Helicobactor pylori: Infection vs. Disease
ABSTRACT & COMMENTARY
Synopsis: Helicobacter pylori infection was found in 13.7% of children 5-8 years of age. Most H. pylori infection was asymptomatic and did not correlate with presence of specific gastrointestinal symptoms. There is a limited role for H. pylori diagnostic testing and treatment in children with nonspecific abdominal pain.
Source: Bode G,et al. Helicobacter pylori and abdominal symptoms: A population-based study among preschool children in Southern Germany. Pediatrics 1998;101:634-637.
The prevalence of Helicobacter pylori infection in children 5-8 years of age in southern Germany was determined using the 13C-urea breath test. Overall, 118 of 863 children (13.7%) were infected. The frequency of abdominal symptoms (abdominal pain, nausea, vomiting, diarrhea, flatulence, burping, and lack of appetite) for the preceding three months was determined by self-administered questionnaire and was correlated to H. pylori infection. The frequency of abdominal pain (P = 0.31) was similar for H. pylori-infected and uninfected children, but vomiting (P = 0.066) and diarrhea (P = 0.015) were actually more likely in H. pylori-uninfected children than in H. pylori-infected children. Using a symptom score that incorporated frequency of each symptom, higher scores (increased frequency) were found in H. pylori-uninfected children (P = 0.009).
COMMENT BY HAL B. JENSON, MD, FAAP
The recognition of H. pylori as the etiologic agent of gastritis in the mid-1980s raised expectations that this organism might also be the cause of vague or recurrent abdominal pain in children, and, therefore, these conditions may be treatable and curable. Some studies have suggested that epigastric abdominal pain, nighttime awakening with abdominal pain, and vomiting may indicate H. pylori infection. Unfortunately, several larger studies have found that there are no clinical symptoms that are specific for H. pylori infection in children.
The diagnosis of H. pylori infection has required additional laboratory testing. The currently available tests include serologic testing for H. pylori antibodies and endoscopy with biopsy for histological examination, culture, or rapid testing for urease. H. pylori is the most potent urease producer of any microbe. The 13C-urea breath test used in this study is a non-invasive test for detection of labeled CO2 in exhaled breath before and after ingestion of urea labeled with a nonradioactive, stable isotope. This test detects active H. pylori infection but is not currently available outside research studies.
The results of this study show that most H. pylori infection in children is asymptomatic and not associated with specific abdominal symptoms, and that vague abdominal symptoms are unlikely to be associated with H. pylori.
Infection with H. pylori in young children is quite common. The prevalence in young children in this cross-sectional study was 13.7%. The seroprevalence in other studies has ranged from approximately 5% in the United States to 40-60% in developing countries. However, even in the presence of documented H. pylori infection, disease appears to be quite uncommon in young children. H. pylori does, however, remain an important candidate for developing a vaccine, since minimizing primary and recurrent infection may reduce the incidence of H. pylori-associated gastritis and the risk of gastric adenocarcinoma and lymphoma.
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