Over a 5-y period, 396 children complaining of recurrent abdominal pain (RA
P) underwent upper gastrointestinal endoscopy in order to identify any unde
rlying organic pathology and determine the prevalence of Helicobacter pylor
i (H. pylori) infection. Histologically confirmed mucosal inflammation was
found in 338 out of 396 children (85.4%); in 113 of 396 patients (28.5%), H
. pylori was identified on the gastric mucosa. Significant discriminating f
actors between H. pylori positive and negative children with RAP included a
ge (mean age for positive 11 y vs. 8.1 y for negative, p < 0.01) and gender
(male gender predominance in the H. pylori positive, p < 0.001). No signif
icant difference was found between H. pylori positive and negative groups r
egarding incidence and character of the presenting symptoms. All H. pylori
positive children (100%) had abnormal histology compared with 225 out of 28
3 negative ones (79.5%). Histologically confirmed gastritis was the most pr
ominent finding in H. pylori positive children compared with H. pylori nega
tive (98.2% vs. 19%, p < 0.001). Conversely, oesophagitis was more common i
n H, pylori negative children (47.7% vs. 27.4%, p < 0.001). The incidence o
f peptic ulcer was higher in H. pylori infected patients than in the H. pyl
ori negative group (5.3% vs. 1%, p < 0.05). Our data suggest that gastroint
estinal pathology is more common than previously thought in children with R
AP, while H. pylori infection is a relatively important factor in the etiol
ogy of upper gastrointestinal inflammation in RAP syndrome.