The role of Helicobacter pylori and gastritis in children with recurrent abdominal pain

Background: Recurrent abdominal pain is a common pediatric diagnostic probl em. Endoscopy is sometimes performed as part of the evaluation. Although ga stritis and/or Helicobacter pylori infection is often present, it is not kn own if they contribute to the symptomatology. Objectives: To evaluate the role of either gastritis or H. pylori infection in the symptomatology of children with RAP. Patients and Methods: We retrospectively studied two groups of patients, 70 children in each, who had undergone endoscopy. One group was evaluated end oscopically for RAP and the other was a heterogeneous group that underwent endoscopy for indications other than RFLP. Biopsies were taken during endos copy and Giemsa staining was performed for the presence of H. pylori. Tripl e therapy was given as indicated, and the children were followed for an ave rage of 6 months. Results: Microscopic gastritis was diagnosed in 39 patients (55.7%) of the RAP group and in 31 of the heterogeneous group (44.2%) (NS), and H. pylori was found in 32 patients of the RAP group and in 16 of the heterogeneous gr oup (45.7% vs. 22.8%, P<0.01). All children with H. pylori, except one in t he heterogeneous group, had accompanying gastritis. On the other hand, gast ritis without H. pylori infection was seen in 7 children in the RAP group a nd in 15 of the other. Endoscopy revealed macroscopic abnormalities in 52 o f the 70 children with microscopic gastritis. There was a clinical improvem ent after triple therapy in 28 of 33 children with H. pylori-associated gas tritis (84.85%), in 4 of 8 children with gastritis unassociated with H, pyl ori (50%), and in 8 of 15 without gastritis or H. pylori (53.3%) (P<0.01 be tween the H. pylori-associated gastritis and each of the other groups). Conclusions: H. pylori infection and gastritis may be associated with RAP i n a selected subgroup of children. We recommend a complete work-up, includi ng endoscopy and invasive or non-invasive diagnostic modalities for H. pylo ri, and treatment of the infection.