RESUMEN
BACKGROUND: Decreasing prevalence of H pylori infection has been reported in some countries. AIM: To evaluate the prevalence of Helicobacter pylori infection in a 10-year period in children submitted to upper digestive endoscopy. METHODS: It was a retrospective observational study. The records of 1,165 endoscopies performed during a 10-year period in a public hospital of the City of São Paulo, SP, Brazil, in patients up to 18-year-old. Only the first endoscopy was considered. Helicobacter pylori infection was defined by the rapid urease test, performed with one fragment of antral mucosa. Chi-square for trend has been estimated to compare Helicobacter pylori prevalence across the period. RESULTS: The main indication for endoscopy was epigastric pain (47.4%). There were 392 patients with H pylori infection (33.6%), 12.8% being infants, 19.4% toddlers, 28.8% schoolchildren and 46.3% adolescents. Prevalence was 60.47% in the first year of the study and 30.43% in the last. Among the less than 6-year-old patients there was a decrease in infection prevalence from 25% for the 1993--6 period to 14.3% in the 2000--02 period, while among the over 12-year-old patients the decrease was from 55.5% in the first period to 39.6% in the latter. The decrease in H pylori infection prevalence was more intense within patients with epigastric pain, in which prevalence has decreased from 48.2% (92/191) in 1993--6, to 41.9% (65/155) in 1997--9 and 27.7% (57/206) in 2000--02. CONCLUSION: The study suggests a significant decrease in the prevalence of H pylori infection regarding the studied patients. The trend was mainly observed in the younger age group and in patients with epigastric pain.
Asunto(s)
Infecciones por Helicobacter/epidemiología , Helicobacter pylori , Adolescente , Brasil/epidemiología , Niño , Preescolar , Gastroscopía , Infecciones por Helicobacter/diagnóstico , Humanos , Lactante , Prevalencia , Estudios Retrospectivos , Adulto JovenRESUMEN
AIM: To evaluate the furazolidone-based triple therapy in children with symptomatic H pylori gastritis. METHODS: A prospective and consecutive open trial was carried out. The study included 38 patients with upper digestive symptoms sufficiently severe to warrant endoscopic investigation. H pylori status was defined based both on histology and on positive (13)C-urea breath test. Drug regimen was a seven-day course of omeprazole, clarithromycin and furazolidone (100 mg, 200 mg if over 30 kg) twice daily. Eradication of H pylori was assessed two months after treatment by histology and (13)C -urea breath test. Further clinical evaluation was performed 7 d, 2 and 6 mo after the treatment. RESULTS: Thirty-eight patients (24 females, 14 males) were included. Their age ranged from 4 to 17.8 (mean 10.9 +/- 3.7) years. On intent-to-treat analysis (n = 38), the eradication rate of H pylori was 73.7% (95% CI, 65.2%-82%) whereas in per-protocol analysis (n = 33) it was 84.8% (95% CI, 78.5%-91%). All the patients with duodenal ulcer (n = 7) were successfully treated (100% vs 56.2% with antral nodularity). Side effects were reported in 26 patients (68.4%), mainly vomiting (14/26) and abdominal pain (n = 13). Successfully treated dyspeptic patients showed improvement in 78.9% of H pylori-negative patients after six months and in 50% of H pylori-positive patients after six months of treatment. CONCLUSION: Triple therapy with furazolidone achieves moderate efficacy in H pylori treatment. The eradication rate seems to be higher in patients with duodenal ulcer.
Asunto(s)
Antiinfecciosos/uso terapéutico , Furazolidona/uso terapéutico , Gastritis/tratamiento farmacológico , Gastritis/microbiología , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Adolescente , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Antiinfecciosos/efectos adversos , Antiulcerosos/efectos adversos , Antiulcerosos/uso terapéutico , Niño , Preescolar , Claritromicina/efectos adversos , Claritromicina/uso terapéutico , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Úlcera Duodenal/microbiología , Femenino , Furazolidona/efectos adversos , Gastritis/etiología , Infecciones por Helicobacter/complicaciones , Humanos , Masculino , Omeprazol/efectos adversos , Omeprazol/uso terapéutico , Estudios ProspectivosRESUMEN
CONTEXT: Although Helicobacter pylori infection is prevalent in our country, there are few studies evaluating the associated histological abnormalities in children. OBJECTIVE: To evaluate the histological features of the gastric mucosa in children and adolescents with Helicobacter pylori gastritis. METHODS: One hundred and thirty two gastric biopsies from 22 symptomatic patients infected with H. pylori (14F/8M, median age 10 y 5 mo, age range 2 y 11 mo to 16 y 9 mo) were evaluated. Evaluated gastric regions included: antrum (lesser and greater curvature), corpus (lesser and greater curvature), incisura angularis and fundus. Histological examination was performed according to the Updated Sydney System, and regional scores for polymorphonuclear and mononuclear cell infiltrate as well as bacterial density were generated. RESULTS: Fifteen (68.2%) patients presented H. pylori-chronic active gastritis, six (27.3%) presented antrum-predominant H. pylori-chronic active gastritis, and one (4.5%) presented corpus-predominant H. pylori-chronic active gastritis. Polymorphonuclear cell infiltrate and mononuclear cell infiltrate were observed in 93.9% and 98.5% of the biopsy specimens, respectively. Higher histological scores for polymorphonuclear infiltrate, mononuclear infiltrate, and bacterial density were observed in the gastric antrum. Intestinal metaplasia and gastric atrophy were not identified in any patient. Lymphoid aggregates and lymphoid follicles were observed in the gastric antrum of three (13.6%) and seven (31.8%) patients, respectively, but they were not related to antral nodularity. CONCLUSIONS: Chronic active gastritis was observed in all patients with H. pylori infection. However, antral or corporeal predominance was not observed in most patients.
Asunto(s)
Mucosa Gástrica/patología , Gastritis/patología , Infecciones por Helicobacter/patología , Helicobacter pylori , Adolescente , Biopsia , Niño , Preescolar , Enfermedad Crónica , Femenino , Mucosa Gástrica/microbiología , Gastritis/microbiología , Humanos , MasculinoRESUMEN
Context: Although Helicobacter pylori infection is prevalent in our country, there are few studies evaluating the associated histological abnormalities in children. Objective: To evaluate the histological features of the gastric mucosa in children and adolescents with Helicobacter pylori gastritis. Methods: One hundred and thirty two gastric biopsies from 22 symptomatic patients infected with H. pylori (14F/8M, median age 10 y 5 mo, age range 2 y 11 mo to 16 y 9 mo) were evaluated. Evaluated gastric regions included: antrum (lesser and greater curvature), corpus (lesser and greater curvature), incisura angularis and fundus. Histological examination was performed according to the Updated Sydney System, and regional scores for polymorphonuclear and mononuclear cell infiltrate as well as bacterial density were generated. Results: Fifteen (68.2 percent) patients presented H. pylori-chronic active gastritis, six (27.3 percent) presented antrum-predominant H. pylori-chronic active gastritis, and one (4.5 percent) presented corpus-predominant H. pylori-chronic active gastritis. Polymorphonuclear cell infiltrate and mononuclear cell infiltrate were observed in 93.9 percent and 98.5 percent of the biopsy specimens, respectively. Higher histological scores for polymorphonuclear infiltrate, mononuclear infiltrate, and bacterial density were observed in the gastric antrum. Intestinal metaplasia and gastric atrophy were not identified in any patient. Lymphoid aggregates and lymphoid follicles were observed in the gastric antrum of three (13.6 percent) and seven (31.8 percent) patients, respectively, but they were not related to antral nodularity. Conclusions: Chronic active gastritis was observed in all patients with H. pylori infection. However, antral or corporeal predominance was not observed in most patients.
Contexto: Embora a infecção por Helicobacter pylori seja prevalente em nosso país, há poucos estudos avaliando a histologia gástrica de crianças infectadas. Objetivo: Avaliar as características histológicas da mucosa gástrica de crianças e adolescentes com gastrite por H. pylori. Métodos: Foram avaliadas 132 biopsias gástricas de 22 pacientes sintomáticos infectados por H. pylori (14F/8M, idade mediana 10 anos e 5 meses, variação: 2a 11m a 16a 9m). As regiões gástricas avaliadas foram: antro (pequena e grande curvatura), corpo (pequena e grande curvatura), incisura angular e fundo. A avaliação histológica foi feita de acordo com o Sistema Sydney Atualizado. Foram gerados escores regionais do infiltrado de células polimorfonucleares, de células mononucleares e de densidade bacteriana. Resultados: Quinze (68,2 por cento) pacientes apresentaram gastrite crônica ativa associada a H. pylori, seis (27,3 por cento) apresentaram gastrite crônica ativa com predominância antral associada a H. pylori, e um (4,5 por cento), gastrite crônica ativa com predominância corpórea associada a H. pylori. Infiltrado de células polimorfonucleares e de mononucleares foram observados em, respectivamente 93,9 por cento e 98,5 por cento dos fragmentos de biopsia. Maior escore histológico de infiltrado de células polimorfonucleares, mononucleares e de densidade bacteriana foi observado no antro gástrico. Metaplasia intestinal e atrofia gástrica não foram observadas em nenhum paciente. Agregados linfóides e folículos linfóides foram observados no antro gástrico de três (13,6 por cento) e sete (31,8 por cento) pacientes, respectivamente, mas não foram associados à ocorrência de nodularidade antral. Conclusão: Gastrite crônica ativa foi observada em todos os pacientes com infecção por H. pylori. Na maioria dos pacientes não houve predominância antral ou corpórea da gastrite.
Asunto(s)
Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Mucosa Gástrica/patología , Gastritis/patología , Helicobacter pylori , Infecciones por Helicobacter/patología , Biopsia , Enfermedad Crónica , Mucosa Gástrica/microbiología , Gastritis/microbiologíaRESUMEN
BACKGROUND: Decreasing prevalence of H pylori infection has been reported in some countries. AIM: To evaluate the prevalence of Helicobacter pylori infection in a 10-year period in children submitted to upper digestive endoscopy. METHODS: It was a retrospective observational study. The records of 1,165 endoscopies performed during a 10-year period in a public hospital of the City of São Paulo, SP, Brazil, in patients up to 18-year-old. Only the first endoscopy was considered. Helicobacter pylori infection was defined by the rapid urease test, performed with one fragment of antral mucosa. Chi-square for trend has been estimated to compare Helicobacter pylori prevalence across the period. RESULTS: The main indication for endoscopy was epigastric pain (47.4 percent). There were 392 patients with H pylori infection (33.6 percent), 12.8 percent being infants, 19.4 percent toddlers, 28.8 percent schoolchildren and 46.3 percent adolescents. Prevalence was 60.47 percent in the first year of the study and 30.43 percent in the last. Among the less than 6-year-old patients there was a decrease in infection prevalence from 25 percent for the 1993-6 period to 14.3 percent in the 2000-02 period, while among the over 12-year-old patients the decrease was from 55.5 percent in the first period to 39.6 percent in the latter. The decrease in H pylori infection prevalence was more intense within patients with epigastric pain, in which prevalence has decreased from 48.2 percent (92/191) in 1993-6, to 41.9 percent (65/155) in 1997-9 and 27.7 percent (57/206) in 2000-02. CONCLUSION: The study suggests a significant decrease in the prevalence of H pylori infection regarding the studied patients. The trend was mainly observed in the younger age group and in patients with epigastric pain.
RACIONAL: Redução da prevalência de infecção por Helicobacter pylori tem sido relatada em alguns países. OBJETIVO: Avaliar, em crianças, a prevalência de infecção por H pylori em um período de 10 anos, realizando endoscopia digestiva alta. MÉTODOS: Estudo retrospectivo observacional. Os relatórios de 1.165 endoscopias digestivas altas realizadas em 10 anos em um hospital público da cidade de São Paulo, SP, foram revisados, sendo incluídas as primeiras endoscopias de pacientes com idade inferior a 18 anos. A infecção por H pylori foi definida pelo teste rápido da urease, com um fragmento de mucosa antral. RESULTADOS: A principal indicação de endoscopia foi dor epigástrica (47,4 por cento). A prevalência de infecção foi 33,6 por cento (12,8 por cento em lactentes, 19,4 por cento em pré-escolares, 28,8 por cento em escolares e 46,3 por cento em adolescentes). No primeiro ano de estudo foi 60,47 por cento, e 30,43 por cento no último. Entre os pacientes menores de 6 anos, houve diminuição na prevalência de 25 por cento (1993-6) para 14.3 por cento (2000-02), enquanto entre os pacientes maiores de 12 anos a diminuição foi de 55,5 por cento (1993-6) para 39,6 por cento (2000-02). A diminuição da prevalência foi significativa nos pacientes com dor epigástrica, nos quais passou de 48,2 por cento (92/191) em 1993-6, para 41,9 por cento (65/155) em 1997-9 e 27,7 por cento (57/206) em 2000-02. CONCLUSÃO: O estudo sugere que houve diminuição significativa na prevalência da infecção por H pylori nos pacientes estudados. A tendência foi principalmente observada no grupo etário mais jovem e nos pacientes com dor epigástrica.