CLINICAL-SIGNIFICANCE OF HELICOBACTER INFECTION IN CHILDREN

Helicobacter pylori infection of the gastric mucosa causes chronic gas tritis and is associated with peptic ulcer disease and gastric carcino ma. These are conditions which usually occur in adult life. However, H . pylori is an infection which is mainly acquired in childhood. The ov erall prevalence of H. pylori in children is 10% in developed countrie s but can be as high as 30-40% in children from lower socio-economic g roups. In developing countries, the prevalence of H. pylori in childre n ranges from 80-100%. H. pylori gastritis does not appear to be assoc iated with symptoms in children in the absence of duodenal ulcer disea se. H. pylori infection is present in the vast majority of children wi th duodenal ulcer disease and, as in adults, eradication of the organi sm results in long-term healing of duodenal ulceration. H. pylori infe ction acquired in childhood is now considered to be a significant risk factor for the development of gastric carcinoma. The World Health Org anization has classified H. pylori as a Group 1 carcinogen. Specific e pidemiological questions which need to be answered in children include the age at which infection is acquired, specific risk factors for inf ection, the mode of transmission and the risk of reinfection following treatment. Recently, a one week treatment regimen using colloidal bis muth subcitrate, metronidazole and clarithromycin has been shown to be effective in treating children, but compliance is important. Currentl y there are no guidelines on the need to treat children and a consensu s is urgently required on this issue.