HELICOBACTER-PYLORI INFECTION IN RECURRENT ABDOMINAL-PAIN IN CHILDHOOD - COMPARISON OF DIAGNOSTIC-TESTS AND THERAPY

Objective. To determine the role of Helicobacter pylori infection in c hildren with recurrent abdominal pain and the usefulness of serologic tests in screening H pylori infection and monitoring treatment of H py lori-associated gastritis. Methods. During a 3 year period, we investi gated the presence of serum immunoglobulin G (IgG) antibody to H pylor i in 456 children using the high-molecular-weight cell-associated prot ein H pylori enzyme immunoassay kit. Among the 456 children studied, 2 18 (age range, 3 to 18 years; mean age, 9.5 years) had symptoms of rec urrent abdominal pain (RAP syndrome) with or without vomiting, and the remaining 238 (age range, 3 to 18 years; mean age, 9.8 years) had no RAP (non-RAP syndrome). We performed upper gastrointestinal endoscopy on 111 consecutive children of the 218 with RAP syndrome and obtained mucosal biopsies for culture, histologic analysis, CLO test (Delta Wes t, Perth, Australia), and H pylori detection by polymerase chain react ion. Results. Thirty-eight (17.4%) of 218 children in the RAP group an d 25 (10.5%) of 238 children in the non-RAP group were seropositive fo r H pylori. Of the 111 children endoscoped, 95 were found to be negati ve, and 12 were positive by all five assays. Specimens from 2 children were negative by culture and the CLO test but positive by the other t hree assays. Specimens from 1 child were negative by histologic analys is but positive by all other tests. The remaining child was positive f or anti-a pylori IgG but negative by all of the other four assays. Upp er gastrointestinal endoscopy detected 14 children with peptic ulcer d isease (9 duodenal ulcer and 5 gastric ulcer) and 12 with antral nodul ar gastritis. Only 4 of the 14 diagnosed with peptic ulcer were H pylo ri positive by all five assays, whereas all 12 children with antral no dular gastritis were H pylori positive. Nine of the 12 H pylori-positi ve children were treated with a combination of bismuth subsalicylate, amoxicillin, and metronidazole for 2 weeks. Sera obtained at 2, 4, and 6 months after treatment from all 9 children showed a decrease in ant i-H pylori IgG titer. Three H pylori-infected children who did not rec eive any treatment served as control children, and their IgG levels re mained elevated or increased over time. Conclusion. The results from o ur study indicate that screening for the serum IgG antibody to H pylor i is a practical method for diagnosing H pylori infection in children, and that serial measurements of the H pylori IgG antibody are useful for monitoring treatment of H pylori because of its high sensitivity a nd ease of performance. Only 4 of the 14 children diagnosed with pepti c ulcer disease were confirmed to be infected with H pylori, whereas a ll 12 children with antral nodular gastritis were found to be infected by H pylori, These observations suggest that H pylori infection is mo re frequently associated with gastritis than with peptic ulcer disease in children, and that H pylori gastritis is a cause of RAP syndrome i n children.