SYMPTOMATIC HELICOBACTER-PYLORI INFECTION IN TUNISIAN CHILDREN - PROSPECTIVE-STUDY OF ITS EPIDEMIOLOGIC, DIAGNOSTIC AND THERAPEUTIC ASPECTS

Background.- Epidemiology, criteria for diagnosis and treatment of Hel icobacter pylori (HP)-related infection in children are still debated. Population and methods.- A total of 130 children and teenagers who pr esented recurrent episodes of unexplained abdominal pain underwent an endoscopic examination. Gastric biopsies were studied for histology an d search for HP (Giemsa and Gram staining, testing for urease and cult ure in an appropriate environment). Serological tests (Elisa) were per formed HP infection was considered as present when two investigations at least proved positive. Infected children were given one drug (amoxi cillin, cimetidine or antiacids) or two drugs (amoxicillin plus tinida zole). Clinical and endoscopic control including histological and bact eriological studies were done for the following 12 to 18 months. Resul ts.- HP infection was present in 70 children (54%). It was associated chronic gastritis in 64 cases (98%) and with duodenal ulcer in the rem aining cases (9%). Recurrent abdominal pain, anorexia, weight loss and family history of peptic diseases were significantly associated with HP infection (P < 0.05). Endoscopic examination was normal in 35 infec ted children (50%); nodular antritis was inconstant (30%) but always a ssociated with HP-related infection (P < 0.001) as was atrophic or fol licular chronic gastritis. Eradication of HP, associated with the disa ppearance of chronic gastritis, was seen in 53% of children given amox icillin alone and in 85% of those given amoxicillin plus tinidazole, b ut never in those receiving cimetidine or antiacids. Relapse of the HP -related infection was observed in four children (16%), 6 to 12 months after thefirst episode. Conclusion. - These results show high prevale nce of HP-related infections in the Tunisian children who suffer from recurrent episodes of abdominal pain. They also confirm tile role of H P in the inflammatory process and the development of gastroduodenal ul cer in children.