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Seo JH, Park JS, Rhee KH, Youn HS. Diagnosis of Helicobacter pylori Infection in Children and Adolescents in Korea. Pediatr Gastroenterol Hepatol Nutr 2018; 21:219-233. [PMID: 30345235 PMCID: PMC6182473 DOI: 10.5223/pghn.2018.21.4.219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori plays an important role in the pathogenesis of chronic gastritis, peptic ulcer disease, gastric cancer, and gastric mucosa-associated lymphoid tissue lymphoma. In Korea, the guidelines for the diagnosis and treatment of H. pylori infection in adults were revised in 2013. The European Helicobacter and Microbiota Study Group and Consensus panel released the fifth edition of the Maastricht Consensus Report for the management of H. pylori infection in 2015, and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition and the North American Society of Paediatric Gastroenterology, Hepatology and Nutrition released the updated joint guidelines for children and adolescents in 2016. Considering these recommendations and recent progress in our research and that of other research teams, this study aimed to discuss the diagnostic strategies for H. pylori infection in children and adolescents.
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Affiliation(s)
- Ji-Hyun Seo
- Department of Pediatrics, Gyeongsang National Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Ji-Sook Park
- Department of Pediatrics, Gyeongsang National Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Kwang-Ho Rhee
- Department of Microbiology, Gyeongsang National Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Hee-Shang Youn
- Department of Pediatrics, Gyeongsang National Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea
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Zabala Torrres B, Lucero Y, Lagomarcino AJ, Orellana-Manzano A, George S, Torres JP, O'Ryan M. Review: Prevalence and dynamics of Helicobacter pylori infection during childhood. Helicobacter 2017. [PMID: 28643393 DOI: 10.1111/hel.12399] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Beatriz Zabala Torrres
- Microbiology and Mycology Program, Faculty of Medicine, Institute of Biomedical Sciences, Universidad de Chile, Santiago, Chile.,Universidad de Aysén, Campus Rio Simpson, Coyhaique, Chile
| | - Yalda Lucero
- Department of Pediatrics, Faculty of Medicine, Hospital Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
| | - Anne J Lagomarcino
- Microbiology and Mycology Program, Faculty of Medicine, Institute of Biomedical Sciences, Universidad de Chile, Santiago, Chile
| | - Andrea Orellana-Manzano
- Escuela Superior Politécnica del Litoral, ESPOL, Facultad de Ciencias de la Vida (FCV), Campus Gustavo Galindo Km. 30.5 Vía Perímetral, P. O. Box 09-01-5863, Guayaquil, Ecuador
| | - Sergio George
- Microbiology and Mycology Program, Faculty of Medicine, Institute of Biomedical Sciences, Universidad de Chile, Santiago, Chile
| | - Juan P Torres
- Department of Pediatrics, Faculty of Medicine, Hospital Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
| | - Miguel O'Ryan
- Microbiology and Mycology Program, Faculty of Medicine, Institute of Biomedical Sciences, Universidad de Chile, Santiago, Chile
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Seo JH, Lim CW, Park JS, Yeom JS, Lim JY, Jun JS, Woo HO, Youn HS, Baik SC, Lee WK, Cho MJ, Rhee KH. Correlations between the CagA Antigen and Serum Levels of Anti-Helicobacter pylori IgG and IgA in Children. J Korean Med Sci 2016; 31:417-22. [PMID: 26955243 PMCID: PMC4779867 DOI: 10.3346/jkms.2016.31.3.417] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/10/2015] [Indexed: 11/20/2022] Open
Abstract
We tested correlations between anti-Helicobacter pylori IgG and IgA levels and the urease test, anti-CagA protein antibody, degree of gastritis, and age. In total, 509 children (0-15 years) were enrolled. Subjects were stratified as 0-4 years (n = 132), 5-9 years (n = 274), and 10-15 years (n = 103) and subjected to the urease test, histopathology, ELISA, and western blot using whole-cell lysates of H. pylori strain 51. The positivity rate in the urease test (P = 0.003), the degree of chronic gastritis (P = 0.021), and H. pylori infiltration (P < 0.001) increased with age. The median titer for anti-H. pylori IgG was 732.5 IU/mL at 0-4 years, 689.0 IU/mL at 5-9 years, and 966.0 IU/mL at 10-15 years (P < 0.001); the median titer for anti-H. pylori IgA was 61.0 IU/mL at 0-4 years, 63.5 IU/mL at 5-9 years, and 75.0 IU/mL at 10-15 years (P < 0.001). The CagA-positivity rate was 26.5% at 0-4 years, 36.5% at 5-9 years, and 46.6% at 10-15 years for IgG (P = 0.036), and 11.3% at 0-4 years, 18.6% at 5-9 years, and 23.3% at 10-15 years for IgA (P < 0.001). Anti-H. pylori IgG and IgA titers increased with the urease test grade, chronic gastritis degree, active gastritis, and H. pylori infiltration. Presence of CagA-positivity is well correlated with a high urease test grade and high anti-H. pylori IgG/IgA levels.
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Affiliation(s)
- Ji-Hyun Seo
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| | - Chun Woo Lim
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| | - Ji Sook Park
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| | - Jung Sook Yeom
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| | - Jae-Young Lim
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| | - Jin-Su Jun
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| | - Hyang-Ok Woo
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| | - Hee-Shang Youn
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| | - Seung-Chul Baik
- Department of Microbiology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| | - Woo-Kon Lee
- Department of Microbiology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| | - Myung-Je Cho
- Department of Microbiology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| | - Kwang-Ho Rhee
- Department of Microbiology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
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Seo JH, Park HK, Park JS, Yeom JS, Lim JY, Park CH, Woo HO, Youn HS, Jun JS, Ko GH, Baik SC, Lee WK, Cho MJ, Rhee KH. Association between Gastric pH and Helicobacter pylori Infection in Children. Pediatr Gastroenterol Hepatol Nutr 2015; 18:246-52. [PMID: 26770899 PMCID: PMC4712537 DOI: 10.5223/pghn.2015.18.4.246] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 09/01/2015] [Accepted: 09/15/2015] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To assess gastric pH and its relationship with urease-test positivity and histological findings in children with Helicobacter pylori infection. METHODS Fasting gastric juices and endoscopic antral biopsy specimens were collected from 562 children and subjected to the urease test and histopathological examination. The subjects were divided into 3 age groups: 0-4, 5-9, and 10-15 years. The histopathological grade was assessed using the Updated Sydney System, while the gastric juice pH was determined using a pH meter. RESULTS The median gastric juice pH did not differ significantly among the age groups (p=0.655). The proportion of individuals with gastric pH >4.0 was 1.3% in the 0-4 years group, 6.1% in the 5-9 years group, and 8.2% in 10-15 years (p=0.101). The proportions of moderate and severe chronic gastritis, active gastritis, and H. pylori infiltration increased with age (p<0.005). Urease-test positivity was higher in children with hypochlorhydria (77.8%) than in those with normal gastric pH (31.7%) (p<0.001). Chronic and active gastritis were more severe in the former than the latter (p<0.001), but the degree of H. pylori infiltration did not differ (20.9% vs. 38.9%; p=0.186). CONCLUSION Gastric pH while fasting is normal in most children regardless of age. Urease-test positivity may be related to hypochlorhydria in children, and hypochlorhydria is in turn related to H. pylori infection.
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Affiliation(s)
- Ji-Hyun Seo
- Department of Pediatrics, Gyeongsang National University Hospital and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Heung Keun Park
- Department of Pediatrics, Gyeongsang National University Hospital and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ji Sook Park
- Department of Pediatrics, Gyeongsang National University Hospital and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jung Sook Yeom
- Department of Pediatrics, Gyeongsang National University Hospital and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jae-Young Lim
- Department of Pediatrics, Gyeongsang National University Hospital and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chan-Hoo Park
- Department of Pediatrics, Gyeongsang National University Hospital and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hyang-Ok Woo
- Department of Pediatrics, Gyeongsang National University Hospital and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hee-Shang Youn
- Department of Pediatrics, Gyeongsang National University Hospital and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jin-Su Jun
- Department of Pediatrics, Gyeongsang National University Hospital and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Gyung-Hyuck Ko
- Department of Pathology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Seung-Chul Baik
- Department of Microbiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Woo-Kon Lee
- Department of Microbiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Myung-Je Cho
- Department of Microbiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kwang-Ho Rhee
- Department of Microbiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
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Seo JH, Park JS, Rhee KH, Youn HS. Limitations of urease test in diagnosis of pediatric Helicobacter pylori infection. World J Clin Pediatr 2015; 4:143-147. [PMID: 26566487 PMCID: PMC4637805 DOI: 10.5409/wjcp.v4.i4.143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 08/13/2015] [Accepted: 09/16/2015] [Indexed: 02/06/2023] Open
Abstract
The diagnosis of Helicobacter pylori (H. pylori) infection is usually based on the results of urease test and histology. The urease test known as a simple and cheap method does not need special skills to perform or to read the result. The time needed for the test to turn positive depends on the concentration of bacteria, and the accuracy is up to the density of H. pylori density in the biopsy sample, which is generally lower in children than adolescents and adults. Therefore, there are debates about the sensitivity of the urease test in children. The reason for lower sensitivity of the urease test in children was not identified, but might be related to the low density and patchy distribution of bacteria. In this review, we discuss the limitations of the urease test in children according to age, histology, number of biopsy samples, and biopsy site. In children under 5 years old, the differences in positivity rate when the urease test used one or three biopsy samples, and samples from the antrum or the gastric body, were larger than those in children aged 5-15 years. Thus, three or more biopsy samples from both the antrum and body would improve the sensitivity of H. pylori infection diagnosis in children under 5 years old.
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Abstract
This review concerns important pediatric studies published from April 2013 to March 2014. New data on pathogenesis have demonstrated that Th1 type cytokine secretion at the gastric level is less intense in children compared with adults. They have also shown that the most significant risk factor for Helicobacter pylori infection is the parents' origin and frequency of childcare in settings with a high prevalence of infection. A new hypothesis on the positive relationship between childhood H. pylori infection and the risk of gastric cancer in adults has been suggested which calls for an implementation of preventive programs to reduce the burden of childhood H. pylori infection in endemic areas. Several studies have investigated the role of H. pylori infection in iron-deficiency anemia, and results support the role of the bacterium in this condition. Antibiotic resistance is an area of intense research with data confirming an increase in antibiotic resistance, and the effect of CYP2C19 genetic polymorphism on proton-pump inhibitor metabolism should be further investigated as cure rates are lower in extensive metabolizers. Studies confirmed that probiotic supplementation may have beneficial effects on eradication and therapy-related side effects, particularly diarrhea in children.
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Affiliation(s)
- Barbara Iwańczak
- Department of Pediatrics, Gastroenterology and Nutrition, Medical University of Wroclaw, Wrocław, Poland
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Seo JH, Park JS, Yeom JS, Lim JY, Park CH, Woo HO, Baik SC, Lee WK, Cho MJ, Rhee KH, Youn HS. Correlation between positive rate and number of biopsy samples on urease test in childhood Helicobacter pylori infection. J Korean Med Sci 2014; 29:106-9. [PMID: 24431913 PMCID: PMC3890459 DOI: 10.3346/jkms.2014.29.1.106] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 11/01/2013] [Indexed: 12/24/2022] Open
Abstract
To identify the correlation between the number of gastric biopsy samples and the positive rate, we compared the results of urease test using one and three biopsy samples from each 255 children who underwent gastroduodenoscopy at Gyeongsang National University Hospital. The children were divided into three age groups: 0-4, 5-9, and 10-15 yr. The gastric endoscopic biopsies were subjected to the urease test. That is, one and three gastric antral biopsy samples were collected from the same child. The results of urease test were classified into three grades: Grade 0 (no change), 1 (6-24 hr), 2 (1-6 hr), and 3 (<1 hr). The positive rate of urease test was increased by the age with no respect to the number of gastric biopsy samples (one biopsy P = 0.001, three biopsy P < 0.001). The positive rate of the urease test was higher on three biopsy samples as compared with one biopsy sample (P < 0.001). The difference between one and three biopsy samples was higher in the children aged 0-9 yr. Our results indicate that the urease test might be a more accurate diagnostic modality when it is performed on three or more biopsy samples in children.
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Affiliation(s)
- Ji-Hyun Seo
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Ji Sook Park
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Jung Sook Yeom
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Jae-Young Lim
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Chan-Hoo Park
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Hyang-Ok Woo
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Seung-Chul Baik
- Department of Microbiology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Woo-Kon Lee
- Department of Microbiology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Myung-Je Cho
- Department of Microbiology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Kwang-Ho Rhee
- Department of Microbiology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Hee-Shang Youn
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Sciences, Jinju, Korea
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