RESUMO
OBJECTIVES: A descriptive and comparative study of gastric histological aspects according to the updated Sydney classification (USC), obtained from Helicobacter pylori-positive versus H pylori-negative children referred for upper gastrointestinal endoscopy. METHODS: The Prisma method was used to perform a systematic review and meta-analysis. Selection criteria were based on following key words USC, H pylori, children, endoscopy, or biopsy. Publication biases were assessed according to the Newcastle-Ottawa Scale, and a meta-regression analysis was done. The study was registered on the PROSPERO platform. RESULTS: Between 1994 and 2017, 1238 references were found; 97 studies were retained for the systematic review with a total number of 25,867 children; 75 studies were selected for the meta-analysis concerning 5990 H pylori-infected and 17,782 uninfected children.H pylori-positive versus H pylori-negative children, according to the USC, showed significantly higher relative risk for gastric antral and corpus chronic inflammation, presence of neutrophils, and of lymphoid follicles, and gastric mucosa atrophy, whereas, intestinal metaplasia showed a significantly higher RR only in antral biopsies. The meta-regression analysis showed that H pylori-positive versus H pylori-negative children had significantly higher risk only for corpus activity according to age, recurrent abdominal pain, and geographical area of low H pylori prevalence. CONCLUSIONS: H pylori infection in children was associated with higher relative risk for gastric antral and corpus chronic inflammation, presence of neutrophils, lymphoid follicles, and rare gastric mucosa atrophy, whereas, rare intestinal metaplasia was only significantly higher in the antral area.
Assuntos
Gastrite , Infecções por Helicobacter , Helicobacter pylori , Biópsia , Criança , Mucosa Gástrica , Gastrite/complicações , Gastrite/diagnóstico , Gastrite/epidemiologia , Gastroscopia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/epidemiologia , Humanos , Metaplasia/patologiaRESUMO
OBJECTIVES: The aim of the study was to assess clinical presentation, endoscopic findings, antibiotic susceptibility and treatment success of Helicobacter pylori (H. pylori) infected pediatric patients. METHODS: Between 2013 and 2016, 23 pediatric hospitals from 17 countries prospectively submitted data on consecutive H. pylori-infected (culture positive) patients to the EuroPedHP-Registry. RESULTS: Of 1333 patients recruited (55.1% girls, median age 12.6 years), 1168 (87.6%) were therapy naïve (group A) and 165 (12.4%) had failed treatment (group B). Patients resided in North/Western (29.6%), Southern (34.1%) and Eastern Europe (23.0%), or Israel/Turkey (13.4%). Main indications for endoscopy were abdominal pain or dyspepsia (81.2%, 1078/1328). Antral nodularity was reported in 77.8% (1031/1326) of patients, gastric or duodenal ulcers and erosions in 5.1% and 12.8%, respectively. Primary resistance to clarithromycin (CLA) and metronidazole (MET) occurred in 25% and 21%, respectively, and increased after failed therapy. Bacterial strains were fully susceptible in 60.5% of group A, but in only 27.4% of group B. Primary CLA resistance was higher in Southern and Eastern Europe (adjusted odds ratio [ORadj]â=â3.44, 95% confidence interval [CI] 2.22-5.32, Pâ<â0.001 and 2.62, 95% CI: 1.63-4.22, Pâ<â0.001, respectively) compared with Northern/Western Europe. Children born outside Europe showed higher primary MET resistance (ORadjâ=â3.81, 95% CI: 2.25-6.45, Pâ<â0.001). Treatment success in group A reached only 79.8% (568/712) with 7 to 14 days triple therapy tailored to antibiotic susceptibility. CONCLUSIONS: Peptic ulcers are rare in dyspeptic H. pylori-infected children. Primary resistance to CLA and MET is markedly dependent on geographical regions of birth and residence. The ongoing survey will show whether implementation of the updated ESPGHAN/NASPGHAN guidelines will improve the eradication success.
Assuntos
Infecções por Helicobacter , Helicobacter pylori , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Criança , Claritromicina/uso terapêutico , Quimioterapia Combinada , Europa (Continente) , Feminino , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/epidemiologia , Humanos , Israel/epidemiologia , Masculino , Metronidazol/uso terapêutico , Sistema de Registros , TurquiaRESUMO
The gut microbiota is intrinsically linked to human health; disturbances in microbial homeostasis are implicated in both intestinal and extraintestinal disorders. Probiotics are "live microorganisms that, when administered in adequate amounts, confer a health benefit on the host," and many commercial preparations comprising a diverse range of species are available. While probiotics have been much researched, better understanding of the probiotic effects and applications of species such as Bacillus clausii is warranted. In this narrative literature review, we review the characteristics and mechanisms of action supporting B. clausii as a probiotic and discuss the evidence from clinical studies evaluating B. clausii probiotics for the management of a variety of gastrointestinal disorders and symptoms in children and adults. Finally, we highlight the challenges of future research and the need for more robust and diverse clinical evidence to guide physicians in the clinical application of probiotics for gastrointestinal disorders and other conditions.
Assuntos
Bacillus clausii , Gastroenteropatias , Microbioma Gastrointestinal , Probióticos , Adulto , Criança , Gastroenteropatias/terapia , Humanos , Probióticos/uso terapêuticoRESUMO
Helicobacter pylori (H. pylori) infection is mainly acquired in childhood and is frequent in developing countries. The infection is associated with chronic gastritis in all infected children, but peptic ulcer disease develops in a small number of them. In our country, H. pylori infection and associated peptic ulcer disease are common. In eastern Turkey, we found peptic ulcer disease in 13.2% of children who underwent endoscopic examination. Peptic ulcers were mostly gastric ulcers and H. pylori-positive in the studied population, and most of the children were admitted due to abdominal pain. As there are no well-established criteria leading directly to diagnosis, pediatricians should include H. pylori infection and peptic ulcer disease in the differential diagnosis list when evaluating children with abdominal pain, failure to thrive and upper gastrointestinal system bleeding.
Assuntos
Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Úlcera Péptica/epidemiologia , Criança , Feminino , Infecções por Helicobacter/diagnóstico , Humanos , Masculino , Úlcera Péptica/diagnóstico , Úlcera Péptica/microbiologia , Úlcera Gástrica/diagnóstico , Úlcera Gástrica/microbiologia , Turquia/epidemiologiaRESUMO
AIM: To date, cross-sectional and case-control studies suggest an inverse association between Helicobacter pylori infection and atopic diseases, whereas the immunologic basis has not been studied yet. In this study we investigated T helper (Th) cell function in H. pylori-infected children and compared cytokine responses in atopic and non-atopic groups. METHODS: The study groups was recruited from a cohort of 327 healthy children evaluated and followed-up for 6 years to assess the natural history of H. pylori infection. Seventy-four of 136 healthy children who underwent (13)C urea breath test were eligible and accepted to participate. All participants were evaluated by a questionnaire, and skin-prick testing. According to the results, children were divided into four groups with respect to the presence or absence of H. pylori and atopy. Peripheral blood mononuclear cells isolated from 34 of 74 children were cultured with H. pylori, Der p 1, and phytohemagglutinin (PHA). Interferon-gamma (IFN-gamma), interleukin (IL)-4 and IL-10, transforming growth factor-beta (TGF-beta) levels were measured in supernatants. RESULTS: The frequency of atopy was lower in H. pylori-infected group (31.9% vs. 48.1, p = .22), while atopic symptoms were similar between infected and non-infected children. While PHA and H. pylori induced IFN-gamma levels were significantly higher in H. pylori-infected children, concomitant presence of both atopy and H. pylori decreased the level of PHA and H. pylori induced IFN-gamma production. PHA and Der p 1-induced IL-4 levels were higher in atopic children, and IL-4 production was suppressed when they were concomitantly infected with H. pylori. The production of TGF-beta was found to be suppressed in atopic children irrespective of the presence of H. pylori infection. CONCLUSION: The results of the current study demonstrated a counteractive Th1 and Th2 cytokine interaction between H. pylori infection and atopy. However, this counteractive immunologic balance did not protect against atopy.
Assuntos
Infecções por Helicobacter/imunologia , Helicobacter pylori/imunologia , Hipersensibilidade Imediata/imunologia , Adolescente , Células Cultivadas , Criança , Citocinas/imunologia , Feminino , Infecções por Helicobacter/complicações , Infecções por Helicobacter/microbiologia , Humanos , Hipersensibilidade Imediata/complicações , Leucócitos Mononucleares/imunologia , Masculino , Fito-Hemaglutininas/imunologia , Estudos ProspectivosRESUMO
Most of the individuals infected with H. pylori acquire the infection early in life. However, there is limited data regarding endoscopic and histopathologic findings of H. pylori infection when it is acquired during infancy. The aim of this study was to investigate the H. pylori-related endoscopic and histopathological findings in children younger than 2 years of age. One hundred and fifty-two infants who underwent upper gastrointestinal endoscopy were included in the study. The diagnosis of H. pylori infection was based on histopathology and a positive rapid urease test. Forty of 152 (26.3%) infants were infected with H. pylori, and 65% of the infected infants had histopathologic gastritis. There were no clinical or endoscopic findings suggestive of H. pylori infection. No correlation could be found between the density of H. pylori and the severity of gastritis. H. pylori infection is associated with various degrees of gastritis in more than half of the infected infants. Since the likelihood of normal histopathology is rare in H. pylori-infected infants, its long-term complications should be cautiously followed up in endemic areas.
Assuntos
Gastrite/microbiologia , Gastrite/patologia , Infecções por Helicobacter/patologia , Helicobacter pylori/patogenicidade , Estômago/microbiologia , Estômago/patologia , Biópsia , Duodeno/microbiologia , Duodeno/patologia , Endoscopia Gastrointestinal , Esôfago/microbiologia , Esôfago/patologia , Feminino , Humanos , Lactente , Masculino , Análise Multivariada , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
AIM: To determine the role of inflammatory cytokines and reactive oxygen species (ROS) in childhood reflux esophagitis. METHODS: A total of 59 subjects who had complaints suggesting GERD underwent esophagogastroduodenoscopy. Endoscopic and histopathologic diagnosis of reflux esophagitis was established by Savary-Miller and Vandenplas grading systems, respectively. Esophageal biopsy specimens were taken from the esophagus 20% proximal above the esophagogastric junction for conventional histopathological examination and the measurements of ROS and cytokine levels. ROS were measured by chemiluminescence, whereas IL-8 and MCP-1 levels were determined with quantitative immunometric ELISA on esophageal tissue. Esophageal tissue ROS, IL-8 and MCP-1 levels were compared among groups with and without endoscopic/histo-pathologic esophagitis. RESULTS: Of 59 patients 28 (47.5%) had normal esophagus whereas 31 (52.5%) had endoscopic esophagitis. In histopathological evaluation, almost 73% of the cases had mild and 6.8% had moderate degree of esophagitis. When ROS and chemokine levels were compared among groups with and without endoscopic esophagitis, statistical difference could not be found between patients with and without esophagitis. Although the levels of ROS, IL-8 and MCP-1 were found to be higher in the group with histopathological reflux esophagitis, this difference was not statistically significant. CONCLUSION: These results suggest that the grade of esophagitis is usually mild or moderate during childhood and factors apart from ROS, IL-8 and MCP-1 may be involved in the pathogenesis of reflux esophagitis in children.
Assuntos
Quimiocina CCL2/análise , Esôfago/química , Refluxo Gastroesofágico/metabolismo , Interleucina-8/análise , Espécies Reativas de Oxigênio/análise , Adolescente , Criança , Pré-Escolar , Endoscopia do Sistema Digestório , Ensaio de Imunoadsorção Enzimática , Esôfago/patologia , Humanos , Lactente , Medições Luminescentes , Mucosa/química , Estudos Prospectivos , Índice de Gravidade de Doença , Regulação para CimaRESUMO
Hepatitis A infection rarely causes extrahepatic manifestations. Here we present a 5-year-old patient with an initial complaint of nuchal rigidity and convulsions during the course of hepatitis A infection. Because hepatitis A virus RNA was demonstrated in the cerebrospinal fluid, it was thought that convulsions might be related to this viral infection.
Assuntos
Hepatite A/complicações , Convulsões/virologia , Líquido Cefalorraquidiano/imunologia , Líquido Cefalorraquidiano/virologia , Pré-Escolar , Hepatite A/virologia , Vírus da Hepatite A/patogenicidade , Humanos , Imunoglobulina M/análise , MasculinoRESUMO
It has been shown that Helicobacter pylori (H. pylori) infection is rare among children in developed countries. In Turkey, the prevalence of H. pylori infection among adults is about 80-85%, which is close to the ratios reported in developing countries. There is limited knowledge, however, on the prevalence, determinants and associations of this infection, such as short stature, familial history of dyspepsia and abdominal pain, in children. The aims of this study were to estimate the prevalence, determinants and associations of H. pylori infection in a group of healthy school children using 13C-urea breath test (13C-UBT). The study subjects were selected from a kindergarten and an elementary school. The H. pylori status was determined by 13C-UBT. Standard questionnaires ascertaining sociodemographic data were completed for each child by questioning the mothers. Three hundred twenty-seven children aged 3-12 years participated in the study. Overall, 162 children (49.5%) were infected with H. pylori, and the prevalence increased with age: 18.2% under 4 years, 41% at 4-6 years, 48.6% at 6-8 years, 50% at 8-10 years, and 63% at 11-12 years of age. No association was determined between H. pylori infection and height and weight percentiles, history of abdominal pain or family history of dyspepsia in the study group. Investigation of the prevalence of H. pylori infection in our study group in relation to socioeconomic data in a logistic regression model revealed that low income, high household density of children, use of stove for heating, and no breast feeding were important risk factors for H. pylori infection. This study was done in a group of healthy Turkish children to estimate the age-related prevalence of H. pylori infection and to determine the factors predisposing to H. pylori infection during childhood. It was found that 1/5 of healthy Turkish children were infected with H. pylori before four years of age, and that every one child out of two under 11 years of age was infected with H. pylori. Low socioeconomic status, poor household living conditions and no breast feeding were determined as independent risk factors of H. pylori infection.
Assuntos
Aleitamento Materno , Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Testes Respiratórios/métodos , Criança , Pré-Escolar , Feminino , Infecções por Helicobacter/etiologia , Humanos , Masculino , Fatores de Risco , Fatores Socioeconômicos , Turquia/epidemiologiaRESUMO
Clinical trials for chronic hepatitis B (HBV) infection in children have shown usefulness of interferon alpha 2b (IFN-alpha) in eliminating HBV replication and in improving liver histology. Although it is not the ultimate goal of the interferon treatment for chronic HBV infection, it has been suggested in adults that HBsAg clearance decreases the likelihood of development of hepatocellular carcinoma, and prolongs the survival. HBV DNA clearance has been shown to be higher with higher doses of interferon in children, but it was rarely associated with HbsAg clearance. Ten MU/m2 was tried in 46 children who had biopsy-proven chronic HBV infection. They received IFN-alpha subcutaneously three times/week for six months. The treatment regimen was completed in 41 children and the second liver hiopsy was carried out one year after the end of the treatment in 30 of 41 patients. With this schedule, 15 (36.6%) children showed persistent loss of HBV DNA 12 months after the cessation of the treatment, 20 (48.7%) lost HBeAg, and eight (19.5%) developed anti-HBs antibody with loss of HBsAg. A significant improvement in liver histology was obtained in children with HBV DNA clearance. Serum ALT levels normalized in all HBeAg seroconverters. These findings suggested that the 10 MU/m2 IFN-alpha treatment was well tolerated and resulted in a high rate of HbsAg clearance in addition to HBV DNA clearance in a group of chidren with chronic HBV infection.
Assuntos
Antígenos de Superfície da Hepatite B/sangue , Hepatite B Crônica/tratamento farmacológico , Interferon-alfa/uso terapêutico , Adolescente , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Feminino , Vírus da Hepatite B/efeitos dos fármacos , Hepatite B Crônica/imunologia , Humanos , Interferon-alfa/efeitos adversos , Masculino , Resultado do TratamentoAssuntos
Anticorpos Monoclonais/uso terapêutico , Síndrome de Behçet/tratamento farmacológico , Adolescente , Síndrome de Behçet/complicações , Síndrome de Behçet/patologia , Criança , Colonoscopia , Feminino , Humanos , Infliximab , Resultado do Tratamento , Úlcera/tratamento farmacológico , Úlcera/etiologia , Úlcera/patologiaRESUMO
BACKGROUND/AIMS: The aim of this study was to evaluate the consistency of the Savary-Miller, the Hetzel-Dent and the Los Angeles endoscopic classification systems and to compare them with the esophageal histopathology in children. MATERIAL AND METHODS: Children between the ages of 5-17 years who underwent esophagogastroduodenoscopy were included in the study. The endoscopic reports and the still images of the esophagus were reclassified by the same gastroenterologist according to the Savary-Miller, Hetzel- Dent and Los Angeles scoring systems. The esophageal biopsies were also reevaluated by the same pathologist and the consistency between endoscopic and histopathologic esophagitis was evaluated. RESULTS: A total of 113 out of 192 pediatric patients were included in the study. Seventy-three patients (64.6%) had esophagitis according to the Hetzel-Dent classification, whereas only 20 (17.7%) patients were defined as having esophagitis according to the other two classification systems. The consistency between the Savary-Miller and Los Angeles classifications was excellent (κ: 0.92) but the agreement between the Hetzel-Dent and Savary-Miller and between the Hetzel-Dent and Los Angeles classifications were poor. A total of 82 patients (72.6%) had histopathological esophagitis, and there was a weak consistency between all 3 endoscopic scoring systems and the histopathology. CONCLUSIONS: Since pediatric patients have milder esophagitis than in adults, the use of endoscopic scoring systems developed for adults seems to be inapplicable for children. The inclusion of minimal endoscopic changes in endoscopic scoring systems by using more sensitive and novel endoscopic techniques would increase the sensitivity of these scoring systems in children.
Assuntos
Endoscopia do Sistema Digestório , Esofagite/classificação , Esofagite/patologia , Refluxo Gastroesofágico/classificação , Refluxo Gastroesofágico/patologia , Adolescente , Fatores Etários , Biópsia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
BACKGROUND: To analyze risk factors associated with gastro-duodenal ulcers and erosions in children. METHODS: Open, prospective, multicenter, case-control study carried out in 11 European countries in patients with gastric or duodenal ulcers/erosions and 2 age-matched controls each. Possible risk factors were recorded. Logistic regression models were performed with adjustment for centers and age groups. RESULTS: Seven-hundred thirty-two patients (244 cases, 153 with erosions only and 91 with ulcers, and 488 controls) were recruited. Children receiving antimicrobials or acid suppressive drugs before endoscopy were excluded (202 cases/390 controls remained for risk factor analysis). Helicobacter pylori was detected more frequently in cases than controls but only in 32.0% versus 20.1% in controls (P = 0.001). Independent exposure factors for gastric ulcers were male gender (P = 0.001), chronic neurologic disease (P = 0.015), chronic renal disease (P < 0.001) and nonsteroidal anti-inflammatory drug consumption (P = 0.035). Exposure factors for duodenal ulcers were H. pylori infection (P < 0.001) and steroid consumption (P = 0.031). Chronic renal disease was the only independent factor associated with gastric erosions (P = 0.026), those associated with duodenal erosions being H. pylori infection (P = 0.023), active smoking (P = 0.006) and chronic arthritis (P = 0.008). No risk factor was identified in 97/202 (48.0%) cases. CONCLUSIONS: H. pylori remains a risk factor for duodenal, but not for gastric lesions in children in countries with low prevalence of infection. No risk factor could be identified in half of the children with gastro-duodenal ulcers/erosions.
Assuntos
Infecções por Helicobacter/epidemiologia , Helicobacter pylori/isolamento & purificação , Úlcera Péptica/epidemiologia , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Europa (Continente)/epidemiologia , Feminino , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/patologia , Humanos , Lactente , Masculino , Úlcera Péptica/microbiologia , Estudos Prospectivos , Fatores de RiscoAssuntos
Coristoma/diagnóstico , Obstrução da Saída Gástrica/microbiologia , Infecções por Helicobacter , Helicobacter pylori , Pâncreas , Gastropatias/diagnóstico , Biópsia , Criança , Coristoma/complicações , Endoscopia do Sistema Digestório , Feminino , Obstrução da Saída Gástrica/diagnóstico , Obstrução da Saída Gástrica/cirurgia , Gastrite/microbiologia , Gastrite/patologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/tratamento farmacológico , Humanos , Gastropatias/complicações , Gastropatias/patologia , UltrassonografiaRESUMO
OBJECTIVES: There is a relationship between nonresponsiveness to hepatitis B virus (HBV) vaccine and certain human leukocyte antigen (HLA) genotypes. In healthy population, 4-10% vaccine recipients fail to produce protective levels of antibodies to the HBV vaccine after standard immunization depending upon age and the presence of various underlying diseases. Celiac disease (CD) is an HLA-associated immunological disease. It has been suggested that certain HLA haplotypes which are linked to CD are associated with nonresponse to HBV vaccine as well. The aim of this study is to assess the response to HBV vaccine prospectively in a group of CD and to explore the potential link between CD and HBV vaccine nonresponse by studying shared HLA haplotypes. PATIENTS AND METHODS: Sixty-three previously diagnosed celiac patients who were on a strict gluten-free diet (GFD) and 54 healthy children were evaluated serologically for anti-HBs status. Celiac children who were anti-HBs negative at baseline were fully vaccinated prospectively, and reevaluated for the response to HBV vaccine. To estimate the role of HLA type in HBV vaccine response in celiac patients, a subgroup of both patients and control participants had HLA genotypes performed. RESULTS: At enrollment, 27 (67.5%) children with CD and 48 (85.2%) healthy children were anti-HBs positive, and the difference between patients and controls was statistically significant (P<0.05). However, failure to respond to HBV vaccine was only 3.6% (response rate 96.4%) in prospectively vaccinated celiac patients. There was no relationship between HLA type and vaccine nonresponse in our study group. CONCLUSION: The response to HBV vaccine in celiac children who were compliant to GFD is not different from a healthy population. CD may be one of the immune diseases associated with a high rate of HBV vaccine nonresponse but it might not be permanent and treatment with GFD and compliance to the treatment may ameliorate the immune response to HBV vaccine in celiac children.
Assuntos
Doença Celíaca/imunologia , Antígenos HLA/genética , Vacinas contra Hepatite B/imunologia , Hepatite B/prevenção & controle , Adolescente , Doença Celíaca/dietoterapia , Doença Celíaca/genética , Criança , Pré-Escolar , Dieta Livre de Glúten , Feminino , Haplótipos , Anticorpos Anti-Hepatite B/sangue , Anticorpos Anti-Hepatite B/imunologia , Vacinas contra Hepatite B/uso terapêutico , Vírus da Hepatite B/imunologia , Humanos , Masculino , Estudos Prospectivos , Adulto JovemRESUMO
UNLABELLED: There are no solid figures of the frequency of ulcer disease during childhood in Europe. We assessed its frequency and analyzed known risk factors. PATIENTS AND METHODS: Ulcers, erosions, indications, and risk factors were recorded in all children undergoing an upper gastrointestinal endoscopy in a prospective study carried out during 1-month simultaneously in 19 centers among 14 European countries. RESULTS: Ulcers and/or erosions were observed in 56 out of 694 children. Children with ulcers/erosions were significantly older than those without lesions (10.3+/-5.5 vs. 8.1+/-5.7 years, P=0.002). Helicobacter pylori infection was present in 15 of 56 children (27%) where NSAIDs were used in eight, steroids in five, immune-suppressive drugs in five, antibiotics in six, antacids in one, H2-blockers in six and proton pump inhibitors in eight children (more than one risk factor was detected in 32 of 56 children). No risk factors were observed in 24 of 56 children (43%). The main indications for endoscopy were epigastric or abdominal pain (24%) and suspicion of gastroesophageal reflux disease (15%). Similarly, epigastric tenderness, hematemesis, melena, and weight stagnation were significantly associated with ulcers/erosions, whereas sex, H. pylori infection, socioeconomic and lifestyle factors were equally distributed. CONCLUSION: Although limited by the short-time duration and the heterogeneity of the patients included throughout the 19 centers, our study shows a frequency of 8.1% of ulcers and/or erosions in children, occurring mainly in the second decade of life. H. pylori infection and gastrotoxic medications were less frequently implicated than expected.
Assuntos
Úlcera Duodenal/epidemiologia , Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Úlcera Gástrica/epidemiologia , Adolescente , Criança , Pré-Escolar , Úlcera Duodenal/patologia , Endoscopia Gastrointestinal , Europa (Continente)/epidemiologia , Feminino , Infecções por Helicobacter/patologia , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco , Úlcera Gástrica/patologiaRESUMO
During the last year, epidemiologic studies have shown that spontaneous clearance of Helicobacter pylori infection has a less significant role in countries with high prevalence and, in contrast to adults, there is no male predominance of H. pylori infection in children. Early acquisition of H. pylori may play a role in the development of recurrent abdominal pain in children less than 5 years of age. In this very young age group, the adequate performance of stool antigen test and (13)C urea-breath test demonstrated satisfactory sensitivity and specificity as non-invasive methods to diagnose H. pylori infection. In the current paper, the most relevant pediatric studies on H. pylori infection published between April 2006 and March 2007 are reviewed.
Assuntos
Antibacterianos/uso terapêutico , Infecções por Helicobacter , Helicobacter pylori , Inibidores da Bomba de Prótons , Adolescente , Adulto , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Quimioterapia Combinada , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/efeitos dos fármacos , Helicobacter pylori/isolamento & purificação , Helicobacter pylori/patogenicidade , Humanos , Resultado do TratamentoRESUMO
BACKGROUND AND AIM: Data on the eradication treatment for childhood Helicobacter pylori are scanty. A register was established on the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) website to collect data on treatment performed by European pediatricians to ascertain what is practiced in the field. SUBJECTS: From January 2001 to December 2002, information on 597 children were entered by 23 European Centers, but only data of 518 treated children were completed and analyzed (86.7%, 262 male subjects, median age 9 years, range 1-14). According to their nationality, 226 children were from Southern Europe, 132 from Eastern Europe, 68 from Western Europe, and 4 from northern Europe, 68 from North Africa, and 20 from Asia. At endoscopy, 454 children had gastritis and 64 had ulcer (12.3%). Antibiotic sensitivity, tested in 361 cases, revealed 18% clarithromycin-resistant and 19% metronidazole-resistant H. pylori strains. RESULTS: Treatment was performed for 1 week in 388 and for 2 weeks in 130 children. Antibiotics were associated with proton pump inhibitors (PPI) in 345 and with bismuth in 121 children. Triple therapy was given to 485 children, dual therapy to 26, quadruple to 7. Follow-up data, by (13)C-Urea-Breath Test or histology or both, were available for 480 children. Overall eradication rate was 65.6%, significantly higher in children with ulcer (79.7%) than without (63.9%, p = .001). When given as first treatment, bismuth-containing triple therapies were more efficacious than PPI-containing ones (77% versus 64%, p = .02, OR 1.88, 95% CI 1.1-3.3). Twenty-seven different treatment regimens were used, but only six were administered to at least 18 children (range 18-157). There was no difference between treatments given for 1 or 2 weeks, or given as first or second therapies. CONCLUSION: European pediatricians entering data in the register used 27 different regimens. Bismuth-containing therapies resulted in higher eradication rate. Omeprazole-containing triple therapies were the most used although their efficacy was low. Therapies recommended for adults do not appear to be suitable for children.
Assuntos
Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/epidemiologia , Helicobacter pylori/efeitos dos fármacos , Adolescente , Antiácidos/uso terapêutico , Bismuto/uso terapêutico , Criança , Pré-Escolar , Claritromicina/uso terapêutico , Quimioterapia Combinada , Europa (Continente)/epidemiologia , Feminino , Infecções por Helicobacter/microbiologia , Helicobacter pylori/patogenicidade , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Omeprazol/uso terapêutico , Sistema de Registros , Resultado do TratamentoRESUMO
BACKGROUND: High seroprevalence rates for Helicobacter pylori have been reported in developing countries, yet few studies exist determining the pattern of change in the epidemiology of H. pylori infection in children. The knowledge of acquisition and loss rates of H. pylori and the relevance to the sociodemographic properties and the symptomatology of infection may provide clues for lifestyle changes that might protect children from infection, and also, it may provide rationale for eradication, screening, and protection policies. Our aim was to conduct a prospective study to elucidate the outcome, rate of acquisition, and loss of H. pylori infection in a population of healthy children. METHODS: This study is based on follow-up of 327 healthy Turkish children aged 3 to 12 years. The follow-up was conducted 6 years after the baseline examination. Helicobacter pylori status was determined by C-urea breath test. Children were investigated for sociodemographic variables and several symptoms. RESULTS: Data from 136 (41%) of 327 children were available. The prevalence of infection increased from 52.9% to 56.6%, mainly increasing in children younger than 10 years. The incidence of H. pylori infection among previously uninfected children was 14%, and the loss rate of infection among previously infected children was 5.5% during the follow-up. Socioeconomic status, household density, and antibiotic use during last 6 months were inversely related to H. pylori prevalence. Children infected with H. pylori were complaining more often of headache but not of abdominal pain or dyspepsia. CONCLUSIONS: In this study, the acquisition rate of H. pylori infection was 2.5-fold higher than the loss of infection, and the acquisition mostly occurred before 10 years of age. Data regarding acquisition and loss of H. pylori infection are critical for understanding the epidemiology of infection and development of preventive and treatment strategies.