Seroprevalence of Helicobacter pylori infection among children of low socioeconomic level in São Paulo.

CONTEXT AND OBJECTIVE: Helicobacter pylori infection is mainly acquired during childhood, and is associated with significant morbidity in adults. The aim here was to evaluate the seroprevalence and risk factors of H. pylori infection among children of low socioeconomic level attended at a public hospital in São Paulo, Brazil. DESIGN AND SETTING: Cross-sectional study, among patients attended at an outpatient clinic. METHODS: 326 children were evaluated (150 boys and 176 girls; mean age 6.82 ± 4.07 years) in a cross-sectional study. Patients with chronic diseases or previous H. pylori treatment, and those whose participation was not permitted by the adult responsible for the child, were excluded. The adults answered a demographic questionnaire and blood samples were collected. The serological test used was Cobas Core II, a second-generation test. Titers > 5 U/ml were considered positive. RESULTS: H. pylori infection was diagnosed in 116 children (35.6%). Infected children were older than uninfected children (7.77 ± 4.08 years versus 5.59 ± 3.86 years; p < 0.0001). The seroprevalence increased from 20.8% among children aged two to four years, to 58.3% among those older than 12 years. There were no significant relationships between seropositivity and gender, color, breastfeeding, number of people in the home, number of rooms, bed sharing, living in a shantytown, maternal educational level, family income or nutritional status. In multivariate analysis, the only variable significantly associated with H. pylori seropositivity was age. CONCLUSION: Infection had intermediate prevalence in the study population, and age was associated with higher prevalence.

Seroprevalence of Helicobacter pylori infection among children of low socioeconomic level in São Paulo / Soroprevalência da infecção por Helicobacter pylori em crianças de baixo nível sócio-econômico em São Paulo

CONTEXT AND OBJECTIVE: Helicobacter pylori infection is mainly acquired during childhood, and is associated with significant morbidity in adults. The aim here was to evaluate the seroprevalence and risk factors of H. pylori infection among children of low socioeconomic level attended at a public hospital in São Paulo, Brazil. DESIGN AND SETTING: Cross-sectional study, among patients attended at an outpatient clinic. METHODS: 326 children were evaluated (150 boys and 176 girls; mean age 6.82 ± 4.07 years) in a cross-sectional study. Patients with chronic diseases or previous H. pylori treatment, and those whose participation was not permitted by the adult responsible for the child, were excluded. The adults answered a demographic questionnaire and blood samples were collected. The serological test used was Cobas Core II, a second-generation test. Titers > 5 U/ml were considered positive. RESULTS: H. pylori infection was diagnosed in 116 children (35.6 percent). Infected children were older than uninfected children (7.77 ± 4.08 years versus 5.59 ± 3.86 years; p < 0.0001). The seroprevalence increased from 20.8 percent among children aged two to four years, to 58.3 percent among those older than 12 years. There were no significant relationships between seropositivity and gender, color, breastfeeding, number of people in the home, number of rooms, bed sharing, living in a shantytown, maternal educational level, family income or nutritional status. In multivariate analysis, the only variable significantly associated with H. pylori seropositivity was age. CONCLUSION: Infection had intermediate prevalence in the study population, and age was associated with higher prevalence.

CONTEXTO E OBJETIVO: A infecção por Helicobacter pylori é adquirida principalmente na infância e é associada a morbidade significativa em adultos. O objetivo foi avaliar a soroprevalência de infecção por H. pylori bem como fatores de risco em crianças de baixo nível socioeconômico atendidas em um hospital público em São Paulo, Brasil. TIPO DE ESTUDO E LOCAL: Estudo transversal, realizado entre pacientes atendidos em ambulatório. MÉTODOS: Foram avaliadas 326 crianças (150 meninos e 176 meninas, idade: média 6,82 ± 4,07 anos) em estudo transversal. Foram excluídas aquelas com doenças crônicas, tratamento prévio de H. pylori e cujo responsável não consentiu participar do estudo. Os responsáveis responderam questionário demográfico e foi coletada uma amostra de sangue. O teste sorológico empregado foi o CobasCore II, exame de segunda geração, sendo considerados positivos títulos > 5 U/ml. RESULTADOS: Infecção por H. pylori foi diagnosticada em 116 (35,6 por cento). A idade dos pacientes infectados foi maior que a dos demais (7,77 ± 4,08 anos versus 5,59 ± 3,86 anos; p < 0,0001). A prevalência aumenta de 20,8 por cento entre dois e quatro anos de idade para 58,3 por cento entre maiores de 12 anos. Não houve relação significativa entre soropositividade e sexo, raça, aleitamento materno, número de pessoas ou de cômodos na casa, compartilhamento de camas, domicílio em favela, escolaridade materna, renda familiar ou estado nutricional. Na análise multivariada, a única variável significativamente associada a soropositividade foi idade. CONCLUSÃO: A infecção possui prevalência intermediária na população estudada, e a idade foi associada a maior prevalência.

Spontaneous elimination of Helicobacter pylori infection in a cohort of asymptomatic school children by enzyme-linked immunosorbent assay polyclonal antigen in stool.

GOAL: To determine the natural evolution of the Helicobacter pylori infection through the fecal antigen of the H. pylori test in a cohort of school children during 2 consecutive years. BACKGROUND: Studies have suggested that the spontaneous elimination rate is higher in developing countries, possibly owing to higher incidence rate. STUDY: One hundred twelve children attending a day care center for the sons and daughters of university employees were evaluated yearly in a 2-year period using the H. pylori stool antigen test. Parents answered a questionnaire with demographic data at baseline. The test was performed according to previously standardized procedures, and results lesser than 0.140 were regarded as negative; higher than 0.016 were regarded as positive. RESULTS: Age ranged from 0.7 to 7.48 years (3.67+/-1.98 y) at baseline, with 58% female and 42% male. H. pylori prevalence was 12.5% (14/112). There was a trend to associate low income (P=0.06), ethnicity non-white (P=0.075), and smaller house (P=0.079) to H. pylori infection at baseline in univariate analysis. Nevertheless, age was the only variable associated to prevalence at multivariate analysis. There was no significant association between H. pylori infection and intestinal parasites. There was only one new infection during the study period (incidence rate 0.53%), and 4 children cleared the infection (elimination rate 2.15%). All those children were older than 4 years. CONCLUSIONS: Spontaneous eradication of the infection was more frequent than incidence of infection in this cohort.

Evolução natural da infecção por Helicobacter pylori em escolares assintomáticos pelo antígeno fecal do Helicobacter pylory / Natural evaluation of Helicobacter pylori infection in asyntomatic students by the Helicobacter pylory antigen stool

Objetivos: Determinar a evolução da natural da infecção, prevalência e fatores sociodemográficos associados à infecção pelo Helicobacter pylori através do antígeno fecal do Helicobacter pylori (HpSA) em coorte de crianças escolares durante três anos consecutivos. Métodos: Estudo de corte transversal e estudo de coorte longitudinal. Casuística: 213 escolares de 6 meses a 7 anos de idade, de ambos os sexos, da Escola Paulistinha de Educação, que atende exclusivamente filhos de funcionários do complexo hospitalar vinculado à UNIFESP/Escola Paulista de Medicina, São Paulo/SP. Realizou-se questionário sociodemográfico e clínico e coletaram-se amostras de fezes para realização do teste HpSA. Posteriormente analisou-se coorte de 109 escolares em três anos consecutivos. O teste HpSA (Meridian Diagnostics Inc) foi feito de acordo com a técnica descrita pelo fabricante com algumas modificações. Resultado positivo amostras com DO >= 0,160; negativo com DO < 0,140 e inconclusivo com DO > 0,140 e < 0,160. Métodos estatísticos: Teste t-Student e teste do Qui Quadrado para comparação de médias e tabelas de contingência. Análise de regressão logística com as variáveis selecionadas e teste de razão de verosimilhança. O nível de significancia considerado foi de 5 por cento. Resultados: A idade das 213 crianças variou de 0,5 - 7,69 anos (Média +/- DP= 3,88+/-2,OOa; Mediana= 3,69a); 45,5 por cento masculino e 54,5 por cento feminino. O teste foi positivo em 13,2 por cento, negativo em 79,3 por cento e inconclusivo em 7,5 por cento. O risco de contrair a infecção foi 2,6 vezes maior nos primeiros 4 anos em relação aos maiores de 4 anos de idade (p= 0,036/OR= 2,6), crianças de cor não branca (p= 0,086/OR= 2,1) e do sexo masculino (p= 0,126/OR= 1,96). 0 estudo de coorte.