Helicobacter pylori Infection in Children: Nutritional Status and Associations with Serum Leptin, Ghrelin, and IGF-1 Levels

Effects of Helicobacter pylori Infection on Ghrelin and Insulin-like Growth Factor 1 Secretion in Children with Idiopathic Short Stature

BACKGROUND

A diagnosis of "idiopathic short stature" (ISS) in a child means that the cause of the disease has not been established, although there are certainly some unknown factors that contributed to its occurrence. Ghrelin and leptin are important in controlling food intake; ghrelin is also a growth hormone (GH) stimulator. Both enterohormones are produced in the stomach and their secretion may be affected by a Helicobacter pylori (H. pylori) infection.

METHODS

Our study included a group of 61 children (53 prepubertal and 8 peripubertal) with ISS, without any gastrointestinal tract symptoms but in whom the histopathological evaluation of stomach tissue was made during gastroscopy to diagnose H. pylori infection. In each child, fasting ghrelin, leptin and IGF-1 concentrations, and GH levels in two stimulation tests were assessed.

RESULTS

H. pylori infection was confirmed in 24.6% of the children. Ghrelin and IGF-1 concentrations were significantly lower in H. pylori-positive than H. pylori-negative children (this was more noticeable in prepubertal subgroups), however there was not a discrepancy in regards to GH concentrations in stimulation tests, leptin levels or the nutritional state between groups.

CONCLUSIONS

Short children, infected by H. pylori seem to have lower ghrelin and IGF-1 concentrations than children without infection, this may be the reason for a worse growth rate in this subgroup.

Development and Validation of a New Screening Tool with Non-Invasive Indicators for Assessment of Malnutrition Risk in Hospitalised Children

There is no evidence of the most effective nutritional screening tool for hospitalized children. The present study aimed to develop a quick, simple, and valid screening tool for identifying malnutrition risk of hospital admission with non-invasive indicators. A cross-sectional study was conducted. Children`s nutritional baseline using a questionnaire, subjective malnutritional risk, and Subjective Global Nutritional Assessment were assessed on admission. Concurrent validity was assessed using American Society for Parenteral and Enteral Nutrition (ASPEN)and Academy of Nutrition and Dietetics assessment and Subjective Global Nutritional Assessment tool. A new screening tool Simple Pediatric Nutritional risk Screening tool (SPENS) was developed, and sensitivity, specificity and reliability were evaluated. A total of 180 children aged from 1 month to 18 years were included (142 in the development phase and 38 in the validation phase). SPENS consist of four variables and shows almost perfect agreement with subjective malnutritional risk assessment (κ = 0.837) with high sensitivity and specificity (93.3% and 91.3% respectively). Compared with Subjective Global Nutritional Assessment and ASPEN and Academy of Nutrition and Dietetics assessment, SPENS had sensitivity 92.9% and 86.7%, a specificity of 87.5% and 87.0%, and an overall agreement of 0.78 and 0.728, respectively. Due to the fast, simple, easy, and practical to use, screening the SPENS can be performed by nurses, physicians, and dieticians.

Effect of Helicobacter Pylori Infection on Nutritional Status in Polish Teenagers

Purpose

Data on an association between Helicobacter pylori (H. pylori) and nutritional status in children are conflicting. We designed a large-sampled prospective community-based study to examine the differences in average body indices among Polish teenagers depending on their H. pylori status.

Methods

From September 2008 to June 2015, 3067 second junior high school students aged between 13 and 17 years (mean age: 14.5) from 11 randomly selected schools from Grudziadz, Poland, were recruited. For the cohort, ¹³C urea breath test for current H. pylori infection was performed and data on anthropometric measurements and sociodemographic characteristics were collected. Z scores of height for age (HAZ), weight for age (WAZ), and BMI for age (BMIZ) were calculated.

Results

The H. pylori colonisation rate was 23.6% with no gender difference. Compared to noninfected, H. pylori infected had significantly lower mean WAZ (0.0085) and BMIZ scores (p = 0.0246). Univariate linear regression models showed that living in the old town district and consumption of tap water were negative predictors of HAZ, living in the old town district, using collective catering facilities, and H. pylori infection were negative predictors of WAZ, and using collective catering facilities and H. pylori infection were negative predictors of BMIZ. In the multiple regression analyses, living in the old town district (p = 0.0039), using collective catering facilities (p < 0.0001), and H. pylori infection (p = 0.0269) were confirmed to be independently associated with lower WAZ, whereas using collective catering facilities (p < 0.0001) and H. pylori infection (p = 0.0265) were confirmed to be independently associated also with lower BMIZ.

Conclusion

Our finding confirms the evidence on independent negative influence of H. pylori infection on nutritional status in Polish teenagers.

Correlation Analysis of Helicobacter pylori Infection and Digestive Tract Symptoms in Children and Related Factors of Infection

BACKGROUND

To analyze the correlation between Helicobacter pylori infection and digestive tract symptoms in children and other related factors, and to explore the risk factors of H. pylori infection in children and the expression of inflammatory factors in H. pylori-positive and H. pylori-negative children.

METHODS

Overall, 234 children with H. pylori test in Xuzhou Children's Hospital, Xuzhou Medical University (Xuzhou, China) were enrolled. Among them, 73 children were H. pylori-positive and 161 were H. pylori-negative. The expression levels of cytokines interleukin-8 (IL-8), interleukin-18 (IL-18) and interferon-γ (IFN-γ) in H. pylori-positive and H. pylori-negative children were determined by ELISA. The correlation between H. pylori-positive and general data, digestive tract symptoms, other clinical symptoms, living habits, eating habits, family history and other related factors was statistically analyzed. Multivariate Logistic regression analysis was used to analyze the independent risk factors of H. pylori infection in children.

RESULTS

Family monthly income, inattentive eating, sharing toothbrushes and cups, gnawing fingers, eating fried food, drinking raw water, eating smoked and pickled food, father suffering from gastropathy and mother suffering from gastropathy were independent risk factors for H. pylori infection in children. The most common digestive tract symptoms of children with H. pylori infection were abdominal pain, accompanied by one or more clinical symptoms. The expression levels of IL-8, IL-18 and IFN-γ in H. pylori-positive children were significantly higher than those in H. pylori-negative children.

CONCLUSION

Prevention of H. pylori infection in children is helpful for healthy growth of children, and cytokines IL-8, IL-18, IFN-γ have the potential to be used as biomarkers for diagnosis of H. pylori-positive children.

No association between Helicobacter pylori infection and gastrointestinal complaints in a large cohort of symptomatic children

AIM

This Polish study estimated the prevalence of the Helicobacter pylori infection in symptomatic children aged 3-18 and investigated its association with gastrointestinal complaints.

METHODS

We prospectively enrolled 1984 children (54% female) with a mean age of 9.5 ± 4.1 years, from Silesia, Poland, for the Good Diagnosis Treatment Life screening programme from 2009 to 2016. They underwent a ¹³ C-isotope-labelled urea breath test (UBT) to assess their Helicobacter pylori status, making this the biggest Polish study to use this approach. Further analysis included parental-reported gastrointestinal symptoms and standard deviation scores (SDS) of anthropometric measurements.

RESULTS

The Helicobacter pylori infection was identified in 220 (11%) children (48% female) and was independent of age and sex. The frequency of symptoms did not differ between Helicobacter positive and negative children (all p > 0.05). Children with a positive UBT result had a lower body mass SDS (-0.41 ± 0.98 versus -0.26 ± 1.01, p = 0.04) and height SDS (-0.45 ± 1.34 versus -0.23 ± 1.27, p = 0.02), but similar body mass index SDS.

CONCLUSION

We found a low prevalence of Helicobacter pylori in symptomatic children, and positive UBT results were not associated with symptoms that suggested Helicobacter pylori infections. Our findings support the 2017 European and North American guidelines for Helicobacter infections in children.

The association of garlic with Helicobacter pylori infection and gastric cancer risk: A systematic review and meta-analysis

BACKGROUND

Garlic may be protective against Helicobacter pylori infection and gastric cancer development. We conducted this study to quantitatively update evidence on garlic intake and gastric cancer with the inclusion of most recent cohort studies and qualitatively summarize epidemiological studies of garlic consumption and Helicobacter pylori infection.

MATERIALS AND METHODS

PubMed, Embase, MEDLINE, and Cochrane Library were searched on April 2018. We conducted a meta-analysis to determine whether garlic intake reduced gastric cancer risk using random-effect models and a systematic review to summarize evidence on the association between garlic consumption and Helicobacter pylori infection. Risk of bias was assessed using tools of Cochrane risk of bias and Robins-I for randomized and nonrandomized studies, respectively.

RESULTS

Meta-analysis of 18 studies (142 921 subjects) demonstrated high garlic consumption (as comparing the highest category to the lowest) was associated with a reduced gastric cancer risk (OR = 0.51, 95% CI = 0.44-0.57). This association became nonsignificant if only derived from the prospective studies (OR = 0.95, 95% CI = 0.66-1.24). Thirteen studies (4889 participants) were included in the systematic review for garlic consumption and Helicobacter pylori infection; ten of which found no significant results. The majority of these studies were poor in quality given the small sample size and high risk of bias.

CONCLUSIONS

Pooled evidence, mainly from case-control studies, suggested a significant inverse association of garlic intake with gastric cancer risk. Given the limitations of included studies, current epidemiological evidence is not sufficient to reach any definite conclusion regarding the association of garlic with Helicobacter pylori infection.

Helicobacter pylori Infection in Pediatric Patients: Update on Diagnosis and Eradication Strategies

Helicobacter pylori infection is acquired mainly in childhood and remains an essential cause of peptic ulcer disease and gastric cancer. This article provides commentary on the last ESPGHAN/NASPGHAN guidelines and on publications made after the consensus conference of 2015. The majority of infected children are asymptomatic and pediatric studies do not support a role for H. pylori in functional disorders such as recurrent abdominal pain. The role of H. pylori infection in failure to thrive, children's growth, type I diabetes mellitus (T1DM), and celiac disease remains controversial. The diagnosis of infection should be based on upper-digestive endoscopy with biopsy-based methods. Eradication control after treatment should be based on validated non-invasive tests. Nodular gastritis is the main endoscopic finding of childhood H. pylori infection, but gastroduodenal erosions/ulcers are seen in some children, especially after 10 years of age. When indicated, eradication treatment should be given when good compliance is expected and based on the antimicrobial susceptibility profile.

Review: Prevalence and dynamics of Helicobacter pylori infection during childhood

INTRODUCTION

Long-term persistent Helicobacter pylori infection has been associated with ulceropeptic disease and gastric cancer. Although H. pylori is predominantly acquired early in life, a clear understanding of infection dynamics during childhood has been obfuscated by the diversity of populations evaluated, study designs, and methods used.

AIM

Update understanding of true prevalence of H. pylori infection during childhood, based on a critical analysis of the literature published in the past 5 years.

METHODS

Comprehensive review and meta-analysis of original studies published from 2011 to 2016.

RESULTS

A MEDLINE^® /PubMed^® search on May 1, 2016, using the terms pylori and children, and subsequent exclusion, based on abstract review using predefined criteria, resulted in 261 citations. An Embase^® search with the same criteria added an additional 8 citations. In healthy children, meta-analysis estimated an overall seroprevalence rate of 33% (95% CI: 27%-38%). Seven healthy cohort studies using noninvasive direct detection methods showed infection prevalence estimates ranging from 20% to 50% in children ≤5 and 38% to 79% in children >5 years. The probability of infection persistence after a first positive sample ranged from 49% to 95%. Model estimates of cross-sectional direct detection studies in asymptomatic children indicated a prevalence of 37% (95% CI: 30%-44%). Seroprevalence, but not direct detection rates increased with age; both decreased with increasing income. The model estimate based on cross-sectional studies in symptomatic children was 39% (95% CI: 35%-43%).

CONCLUSIONS

The prevalence of H. pylori infection varied widely in the studies included here; nevertheless, model estimates by detection type were similar, suggesting that overall, one-third of children worldwide are or have been infected. The few cohort and longitudinal studies available show variability, but most studies, show infection rates over 30%. Rather surprisingly, overall infection prevalence in symptomatic children was only slightly higher, around 40%. Studies including only one positive stool sample should be interpreted with caution as spontaneous clearance can occur.

Helicobacter pylori infection in children

Helicobacter pylori infection in children differs from that in adults, from the point of view of epidemiology, host response, clinical features, related diseases, and diagnosis, as well as treatment strategies. The prevalence of H. pylori infection, in both children and adults, is decreasing in the Western World as well as in some developing countries, which contrasts with the increase in childhood asthma and allergic diseases. Recurrent abdominal pain is not specific during H. pylori infection in children. The role of H. pylori infection and failure to thrive, children's growth, type I diabetes mellitus (T1DM) and celiac disease remains controversial. The main initial diagnosis is based on upper digestive endoscopy with biopsy-based methods. Nodular gastritis may be a pathognomonic endoscopic finding of childhood H. pylori infection. The infection eradication control is based on validated noninvasive tests. The main cause of treatment failure of H. pylori infection is its clarithromycin resistance. We recommend standard antibiotic susceptibility testing of H. pylori in pediatric patients prior to the initiation of eradication therapy. H. pylori treatment in children should be based on an evaluation of the rate of eradication in the local population, a systematic use of a treatment adapted to the susceptibility profile and a treatment compliance greater than 90%. The last meta-analysis in children did not show an advantage for sequential therapy when compared to a 14-day triple therapy. Finally, the high rate of antibiotic resistance responsible for therapy failure in recent years justifies the necessity of a novel vaccine to prevent H. pylori infection in children.

Helicobacter pylori infection is not associated with failure to thrive: a case control study

Purpose

The long-term impact of Helicobacter pylori infection is complex, and concerns about the need for eradication exist. We conducted this case control study to investigate the association between H. pylori infection and failure to thrive (FTT).

Patients and methods

From January 2009 to December 2011, 53 children with FTT group and matched children with the same sex and age and similar socioeconomic status without FTT (control group) were enrolled. A questionnaire was administered to the parents/guardian, and a ¹³C-urea breath test was performed to detect H. pylori infection.

Results

We found that the total prevalence of H. pylori infection was 29.2% and that there was no association between FTT and H. pylori infection (FTT group: 32%; control group: 26.4%; P=0.67). Short stature was more common in the FTT group and abdominal pain in the control group (FTT group: 37.7%; control group: 11.3%; P=0.003). In a comparison between the H. pylori-positive and -negative groups, abdominal pain (87.1% vs 64%; P=0.032) and the frequency of endoscopy (74.2% vs 32%; P<0.001) were significantly more common in the H. pylori-positive group.

Conclusion

We found that children with H. pylori infection are at an increased risk for abdominal pain and that FTT is not associated with H. pylori infection. The decision for eradication should be evaluated carefully and individualized.

Role of Helicobacter pylori Infection in Body Height of Adult Dyspeptic Patients

INTRODUCTION

The prevalence of H. pylori infection is high in underdeveloped countries and is associated with growth retardation. In the first half of the 20th century, Sardinia was an underdeveloped region; however, more recent development resulted in a decline in H. pylori infection. Because body height is correlated with health and nutritional status in childhood, the association among H. pylori infection and height was explored.

MATERIALS AND METHODS

A retrospective observational study was conducted involving patients undergoing endoscopy for dyspepsia from 2002 to 2012. H. pylori status was assessed by histology plus the rapid urease test or 13Carbon-urea breath test.

RESULTS

Body height and H. pylori status were assessed in 5045 adult patients: 3257 (64.6%) were women. Patients born after 1950 showed a significant increase in height (average 3.22 cm) compared to patients born before 1950 (163.93 vs 160 cm; 95% confidence interval, CI = 2.74-3.70 cm) (p < .0001). H. pylori-infected patients were nearly 1 cm shorter than uninfected patients (95% CI = -1.35 to·-0.09 cm) (p = .012). The multivariate linear regression analysis showed male gender, birth cohort, and occupational categories to be strongly associated with height, while the weak effect of H. pylori infection disappeared.

CONCLUSIONS

Our results demonstrate a strong secular trend related to body height in Sardinia with a minimal influence of H. pylori infection.

Helicobacter pylori in children

Helicobacter pylori infection in early childhood may differ in many aspects compared to infection in adulthood: the immune response in the gut, the type and prevalence of complications within and outside the stomach, and the impact on long-term health. In high prevalence countries, transient infections seem to be common in infants and toddlers, and the consequences of this phenomenon on the short- and long-term immune response are still unclear. Other controversial issues are related to the question of which H. pylori-infected children benefit from treatment and which is the best regimen to eradicate the infection in the presence of a worldwide increasing antibiotic resistance. The first large-scale randomized placebo-controlled vaccination trial in schoolchildren indicates that prevention of the infection may be possible.

Cytokines, adipocytokines and inflammatory markers in patients on continuous ambulatory peritoneal dialysis and hemodialysis

BACKGROUND

Cytokines are essential mediators of immune response. Chronic renal failure patients suffer from chronic inflammation that results from factors such as impaired renal function, accumulation of uremic toxins and bio incompatibility of dialyzer membranes. These patients are also at increased risk of cardiovascular diseases. We have evaluated cytokines, adipocytokines and inflammatory markers in patients with chronic renal failure undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD).

MATERIAL AND METHODS

We have determined serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), leptin and ghrelin levels of chronic renal failure patients treated with either HD (n = 20) or CAPD (n = 20). TNF-α, IL-6, ghrelin and leptin measurements were performed by commercially available kits based on enzyme-linked immunosorbent assay (ELISA) method. hsCRP levels were determined by turbidimetric methods.

RESULTS

Serum TNF-α and IL-6 levels of patients on HD were significantly higher than those of the ones on CAPD (p < 0.05). Ghrelin, leptin and hsCRP concentrations were similar in both groups.

CONCLUSIONS

We can conclude that cytokine production is more obvious in HD process.