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Weiner N, Shaoul R. Impact of Age, Gender, and Addition of Probiotics on Treatment Success for Helicobacter pylori in Children. Glob Pediatr Health 2015; 2:2333794X15607798. [PMID: 27335981 PMCID: PMC4784617 DOI: 10.1177/2333794x15607798] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The primary objective of this study was to evaluate the effect of age, gender, and the use of probiotics with standard treatment regimen on Helicobacter pylori eradication. Based on endoscopic findings and clinical presentation, selected patients were treated with standard triple therapy (omeprazole, clarithromycin, and amoxicillin). Those who failed were offered a repeat treatment with omeprazole, metronidazole, and amoxicillin. After the publications of the possible advantages of probiotic treatment on H pylori eradication, the probiotic agent “Probiotica Forte” was routinely added to the treatment. Eradication was noted for 94/130 patients (72%) and for 128/197 patients (65%) with or without probiotic agent, respectively (P = .23). For second-line treatment eradication was noted in 33/46 (72%) and in 9/20 (45%) with or without probiotic agent, respectively (P = .053). The addition of probiotics may improve eradication success especially in addition to second-line treatment.
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Affiliation(s)
- Noam Weiner
- Meyer Children's Hospital of Haifa, Haifa, Israel
| | - Ron Shaoul
- Meyer Children's Hospital of Haifa, Haifa, Israel
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2
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Ding Z, Zhao S, Gong S, Li Z, Mao M, Xu X, Zhou L. Prevalence and risk factors of Helicobacter pylori infection in asymptomatic Chinese children: a prospective, cross-sectional, population-based study. Aliment Pharmacol Ther 2015; 42:1019-26. [PMID: 26271484 DOI: 10.1111/apt.13364] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 07/07/2015] [Accepted: 07/23/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Limited research has been published on current Helicobacter pylori infection rate in asymptomatic children in China. AIM To assess current Helicobacter pylori infection rate, distribution characteristics and risk factors in Chinese asymptomatic children. METHODS A prospective, cross-sectional, population-based study was performed from 2009 to 2011 in three cities of China. Helicobacter pylori infection was diagnosed by a stool antigen test. Multi-stage cluster random sampling was used to select asymptomatic children including neonates. Socioeconomic details were obtained through a standardised questionnaire. RESULTS Among total of 3491 children (0-18 years), the global infection rate was 6.8% and there were no significant differences between genders. Age specific infection rate between regions was significantly different (P < 0.05). The infection rate significantly increased with age (P for trend <0.01). It was low during the newborn (0.6%) to preschool period and was significantly increased in high school students (13.5%) (P < 0.01). Multivariable regression indicated that hand sanitisation, individually served meals, higher education level of mother, above average living space and residence in urban areas were significantly protective against infection (OR 0.749, 0.698, 0.720, 0.838 and 0.770 respectively). Conversely, consuming meals in unsanitised conditions, sharing towels, receiving pre-chewed food from the mother, artificial feeding and family history of gastrointestinal disease were significantly associated with the risk of infection (OR 1.200, 1.965, 2.002, 1.071 and 2.093 respectively). CONCLUSIONS Helicobacter pylori infection rate increases with age in Chinese asymptomatic children and is common after 10 years of age. The rate of infection is related to socioeconomic status.
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Affiliation(s)
- Z Ding
- Department of Gastroenterology, Beijing Children's Hospital of Capital Medical University, Beijing, China
| | - S Zhao
- Department of Gastroenterology, Beijing Children's Hospital of Capital Medical University, Beijing, China
| | - S Gong
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center of Guangzhou Medical College, Guangzhou, China
| | - Z Li
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
| | - M Mao
- Department of Pediatrics, West China Second Hospital of Sichuan University, Chengdu, China
| | - X Xu
- Department of Gastroenterology, Beijing Children's Hospital of Capital Medical University, Beijing, China
| | - L Zhou
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
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Ozbey G, Dogan Y, Demiroren K, Ozercan IH. Prevalence of Helicobacter pylori in children in eastern Turkey and molecular typing of isolates. Braz J Microbiol 2015; 46:505-11. [PMID: 26273266 PMCID: PMC4507543 DOI: 10.1590/s1517-838246220140234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/30/2014] [Indexed: 12/19/2022] Open
Abstract
The objectives of the present study were to determine Helicobacter
pylori via culture, polymerase chain reaction and histopathological
diagnosis in 101 children ranging in age from 4 to 18 years, to identify the
association among restriction fragment length polymorphism types and clinical
disease and to investigate the relationships among different isolates of
H. pylori in different age groups. We observed a high
prevalence of H. pylori infections in children between the ages
of 13 and 18 (75.8%), while children aged 4 to 6 years had the lowest prevalence
of infection (40%). H. pylori was detected in 30.7% (31 of
101), 66.3% (67 of 101) and 63.2% (60 of 95) of children as determined by
culture methods, PCR and histological examination, respectively. H.
pylori isolates with RFLP types I and III were the most common
among children with antral nodularity, whereas RFLP types II and IV were the
least detected types. Interestingly, all isolates from peptic ulcer patients
were type III. Although our results show a high prevalence of H.
pylori infections in the pediatric population in eastern Turkey, no
association was identified between H. pylori infection with
antral nodularity and recurring abdominal pain. In addition, we found low
genetic variation among H. pylori isolates from children and no
association between RFLP types and antral nodularity (p > 0.05).
Additionally, we found that H. pylori isolates with specific
RFLP types were predominant in different age groups.
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Affiliation(s)
- Gokben Ozbey
- Firat University, Vocational School of Health Services, Firat University, Elazig, Turkey, Vocational School of Health Services, Firat University, Elazig, Turkey
| | - Yasar Dogan
- Firat University, Department of Pediatric Gastroenterology, Faculty of Medicine, Firat University, Elazig, Turkey, Department of Pediatric Gastroenterology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Kaan Demiroren
- Firat University, Department of Pediatric Gastroenterology, Faculty of Medicine, Firat University, Elazig, Turkey, Department of Pediatric Gastroenterology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Ibrahim Hanifi Ozercan
- Firat University, Department of Pathology, Faculty of Medicine, Firat University, Elazig, Turkey, Department of Pathology, Faculty of Medicine, Firat University, Elazig, Turkey
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Pedullà M, Fierro V, Del Tufo E, Alfano R, Triassi M, Perrone L. Helicobacter pylori immunization and atopic dermatitis in South Italian children. United European Gastroenterol J 2014; 2:263-7. [PMID: 25083283 DOI: 10.1177/2050640614544314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 06/02/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The epidemiological decrease of Helicobacter pylori (Hp) infection has been recently associated to the increase of several extra-intestinal allergic disorders. OBJECTIVE We investigated the role of specific Hp IgG production in the development of IgE or not IgE mediated food allergy (FA) in children affected by atopic dermatitis (AD). METHODS From January 2010 to July 2013, 290 South Italian children, aged between 26 and 142 months, were consecutively referred to the Pediatric Clinic of the Pediatric Department at Second University of Naples and were diagnosed as affected by AD. The patients were classified in two groups on the basis of diagnosis of food allergy (88 FA affected and 202 not FA affected) and further divided on the basis of the diagnosis of atopy (63 IgE mediated and 23 not IgE mediated). Hp serum IgG was detected using an enzyme linked immunosorbent assay (ELISA) kit (Wampole® Helicobactor pylori IgG ELISA II, Wampole Laboratories, Cranbury, NJ) and Hp stool antigens using enzyme immunoassay (Premier Platinum HpSa plus, Cincinnati OH). RESULTS We found a statistically significant higher prevalence of Hp serology positivity in not FA vs. FA AD-affected children (p = 0.032) and a significant inverse association between FA and Hp immunization (1/OR 0.32 95% CI 0.11-0.95). Further, we identified an absolute prevalence Hp serology positivity in not-IgE-mediated rather than in IgE-mediated FA AD-affected patients (p = 0.0006). CONCLUSION We hypothesize that specific Hp IgG production could protect against the development of both FA and atopy in AD-affected children.
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Affiliation(s)
- Marcella Pedullà
- Department of Pediatrics "Francesco Fede" - Second University of Naples, Naples, Italy
| | - Vincenzo Fierro
- Department of Pediatrics "Francesco Fede" - Second University of Naples, Naples, Italy
| | - Ester Del Tufo
- Department of Pediatrics "Francesco Fede" - Second University of Naples, Naples, Italy
| | - Rossella Alfano
- Department of Public Health - University of Naples Federico II, Naples, Italy
| | - Maria Triassi
- Department of Public Health - University of Naples Federico II, Naples, Italy
| | - Laura Perrone
- Department of Pediatrics "Francesco Fede" - Second University of Naples, Naples, Italy
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Bastos J, Peleteiro B, Pinto H, Marinho A, Guimarães JT, Ramos E, La Vecchia C, Barros H, Lunet N. Prevalence, incidence and risk factors for Helicobacter pylori infection in a cohort of Portuguese adolescents (EpiTeen). Dig Liver Dis 2013; 45:290-5. [PMID: 23266208 DOI: 10.1016/j.dld.2012.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 11/04/2012] [Accepted: 11/18/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Helicobacter pylori infection is acquired mainly during childhood, but it may occur throughout life. Understanding the determinants of infection at different ages is essential to clarify dynamics of H. pylori related diseases and to design preventive strategies. AIM To estimate the prevalence of H. pylori infection at the age of 13 and the incidence after a 3-year follow-up and to identify risk factors for infection. SUBJECTS AND METHODS Adolescents born in 1990 were recruited in schools from Porto. Whole-cell anti-H. pylori IgG antibodies were quantified by ELISA. Prevalence ratios (PR) and incidence rate ratios (RR) adjusted for parental education were computed at baseline (n = 1312) and at follow-up (n = 280). RESULTS The prevalence was 66.2%, lower in subjects with more educated parents (PR = 0.72, 95%CI: 0.63-0.82), and higher for those having more than one sibling (PR = 1.10, 95%CI: 1.02-1.19) and for smokers (PR = 1.11, 95%CI: 1.02-1.20). The incidence was 4.1/100 person-years. Smoking (RR = 2.35, 95%CI: 1.16-4.75) and type of school (RR = 0.38, 95%CI: 0.16-0.95) were associated with the incidence of infection. CONCLUSIONS Prevalence and incidence of H. pylori infection were high, suggesting that gastric cancer will remain an important public health problem in this generation of Portuguese. We identified smoking as a modifiable risk factor for infection.
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Affiliation(s)
- Joana Bastos
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
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Muhsen K, Jurban M, Goren S, Cohen D. Incidence, age of acquisition and risk factors of Helicobacter pylori infection among Israeli Arab infants. J Trop Pediatr 2012; 58:208-13. [PMID: 21908868 DOI: 10.1093/tropej/fmr068] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We examined the age of acquisition of Helicobacter pylori infection in a prospective study that was conducted among 231 Israeli Arab children. Helicobacter pylori was identified in stool specimens collected at ages 2, 4, 6, 8, 12 and 18 months, using a monoclonal stool antigen immunoassay. Information on household characteristics, breastfeeding, antibiotic use and hygiene practices was obtained. The incidence of H. pylori infection was 33.3%. The estimated mean age of H. pylori infection acquisition was 14 months. The determinants of H. pylori infection were living in a low socioeconomic status (SES) village: OR 9.60 (95% CI 2.91-31.68, p < 0.001); low paternal education: OR 3.35 (95% CI 1.21-9.29, p = 0.02); and boiling feeding bottles and nipples at low frequency: OR 7.12 (95% CI 1.82-27.86, p = 0.005). In conclusion, H. pylori infection is acquired at a higher rate in low SES settings. Parental education and hygiene play an important role in H. pylori acquisition in infancy.
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Affiliation(s)
- Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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Zevit N, Balicer RD, Cohen HA, Karsh D, Niv Y, Shamir R. Inverse association between Helicobacter pylori and pediatric asthma in a high-prevalence population. Helicobacter 2012; 17:30-5. [PMID: 22221613 DOI: 10.1111/j.1523-5378.2011.00895.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Helicobacter pylori-associated disease has led to aggressive diagnostic and eradication protocols that are partially responsible for the decrease in prevalence of H. pylori carriage. Recent evidence indicates that in low-prevalence populations, H. pylori may have protective effects on allergic diseases. The aim of this study was to explore the relationship between pediatric asthma and H. pylori infection in a population with high prevalence of H. pylori infection. MATERIALS AND METHODS A national referral laboratory was screened for all (13) C urea breath tests performed in children aged 5-18 years between 2007 and 2008, for patient demographics and physician-diagnosed asthma. Data concerning asthma-associated medication usage were extracted from electronic medical records and databases. Data were analyzed using a stepwise logistic regression model. RESULTS During the study period, 6959 patients underwent urea breath testing (average age 12.4±3.5years). Of these, 3175/6959 (45.6%) were positive for H. pylori, and 578/6959 (8.3%) had asthma. Rates of asthma in H. pylori-positive and H. pylori-negative children were 7.3 and 9.1%, respectively (odds ratio 0.82; 95% confidence interval (CI) 0.69-0.98; p=.032). We also confirmed that male gender, urban residence, and age are associated with childhood asthma. CONCLUSIONS We demonstrate an inverse association between H. pylori and pediatric asthma in a population with a high prevalence of H. pylori.
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Affiliation(s)
- Noam Zevit
- Institute of Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel.
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Seroprevalence, correlates and trends of Helicobacter pylori infection in the Israeli population. Epidemiol Infect 2011; 140:1207-14. [PMID: 22014090 DOI: 10.1017/s0950268811002081] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We examined the prevalence, correlates and trends of H. pylori infection in Israel using residual sera obtained in 2007-2008 from 1466 Jewish subjects aged 0-77 years and 897 Arabs aged 0-19 years, and in 2000-2001 from 627 Jewish and 575 Arab subjects aged 0-19 years. H. pylori IgG antibodies were measured by ELISA. The age-adjusted H. pylori seroprevalence was 45.2% in Jewish participants. Seropositivity increased with age, reaching 60% at age ≥ 50 years and ranged from 24.3% in subjects originating from North America/Western Europe/Australia, to 63.2% in those from Asia/Africa/South America. Among Arabs, H. pylori seroprevalence was 42.1% and reached 65% in adolescents. There was no significant change in seroprevalence between 2000-2001 and 2007-2008. High prevalence of H. pylori was found in Arabs, and in Jews originating from countries of high H. pylori endemicity. These findings are characteristic of countries of diverse ethnic structure and recent immigration.
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Oleastro M, Pelerito A, Nogueira P, Benoliel J, Santos A, Cabral J, Lopes AI, Ramalho PM, Monteiro L. Prevalence and incidence of Helicobacter pylori Infection in a healthy pediatric population in the Lisbon area. Helicobacter 2011; 16:363-72. [PMID: 21923682 DOI: 10.1111/j.1523-5378.2011.00858.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Helicobacter pylori is mainly acquired in childhood. Although adult studies reported a high prevalence of H. pylori infection in Portugal, the actual rate in children remains unknown. This study aimed to determine the prevalence and the incidence of H. pylori infection in an asymptomatic pediatric population of the Lisbon area and to correlate prevalence with sociodemographic determinants. MATERIALS AND METHODS Helicobacter pylori infection was determined by stool antigen test in 844 asymptomatic children (age 0-15 years; 49.4% boys). For the incidence study, H. pylori-negative children in the prevalence study were followed-up every 6 months over a 3-year period. RESULTS The global prevalence of H. pylori infection was 31.6%, increasing with age (19.9, 37.0 and 51.5%, in age groups 0-5, 6-10, and 11-15, respectively), but was similar among genders (34.5% in boys and 28.4% in girls). Older age and attendance of nursery/kindergarten during preschool constituted independent risk factors. The overall estimated incidence was 11.6 per 100 child-years (CY). Although 47.5% of children acquired H. pylori infection before 5 years of age, the mean age of acquisition was 6.3. The incidence of infection was similar among the three age groups (11.5, 13.0, and 10.5 per 100 CY, in age groups 0-5, 6-10, and 11-15, respectively). CONCLUSIONS The prevalence of H. pylori infection in the Portuguese pediatric population is still high. Although this study confirmed that the highest acquisition rate occurs at young age, it showed that in high-prevalence populations, older children can also acquire H. pylori infection at a rate similar to that of young children.
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Affiliation(s)
- Mónica Oleastro
- Departamento de Doenças Infecciosas, Instituto Nacional Saúde Dr Ricardo Jorge, Lisboa, Portugal.
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Liu G, Xu X, He L, Ding Z, Gu Y, Zhang J, Zhou L. Primary antibiotic resistance of Helicobacter pylori isolated from Beijing children. Helicobacter 2011; 16:356-62. [PMID: 21923681 DOI: 10.1111/j.1523-5378.2011.00856.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The antimicrobials resistance of Helicobacter pylori (H. pylori) was able to sharply decline the eradication rate of H. pylori both in adults and children, but there are limited studies about the primary antibiotic resistance and the related gene mutations, specifically in China. MATERIALS AND METHODS The primary resistance to 9 antibiotics of 73 H. pylori strains isolated from gastric biopsies of children recruited at Beijing Children's Hospital was assessed, and the mutations in 23S rRNA gene of 65 macrolide-resistant strains and in gyrA and gyrB of 12 quinolone-resistant strains were investigated. RESULTS The resistance rate to clarithromycin, azithromycin, metronidazole, levofloxacin, moxifloxacin, and rifampicin was 84.9%, 87.7%, 61.6%, 13.7%, 15.1%, and 6.8%, respectively. No resistance to amoxicillin, gentamicin, and tetracycline was observed. Dual, triple, and quadruple antibacterial resistant percentage was 46.6% (34/73), 15.1% (11/73), and 2.7% (2/73), respectively. The gene mutation rate of A2142C, A2142G, and A2143G in 23S rRNA gene was 1.5% (1/65), 6.2% (4/65), and 84.6% (55/65), respectively. The detection rate of mutations of Asn87, Asp91, and Met191 in GyrA was 41.7% (5/12), 25% (3/12), and 25% (3/12), respectively. CONCLUSION The high prevalence of primary antibiotic resistance was out of expectation in H. pylori strains isolated from the children in Beijing. Antibiotic susceptibility should be made clear before the antibiotic was used in the anti-H. pylori therapy in this population. The A2143G was the most populated mutation in macrolide-resistant strains, and Asn87 and Asp91 of GyrA were the most common mutation points in quinolone resistance strains.
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Affiliation(s)
- Guodong Liu
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Tanih NF, Dube C, Green E, Mkwetshana N, Clarke AM, Ndip LM, Ndip RN. An African perspective on Helicobacter pylori: prevalence of human infection, drug resistance, and alternative approaches to treatment. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2010; 103:189-204. [PMID: 19341534 DOI: 10.1179/136485909x398311] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Helicobacter pylori is a Gram-negative, micro-aerophilic, motile, curved rod that inhabits the gastric mucosa of the human stomach. It chronically infects thousands of millions of people world-wide, and is one of the most genetically diverse of bacterial species. Infection with the bacterium leads to chronic gastritis, peptic ulceration, gastric cancers and gastric mucosa-associated lymphoid-tissue (MALT) lymphoma. The prevalence of infection appears to be partly determined by geographical and socio-demographic factors, being higher in Africa than elsewhere. Current treatment, based on potent combinations that each consist of a proton-pump inhibitor and two antibiotics, is successful in 80%-90% of patients. Some undesirable side-effects, poor patient compliance and drug resistance are, however, associated with significant levels of treatment failure and with contra-indications for some patients. Antibiotic resistance in H. pylori is a growing global concern that merits the urgent attention of public-health authorities. Numerous pieces of clinical evidence have revealed that eradication of the organism from a patient results in improvement of gastritis and drastically decreases the frequency of relapse of gastric and duodenal ulcers. Natural products, including medicinal plants and honey, may offer useful alternatives in the treatment of H. pylori-related infections.
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Affiliation(s)
- N F Tanih
- Microbial Pathogenicity and Molecular Epidemiology Research Group, Department of Biochemistry and Microbiology, Faculty of Science and Agriculture, University of Fort Hare, P.M.B. X1314, Alice 5700, South Africa
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Guarner J, Kalach N, Elitsur Y, Koletzko S. Helicobacter pylori diagnostic tests in children: review of the literature from 1999 to 2009. Eur J Pediatr 2010; 169:15-25. [PMID: 19618211 DOI: 10.1007/s00431-009-1033-x] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Accepted: 07/08/2009] [Indexed: 02/07/2023]
Abstract
The array of tests that can be used for diagnosis of Helicobacter pylori infection is large, and it can be confusing to define which test to use particularly in children where results may not be comparable to those obtained in adult patients. Using PubMed, we reviewed the English literature from January 1999 to May 2009 to identify articles that determined sensitivity and specificity of H. pylori invasive and non-invasive diagnostic tests in children. We excluded articles that presented a review of the literature, abstracts, case reports, or series where children's results could not be separated from adult populations. Of the tissue based methods, rapid urease tests have better sensitivity than histology to detect presence of H. pylori; however, histology can detect the pathology associated with disease including gastritis, intestinal metaplasia, and other conditions that could be the cause of the child's symptoms. Culture of gastric tissues or stool has 100% specificity but sensitivity is low. Of the serologic tests, immunoblot has the best sensitivity. The urea breath tests have >75% sensitivity for detection of H. pylori before and after treatment. Immunoassays in stool using monoclonal antibodies have >95% sensitivity for detection of H. pylori before and after treatment. PCR testing can be performed in tissue and stool samples and can detect genes associated to antibiotic resistance. In summary, the current commercial non-invasive tests have adequate sensitivity and specificity for detecting the presence of H. pylori; however, endoscopy with histopathology is the only method that can detect H. pylori and lesions associated with the infection.
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Affiliation(s)
- Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University Hospital (rm C179A), 1364 Clifton Rd, Atlanta, GA 30322, USA.
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Abstract
his review summarizes the articles published on Helicobacter pylori infection in children between April 2008 and March 2009. Recent evidence highlights the decreasing prevalence trend of H. pylori infection and supports both intrafamilial and extrafamilial transmission. The association with various symptoms is still being debated. Interestingly, H. pylori infection seems inversely associated with allergic diseases. Monoclonal stool antigen tests are widely used and accurate for the diagnosis of H. pylori infection, but less accurate in young children. The new biprobe real-time PCR assay applied to stools showed a poor sensitivity in children. Using the urea hydrolysis rate next to the delta over baseline values, the (13)C-urea breath test provides excellent results for all age children, even for young children. Treatment of H. pylori infection remains a challenge, considering suboptimal efficacy of current therapy. Among emerging alternatives, sequential treatment appears promising. The adjunction of probiotics to conventional regimens, although eliciting great interest, has shown limited therapeutic benefit.
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Affiliation(s)
- Angelika Kindermann
- Department of Pediatric Gastroenterology, Emma's Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
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Azevedo NF, Huntington J, Goodman KJ. The epidemiology of Helicobacter pylori and public health implications. Helicobacter 2009; 14 Suppl 1:1-7. [PMID: 19712161 DOI: 10.1111/j.1523-5378.2009.00703.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article presents a review of the literature on the epidemiology and public health implications of Helicobacter pylori infection published from April 2008 through to March 2009. The authors used MeSH terms "Helicobacter infections epidemiology,""Helicobacter infections prevention and control" to search multiple databases (PubMed, Embase, Cochrane, Cochrane Library, EBMR, BIOSIS), and independently searched PubMed using the term "Helicobacter" with "Epidemiology,""Transmission,""Prevalence" or "Environment." Articles without topical relevance were excluded. Two additional papers known to the authors were added. The identified literature is summarized by subtopic: reviews; prevalence; incidence; transmission; risk factors; and public health policy.
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Affiliation(s)
- Nuno F Azevedo
- LEPAE, Department of Chemical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
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