Natural outcome of Helicobacter pylori infection in asymptomatic children:A two-year follow-up study

Background and Objectives. It is known that Helicobacter pylori can be acqu ired in early childhood. There is not enough data to know whether or not in fected children should be treated. A better knowledge of the natural outcom e and implications of H pylori infection may provide evidence that eradicat ion therapy is beneficial in childhood. This prospective study looks at cli nical symptoms, endoscopic, microbial, and histologic changes during a 2-ye ar period in infected asymptomatic children. It is hoped that some prognost ic indicators will be found that select out the children that later need th erapy. Patients and Methods. During epidemiologic study of the prevalence of H pyl ori infection, 18 children aged 7 +/- 4 years (mean +/- 1 SD) were discover ed to have N pylori infection and enrolled in the 2-year follow-up study. T hese patients had received no eradication therapy because they were asympto matic. The follow-up for each patient consisted of an initial assessment, a clinical examination every 6 months, and an endoscopic reevaluation at the end of the first and second years. Gastric mucosal samples were analyzed f or bacteriologic and histologic changes. Various factors were initially rec orded: individual factors included sex, age, and housing conditions; microb ial factors included bacterial load and the presence of the CagA gene. Infl ammatory changes were also noted, such as the presence of active gastritis and nodular formation, and these were correlated with the histology which w as described using the Sydney classification. Typing polymerase chain react ion-restriction fragment length polymorphism was performed to check the per sistence of the same strain of H pylori in each patient. Results. All of the children were still infected after 2 years with the sam e strain as in the initial assessment with the exception of 1 child whose i nfection cleared spontaneously. The density of antral and fundal mucosal co lonization with H pylori also remained stable. There were progressive infla mmatory changes in this cohort, particularly between the first and second y ear (histologic score, 3.5 +/- 1.3 vs 5 +/- 1). Active antral gastritis occ urred in 3 out of 14 and 1 out of 8 children during the first and second ye ar, respectively. Gastritis became active in the fundus in 2 out of 14 and 2 out of 8 children during the same period. Increases in the histologic sco re were found particularly in male children, and children colonized by cagA - strains of H pylori during the follow-up. The frequency of nodular gastri tis significantly rose from 11% (2 out of 18 children) to 64% (9 out of 14 children) after 1 year, and to 80% (8 out of 10 children) after 2 years. Conclusion. These findings demonstrate a deterioration in the histologic fe atures of the gastric mucosa of infected children despite stable H pylori c olonization and the absence of symptoms.