after healing by omeprazole: is it advisable?

Am J Gastroenterol

Classification and grading of gastritis: the updated Sydney System

Am J Surg Pathol

Original Article
Helicobacter pylori Chronic Gastritis in Children: To Eradicate or Not to Eradicate?