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Liang M, Zhu C, Zhao P, Zhu X, Shi J, Yuan B. Comparison of multiple treatment regimens in children with Helicobacter pylori infection: A network meta-analysis. Front Cell Infect Microbiol 2023; 13:1068809. [PMID: 36909732 PMCID: PMC9995679 DOI: 10.3389/fcimb.2023.1068809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Background Multiple regimens have been widely used in the eradication treatment of Helicobacter pylori infection in children. However, there is a lack of comparison and evaluation of their effectiveness in different regions of the world. Methods Randomized controlled trials were retrieved. Review Manager 5.4, Stata SE 15 and R 4.0.4 statistical software were used to analyze date. The ranking probability is assessed according to the surfaces under cumulative ranking (SUCRA). Results 163 studies were eligible for this study, involving 336 arms and 18,257 children, and 10 different interventions. The results showed that the eradication rates of sequential therapy with probiotics (SP), bismuth-containing quadruple (Quadruple) therapy, concomitant therapy and PCN therapy were at least 90%. Cumulative ranking showed that SP therapy had the best eradication effect (SUCRA 92.7%) whereas Bismuth-containing triple therapy (B) had the worst (SUCRA 3.5%). Subgroup analysis suggested that SP therapy ranked first in China and other regions, and the ranking of Triple therapy with probiotics therapy (TP) was equally stable (SUCRA 72.0% vs 76.4% respectively). The security of the SP and TP therapy had great advantages. Conclusions As for the eradication treatment of Helicobacter pylori infection in children, SP therapy ranks highest. SP and TP therapies are most safe.
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Affiliation(s)
- Miaomiao Liang
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chengbi Zhu
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Peipei Zhao
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaohui Zhu
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Junwei Shi
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Bin Yuan
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- *Correspondence: Bin Yuan,
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Valizadeh Toosi SM, Yaghobi M, Mohammad Pour RA. Prevalence of Helicobacter Pylori Infection in Patients with Dyspepsia in North of Iran. Middle East J Dig Dis 2021; 13:230-236. [PMID: 36606221 PMCID: PMC9489463 DOI: 10.34172/mejdd.2021.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 03/10/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Dyspepsia is a common complaint among patients who refer to gastroenterology clinics. Studies have shown that there is a strong relationship between dyspepsia and Helicobacter pylori (HP) infection. We have investigated the prevalence of HP infection in patients with dyspepsia and its correlation with age and socioeconomic status (SES) of patients in Mazandaran province, northern Iran. METHODS In this cross-sectional study, patients with dyspepsia who had undergone upper gastrointestinal endoscopy were enrolled. Diagnosis of HP infection was according to the results of rapid urease test (RUT), and Giemsa staining of pathology samples. A questionnaire including endoscopic findings, demographic data, and SES information was completed for each patient. RESULTS The mean age of the 614 patients was 45.8±5 years, and 60% of them were female. Most patients had normal endoscopy (56.1%), and gastric ulcer and erosion was the most common abnormal endoscopic finding (24.7%). The prevalence of HP infection in patients with dyspepsia was about 66.6%. HP infection was associated with a lower prevalence in people aged below 30 years and good SES. CONCLUSION The prevalence of HP infection in patients with dyspepsia was 66.6%. In addition, HP infection rate was lower in people under the age of 30 years and patients with good SES.
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Affiliation(s)
- Seyed Mohammad Valizadeh Toosi
- Non-communicable Diseases Institute, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
,Corresponding Author: Dr Seyed Mohammad Valizadeh Toosi, M D Department of Internal Medicine, Imam Khomeini Hospital, Sari, Iran (Postal Code: 48166-33131) Telefax: + 98 11 33377176
| | - Mahdis Yaghobi
- Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Ali Mohammad Pour
- Department of Biostatics, School of Health, Mazandaran University of Medical Sciences, Sari, Iran
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3
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Alihosseini S, Ghotaslou R, Heravi FS, Ahmadian Z, Leylabadlo HE. Management of antibiotic-resistant Helicobacter pylori infection: current perspective in Iran. J Chemother 2020; 32:273-285. [PMID: 32657237 DOI: 10.1080/1120009x.2020.1790889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Helicobacter pylori is a common gastric bacterial pathogen implicated in the pathogenesis of many digestive tract disorders. H. pylori infection prevalence has been reported alarmingly in Iran. A plethora of studies have been conducted to evaluate the efficiency of first-line and second-line eradication attempts in patients diagnosed with H. pylori infections in Iran. The present study, was evaluated the efficacy of first-line and second-line therapy in H. pylori infections in Iran. We aimed to consider the literature review of the various library and electronic databases (Science Direct, PubMed, and Google Scholar) until 2020. The frequency of bacterial resistance to tetracycline, ampicillin, trimethoprim, erythromycin, ofloxacin, and metronidazolewas found to be high in Iran, while the most effective antibiotics were clarithromycin, rifampin, rifampicin, tetracycline, amoxicillin, ciprofloxacin, levofloxacin, moxifloxacin, and azithromycin. The therapeutic choice for H. pylori eradication in Iran could be quadruple therapy using two antibiotics amoxicillin and metronidazole/clarithromycin for the first-line regimen, and a combination of furazolidone plus tetracycline/amoxicillin and bismuth plus proton pump inhibitor for the second-line regimen. Due to increased antibiotic resistance in our region, empirical therapy must be replaced by more targeted treatment based on antimicrobial drug resistance profiles obtained from patients. Although we limited our investigation on the H. pylori eradication regimens in Iran, the results can be generalized to any region as long as the patterns of resistance are the same.
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Affiliation(s)
- Samin Alihosseini
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Ghotaslou
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Zainab Ahmadian
- Department of Pharmaceutics, School of Pharmacy, Zanjan University of Medical Science, Zanjan, Iran
| | - Hamed Ebrahimzadeh Leylabadlo
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Yousefi-Avarvand A, Vaez H, Tafaghodi M, Sahebkar AH, Arzanlou M, Khademi F. Antibiotic Resistance of Helicobacter pylori in Iranian Children: A Systematic Review and Meta-Analysis. Microb Drug Resist 2018; 24:980-986. [PMID: 29227738 DOI: 10.1089/mdr.2017.0292] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Antibiotic therapy for children infected with Helicobacter pylori is important. However, resistance to antibiotics is one of the main causes of treatment failure. This study was designed to evaluate the prevalence pattern of antibiotic resistance of H. pylori in Iranian children using a systematic review and meta-analysis of literature. A computerized search (until June 10, 2017) using related keywords in the national and international databases was performed. A total of 261 original articles on antibiotic resistance of H. pylori in Iranian children were collected. After screening for inclusion and exclusion criteria, six eligible articles were included in the meta-analysis. Resistance rates of H. pylori to different antibiotics were as follows: metronidazole: 71%, clarithromycin: 12.2%, amoxicillin: 20.4%, tetracycline: 8.4%, ampicillin: 21.4%, rifampin: 28.6%, furazolidone: 8.4%, ciprofloxacin: 16.2%, azithromycin: 19%, erythromycin: 15.3%, and nitrofurantoin: 0%. The prevalence of H. pylori resistance to metronidazole, amoxicillin, ampicillin, and rifampin among Iranian children was high. Therefore, a careful monitoring of antibiotic resistance to select the best treatment options and prevent treatment failure is required. Although resistance to some antibiotics such as clarithromycin, tetracycline, furazolidone, and ciprofloxacin was less prevalent, frequent consumption of these drugs in children should be controlled owing to their known adverse events.
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Affiliation(s)
- Arshid Yousefi-Avarvand
- 1 Department of Medical Bacteriology and Virology, School of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Hamid Vaez
- 2 Department of Microbiology, School of Medicine, Zabol University of Medical Sciences , Zabol, Iran
| | - Mohsen Tafaghodi
- 3 Nanotechnology Research Center, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Amir Hossein Sahebkar
- 4 Biotechnology Research Center, School of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Mohsen Arzanlou
- 5 Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences , Ardabil, Iran
| | - Farzad Khademi
- 5 Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences , Ardabil, Iran
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Sebghatollahi V, Soheilipour M, Khodadoostan M, Shavakhi A, Shavakhi A. Levofloxacin-containing versus Clarithromycin-containing Therapy for Helicobacter pylori Eradication: A Prospective Randomized Controlled Clinical Trial. Adv Biomed Res 2018; 7:55. [PMID: 29657940 PMCID: PMC5887790 DOI: 10.4103/abr.abr_133_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: This study evaluated the clinical efficacy and tolerability of a 14-day course of bismuth-based quadruple therapy including tinidazole and levofloxacin in compare to a 14-day bismuth-based quadruple therapy including clarithromycin as first-line treatment for Helicobacter pylori infection in Iranian adults. Materials and Methods: The study was a prospective, parallel group, randomized controlled, clinical trial that conducted on 150 patients with H. pylori infection. Patients were randomly assigned to the two groups as follows: first group received pantoprazole 40 mg, bismuth subcitrate 240 mg, amoxicillin 1 g, and clarithromycin 500 mg (PBAC group), and other group received pantoprazole 40 mg, bismuth subcitrate 240 mg, amoxicillin 1 g, tinidazole 500 mg for 7 days, followed by levofloxacin 500 mg for the second 7 days (PBATL group). Main outcomes were eradication rate, tolerance of treatment, and dyspepsia severity. Results: The eradication rates for PBAC regimen was 81.1% (95% confidence interval [CI]: 71.9–90.2) and for PBATL regimen was 70.8% (95% CI: 60.1–81.6), which was not significantly different (P = 0.147). Tolerance of treatment was similar between groups. The median of severity of dyspeptic after treatment in PBAC group was 10 [9–14.75], which was similar to PBATL group 10 [9–13.5] (P = 0.690). Conclusion: There is no significant difference between PBAC and PBATL regimen, and efficacy was similar in both groups. The overall rate of treatment failure suggests that up to 18%–30% of patients will fail bismuth-based quadruple therapy and require retreatment for the infection.
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Affiliation(s)
- Vahid Sebghatollahi
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Soheilipour
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Khodadoostan
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Shavakhi
- Department of Internal Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Ahmad Shavakhi
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Hong J, Yang HR. Efficacy of Proton Pump Inhibitor-based Triple Therapy and Bismuth-based Quadruple Therapy for Helicobacter pylori Eradication in Korean Children. Pediatr Gastroenterol Hepatol Nutr 2012; 15:237-42. [PMID: 24010093 PMCID: PMC3746056 DOI: 10.5223/pghn.2012.15.4.237] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 10/31/2012] [Accepted: 11/05/2012] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The aim of this study was to assess and compare the efficacies of proton pump inhibitor-based triple therapy and bismuth-based quadruple therapy as first-line treatments for Helicobacter pylori eradication in Korean children. METHODS We retrospectively reviewed the data of children who had been diagnosed with H. pylori infection at the Seoul National University Bundang Hospital from March 2004 to August 2012. The patients were randomly assigned to receive either triple therapy consisting of omeprazole, amoxicillin, and clarithromycin for 2 weeks (OAC group) or quadruple therapy comprising omeprazole, amoxicillin, metronidazole, and bismuth salts for 1 week (OAMB group). The patients were evaluated for eradication of H. pylori infection at 4 weeks after the completion of the treatment. RESULTS Of the 129 children enrolled in this study, 118 (91.5%) were included in the final analysis. The eradication rates in OAC and OAMB groups were 67.7% (42/62) and 83.9% (47/56), respectively, which were significantly different between the 2 treatment groups (p=0.041). The eradication rates in the OAMB group during the periods 2004-2006, 2007-2009, and 2010-2012 were superior to those in the OAC group. CONCLUSION This study indicated that the 1-week bismuth-based quadruple therapy, compared with the standard 2-week triple therapy, was significantly more successful in eradicating H. pylori infection in Korean children.
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Affiliation(s)
- Jeana Hong
- Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea. ; Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
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Pacifico L, Osborn JF, Anania C, Vaira D, Olivero E, Chiesa C. Review article: bismuth-based therapy for Helicobacter pylori eradication in children. Aliment Pharmacol Ther 2012; 35:1010-26. [PMID: 22404517 DOI: 10.1111/j.1365-2036.2012.05055.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 02/12/2012] [Accepted: 02/20/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND Because of the decrease in the Helicobacter pylori eradication rate after standard triple therapy with a proton pump inhibitor and two antibiotics, bismuth-based therapy has recently been recommended as alternate first-line regimen in children. AIM To comprehensively review the clinical, pharmacologic and microbiologic properties of bismuth salts, and to summarise the evidence for the therapeutic efficacy of bismuth-based therapy for H. pylori eradication in children. METHODS Bibliographical searches were performed in MEDLINE. Results on the efficacy of bismuth-containing regimens on H. pylori eradication were combined using the inverse variance method. RESULTS Bismuth monotherapy showed a very low efficacy. Overall, the mean eradication rate with bismuth-based dual therapy was 68% (95% CI, 60-76%) (intention-to-treat analysis-ITT) and 73% (95% CI, 64-81%) (per protocol-PP). In case series, the overall percentages of children with successful eradication for triple therapy containing bismuth were 82% (95% CI, 76-88%) and 86% (95% CI, 80-92%) according to ITT and PP respectively. In comparative studies, H. pylori eradication rates ranged between 69% and 85% according to ITT and between 74% and 96% PP. Side effects included dark stools, urine discoloration, black tongue, burning tongue, and marked darkness of the gums. CONCLUSIONS The evidence in favour of bismuth compounds for treating infected children is still not clear. Well-designed, randomised, multi-centre studies of H. pylori eradication trials in children comparing bismuth-based triple therapy with the best available recommended first-line therapies are needed. The evidence obtained from audited case series that produce an eradication rate of >95% on PP analysis should also be considered.
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Affiliation(s)
- L Pacifico
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
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8
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Mehri N, Kambiz E, Ahmad K, Fatemeh F, Farzaneh M, Hossein FG, Fatemeh M. The efficacy of a 1-week triple therapy for eradication of Helicobacter pylori infection in children. Arab J Gastroenterol 2011; 12:37-9. [PMID: 21429454 DOI: 10.1016/j.ajg.2011.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 10/03/2010] [Accepted: 11/11/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND STUDY AIMS Poor compliance to therapy and antibiotic resistance are the main causes for failure of anti-Helicobacter pylori (H. pylori) therapy. The purpose of this study was to assess the effectiveness of omeprazole-based triple therapy in Iranian children. PATIENTS AND METHODS Fifty-seven children with H. pylori-related gastroduodenal disease received 1-week triple therapy with a combination of omeprazole, amoxicillin and clarithromycin (according to the susceptibility test). Success of eradication was assessed by (13)C-urea breath test and endoscopy. RESULTS Sixty-four patients (mean age 11.3years; range 2.7-16years) were included. Eradication was successful in 84.2% (95% confidence interval, 72.8% intention to treat). CONCLUSION One-week triple therapy was effective for the eradication of H. pylori infection in children.
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Affiliation(s)
- Najafi Mehri
- Gastroenterology, Children Medical Center Hospital, Tehran, Iran.
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9
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Chiesa C, Pacifico L, Anania C, Poggiogalle E, Chiarelli F, Osborn JF. Helicobacter pylori therapy in children: overview and challenges. Int J Immunopathol Pharmacol 2010; 23:405-16. [PMID: 20646336 DOI: 10.1177/039463201002300203] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Helicobacter pylori is one of the most common infections found in humans. It was first identified in 1982 and by 1989 had been associated with gastric inflammation and ulcers in adults and children. During the 1990's evidence emerged of its etiologic role in stomach cancers in adults. That the infection is common and may have serious consequences, has led to an avalanche of research during the last twenty years. During this time, there have been many studies on children which have sought an effective and safe treatment to eradicate the infection, but as yet, no therapy regimen has been found which is always effective and safe. This article provides information, from a pediatric point of view, on the major developments in the therapeutics and therapy of H. pylori infection. It examines first-line treatment regimens, evaluates the efficacy of the main drugs used in the management of (primary) H. pylori infection in children, assesses the potential for the use of probiotics and sequential therapy, examines therapeutic options after failure of initial treatment, and discusses factors affecting eradication rate, including antibiotic resistance, adherence to therapy, and bacterial factors.
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10
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Orenstein SR. Clinical trials report: optimal treatment of Helicobacter pylori gastric infection in children. Curr Gastroenterol Rep 2010; 12:157-159. [PMID: 20437212 DOI: 10.1007/s11894-010-0099-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Susan R Orenstein
- Pediatric Gastroenterology, University of Pittsburgh School of Medicine, 303 Church Lane, Pittsburgh, PA, 15238, USA.
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12
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Dehghani SM, Erjaee A, Imanieh MH, Haghighat M. Efficacy of the standard quadruple therapy versus triple therapies containing proton pump inhibitor plus amoxicillin and clarithromycin or amoxicillin-clavulanic acid and metronidazole for Helicobacter pylori eradication in children. Dig Dis Sci 2009; 54:1720-4. [PMID: 19005755 DOI: 10.1007/s10620-008-0547-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Accepted: 09/12/2008] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Helicobacter pylori (H. pylori) cure rates vary in different geographical regions because of differences in hosts as well as in H. pylori strains. In this study we evaluated the efficacy of different treatment regimens for eradication of H. pylori infection in children, in order to select a treatment regimen that is most effective with the least adverse effects and cost. METHOD Through a randomized clinical trial study we enrolled 120 pediatric patients (age <or= 18 years) with H. pylori infection confirmed through histopathological examination of their upper endoscopic findings and positive rapid urease test. Patients were randomized into three groups: group A received omeprazole, amoxicillin, metronidazole, and bismuth subcitrate; group B received omeprazole, amoxicillin, and clarithromycin; and group C the most recent regime of omeprazole, amoxicillin-clavulanic acid, and metronidazole. Subjects were followed 6 weeks after completing the antimicrobial therapy and H. pylori eradication was assessed with urea breath test. RESULTS A total of 117 patients with a mean age of 12 +/- 4 years completed the study. Eradication rate was 91.9% in group A, compared with 82.1% in group B, and 80.5% in group C (P = 0.33). CONCLUSION Considering these data we suggest quadruple therapy as the first line of therapy for eradication of H. pylori infection in children in our geographic area (Iran).
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Affiliation(s)
- Seyed Mohsen Dehghani
- Gastroenterohepatology Research Center, Pediatric Gastroenterology Department, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, 71937-11351, Iran.
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Rajindrajith S, Devanarayana NM, de Silva HJ. Helicobacter pylori infection in children. Saudi J Gastroenterol 2009; 15:86-94. [PMID: 19568571 PMCID: PMC2702974 DOI: 10.4103/1319-3767.48964] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 11/02/2008] [Indexed: 12/11/2022] Open
Abstract
Helicobacter pylori infection is a common problem in pediatric practice, and its acquisition is related with poor socioeconomic conditions. Although the organism is thought to be responsible for many diseases, only a handful of them have a direct causal relationship. At present, only a small number of children with well-defined clinical syndromes are benefited from testing and treatment. The treatment should include at least two antibiotics with a proton pump inhibitor.
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Affiliation(s)
- Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
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Sabbi T, De Angelis P, Dall'Oglio L. Helicobacter pylori infection in children: management and pharmacotherapy. Expert Opin Pharmacother 2008; 9:577-85. [PMID: 18312159 DOI: 10.1517/14656566.9.4.577] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Helicobacter pylori infection is mainly acquired during childhood: it is recognised as a cause of gastritis and peptic ulcer and it has been classified as a group A carcinogen by the World Health Organisation. The exact mode of transmission is as yet unknown. The aim of this review was to analyse the literature about H. pylori infection in paediatric patients. The large diffusion of H. pylori infection in paediatric patients, the absence of a specific clinical feature, the new non-invasive methods for diagnosis and follow-up, which are still not validated and the different therapeutic schedules have led to the necessity of determining the real clinical outcome in affected children and adolescents. The scope of the review was to identify better eradication therapy and the most important factors in treatment failure. The international literature has shown the importance of culture, antibiograms, the compliance of families and patients and the use of probiotics during triple eradication therapy. The review paid attention to the management, diagnostic techniques and therapy of this infection in paediatric patients.
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Affiliation(s)
- Tamara Sabbi
- Bambino Gesù Pediatric Hospital, Endoscopic Digestive Unit, Piazza S. Onofrio, 4-00165 Rome, Italy.
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Abstract
During the last year, epidemiologic studies have shown that spontaneous clearance of Helicobacter pylori infection has a less significant role in countries with high prevalence and, in contrast to adults, there is no male predominance of H. pylori infection in children. Early acquisition of H. pylori may play a role in the development of recurrent abdominal pain in children less than 5 years of age. In this very young age group, the adequate performance of stool antigen test and (13)C urea-breath test demonstrated satisfactory sensitivity and specificity as non-invasive methods to diagnose H. pylori infection. In the current paper, the most relevant pediatric studies on H. pylori infection published between April 2006 and March 2007 are reviewed.
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Affiliation(s)
- Gabor Veres
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary.
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Oderda G, Shcherbakov P, Bontems P, Urruzuno P, Romano C, Gottrand F, Gómez MJM, Ravelli A, Gandullia P, Roma E, Cadranel S, De Giacomo C, Canani RB, Rutigliano V, Pehlivanoglu E, Kalach N, Roggero P, Celinska-Cedro D, Drumm B, Casswall T, Ashorn M, Arvanitakis SN. Results from the pediatric European register for treatment of Helicobacter pylori (PERTH). Helicobacter 2007; 12:150-6. [PMID: 17309752 DOI: 10.1111/j.1523-5378.2007.00485.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Data on the eradication treatment for childhood Helicobacter pylori are scanty. A register was established on the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) website to collect data on treatment performed by European pediatricians to ascertain what is practiced in the field. SUBJECTS From January 2001 to December 2002, information on 597 children were entered by 23 European Centers, but only data of 518 treated children were completed and analyzed (86.7%, 262 male subjects, median age 9 years, range 1-14). According to their nationality, 226 children were from Southern Europe, 132 from Eastern Europe, 68 from Western Europe, and 4 from northern Europe, 68 from North Africa, and 20 from Asia. At endoscopy, 454 children had gastritis and 64 had ulcer (12.3%). Antibiotic sensitivity, tested in 361 cases, revealed 18% clarithromycin-resistant and 19% metronidazole-resistant H. pylori strains. RESULTS Treatment was performed for 1 week in 388 and for 2 weeks in 130 children. Antibiotics were associated with proton pump inhibitors (PPI) in 345 and with bismuth in 121 children. Triple therapy was given to 485 children, dual therapy to 26, quadruple to 7. Follow-up data, by (13)C-Urea-Breath Test or histology or both, were available for 480 children. Overall eradication rate was 65.6%, significantly higher in children with ulcer (79.7%) than without (63.9%, p = .001). When given as first treatment, bismuth-containing triple therapies were more efficacious than PPI-containing ones (77% versus 64%, p = .02, OR 1.88, 95% CI 1.1-3.3). Twenty-seven different treatment regimens were used, but only six were administered to at least 18 children (range 18-157). There was no difference between treatments given for 1 or 2 weeks, or given as first or second therapies. CONCLUSION European pediatricians entering data in the register used 27 different regimens. Bismuth-containing therapies resulted in higher eradication rate. Omeprazole-containing triple therapies were the most used although their efficacy was low. Therapies recommended for adults do not appear to be suitable for children.
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