The prevalence and related symptomatology of Helicobacter pylori in children with recurrent abdominal pain.

The aim of the study was to assess and compare the IgG seroprevalence of H. pylori in children with recurrent abdominal pain with healthy children and to investigate the related symptoms. IgG antibodies against low-molecular weight H. pylori antigens were assessed in 438 children with recurrent abdominal pain and in 91 healthy controls. Sera with an ELISA unit-value above the cut-off level were confirmed by Western immunoblot. Only seropositive children with recurrent abdominal pain were examined by an oesophago-gastro-duodenoscopy. Symptomatology was recorded according to the localization of the abdominal pain, presence of pyrosis, nocturnal pain, relation of pain to meals and bowel irregularities. The seroprevalence was 21% (95% CI: 17-25%) in the children with recurrent abdominal pain and 10% (95% CI: 5-18%) in the healthy controls (p = 0.30). In seropositive children with RAP H. pylori was found in 46/66 by culture and histology. The presence of H. pylori was significantly associated with active or inactive chronic gastritis. The presence of H. pylori was associated with both parents being born in a country with a high prevalence and a low social class. Helicobacter pylori-positive children had more often pain related to meals than the H. pylori-negative children. No differences among the two groups were seen according to the levels of haemoglobin, leucocytes, thrombocytes, weight and height. In conclusion, the seroprevalence of H. pylori is comparable in children with recurrent abdominal pain and healthy children. No specific symptomatology was seen in H. pylori-positive children with RAP.

[Esophago-gastro-duodenoscopy of pediatric patients]. / Osofago-gastro-duodenoskopi af paediatriske patienter.

In total 199 oesophago-gastro-duodenoscopies (OGD) were performed in 71 female and 71 male paediatric patients (three months-15 years, median 8 years 2 months). The endoscopy was performed in general anaesthesia in children less than five years old, and in an intravenous sedation in older patients. The indications for OGD were: recurrent abdominal pain and concomitant positive antibodies against Helicobacter pylori as a part of a scientific project, upper dyspepsia, upper gastrointestinal bleeding, failure to thrive, coeliac disease, suspicion of chronic inflammatory bowel disease and a percutaneous gastrostomy. Seventy-two OGD were carried out in general anaesthesia, 86 in intravenous sedation with midazolam and pethidine and 41 in intravenous midazolam sedation. Complications related to the sedation or to the endoscopy were not observed. Amnesia was reported in 94/95 children who were sedated intravenously with midazolam and pethidine or midazolam alone. Six endoscopies could not be carried out in intravenous sedation because of agitation. In the primary OGD endoscopy revealed a normal mucosa in 121/142 (85%), oesophagitis in four (3%), nodular mucosa in six (4%), gastritis in four (3%) and a duodenal ulcer in one (0.7%). Histology disclosed active or inactive chronic gastritis at the primary endoscopy in 35/69 (51%) of the children with recurrent abdominal pain and antibodies against H. pylori. In children with failure to thrive an avillous duodenal mucosa was seen in 3/32 (9%). A comparison between histological and stereomicroscopical evaluation of the duodenal biopsies revealed agreement in 41/47 (87%). We conclude that OGD is a safe and tolerable procedure in paediatric patients, in whom possible morphological changes are suspected. The indications for an OGD need further evaluation.