Helicobacter pylori infection in pediatric patients. A review of twenty-three cases

Pediatric Helicobacter pylori infection is rare but can be transmitted within families or institutions. There are few secondary risk factors. Chronic carriage of Helicobacter pylori can start during childhood. Findings from 117 upper gastrointestinal tract endoscopies in 100 children with abdominal pain, vomiting, or hematemesis were studied retrospectively. Helicobacter pylori was looked for using Giemsa-stained sections and/or cultures. Twenty-three patients (20% of endoscopies) tested positive for Helicobacter pylori; 58% were girls, and mean age was 11.5 +/- 4.5 years. The most common symptom was abdominal pain (79%), which was usually chronic (mean duration, 8.1 months) and located in the stomach area. Vomiting occurred in 37% of cases. A substantial proportion of Helicobacter pylori-positive patients were of North African descent (47%); 21% lived in institutions, and 16% had encephalopathy. Endoscopic evidence of gastritis was found in 61% of the Helicobacter pylori-positive patients. Micronodular gastritis was rare. Half of the few patients with gastroduodenal ulcers tested positive for Helicobacter pylori. The most common histologic pattern was chronic gastritis (72%) and atrophic gastritis (56%); active gastritis and follicular gastritis were rare. Sensitivity was 80% for stained sections and 67% for cultures. Helicobacter pylori gastritis should be looked for in children with recurrent epigastric pain. Appropriate management of Helicobacter pylori infection in childhood may reduce the incidence of peptic ulcer disease in adults. Screening of symptomatic patients and family members could benefit from development of indirect diagnostic methods, such as antibody detection and the urea breath test.