[Helicobacter pylori infection in the child population in Spain: prevalence, related factors and influence on growth]

Helicobacter pylori "Test-and-Treat" strategy with urea breath test: A cost-effective strategy for the management of dyspepsia and the prevention of ulcer and gastric cancer in Spain-Results of the Hp-Breath initiative

BACKGROUND

Data from clinical trials comparing Helicobacter pylori (H. pylori) management strategies in patients with dyspepsia are limited. Cost-effectiveness simulation models might help to identify the optimal strategy.

OBJECTIVE

To assess the cost-effectiveness of the H. pylori "Test and Treat" (T&T) strategy including the use of urea breath test (UBT) vs symptomatic treatment (ST) and vs upper gastrointestinal endoscopy (UGE) as a first procedure in patients with dyspepsia.

METHODS

Three main strategies: "T&T" strategy including the use of UBT, "UGE" and "ST" have been compared using cost-effectiveness models developed in accordance with the Spanish medical practice. For the model simulations, a time horizon of 4 weeks was considered for the endpoint "Dyspepsia symptoms relief" and 10 years when using "Peptic ulcer avoided" and "Gastric cancer avoided" endpoints.

RESULTS

For the endpoint "Dyspepsia symptoms relief", T&T strategy appears to be the most cost-effective (883€/success) compared to UGE strategy and to ST strategy (respectively 1628€ and 990€/success). For the endpoint "Probability of peptic ulcer", the T&T strategy appears to be the most cost-effective (421€/peptic ulcer avoided/y) compared to UGE strategy and ST strategy (respectively 728€ and 632€/peptic ulcer avoided/y). For the endpoint "Gastric cancer avoided", the T&T strategy appears to be the most cost-effective (524€/gastric cancer avoided/y) compared to UGE strategy and "ST" strategy (respectively 716€ and 696€/gastric cancer avoided/y).

CONCLUSIONS

T&T strategy including the use of UBT is the most cost-effective medical approach for management of dyspepsia and for the prevention of ulcer and gastric cancer.

Dietary and anthropometric indicators of nutritional status in relation to Helicobacter pylori infection in a paediatric population

It has been postulated that Helicobacter pylori infection could affect growth and appetite, consequently influencing body weight. Therefore, the association between H. pylori infection and the dietary and anthropometric indicators of nutritional status of a paediatric population were investigated. A total of 525 children (aged 4-16 years) who were referred to the gastroenterology unit of the Sor Maria Ludovica Children's Hospital from Buenos Aires, Argentina, were enrolled and completed an epidemiological questionnaire. H. pylori infection was diagnosed using the ¹³C-urea breath test (¹³C-UBT). Height and weight were assessed for calculation of anthropometric indicators. Energy and macronutrient intakes were estimated by 24 h dietary recall. Data analysis was performed using a χ² test, a Student's t test, a Mann-Whitney U test and linear and logistic regressions. The prevalence of H. pylori infection was 25·1 % (with a mean age of 10·1 (SD 3·1) years). A tendency towards lower energy, carbohydrate, protein and fat intakes was observed in infected patients; however, it was not associated with H. pylori infection in any of the evaluated age groups (4-8, 9-13 and 14-16 years). Underweight, stunting, overweight and obesity were also not associated with the infection. Although height-for-age and BMI-for-age Z scores tended to be lower in infected patients, the differences between H. pylori-positive and H. pylori-negative children were not statistically significant. In conclusion, H. pylori infection was not associated with dietary intake or with anthropometric indicators in the present population of children with gastrointestinal symptoms; however, an increased sample size would be needed to confirm the observed tendency towards lower dietary intake and lower anthropometric indicators of nutritional status in H. pylori-infected children.

Prevalence and risk factors of Helicobacter pylori in Turkey: a nationally-representative, cross-sectional, screening with the ¹³C-Urea breath test

Background

Helicobacter pylori is an important global pathogen infecting approximately 50% of the world’s population. This study was undertaken in order to estimate the prevalence rate of Helicobacter pylori infections among adults living in Turkey and to investigate the associated risk factors.

Method

This study was a nationally representative cross sectional survey, using weighted multistage stratified cluster sampling. All individuals aged ≥18 years in the selected households were invited to participate in the survey. Ninety two percent (n = 2382) of the households in 55 cities participated; 4622 individuals from these households were tested with the ¹³C-Urea breath test. Helicobacter pylori prevalence and associated factors were analysed by the t test, chi square and multiple logistic regression with SPSS11.0.

Results

The weighted overall prevalence was 82.5% (95% CI: 81.0-84.2) and was higher in men. It was lowest in the South which has the major fruit growing areas of the country. The factors included in the final model were sex, age, education, marital status, type of insurance (social security), residential region, alcohol use, smoking, drinking water source. While education was the only significant factor for women, residential region, housing tenure, smoking and alcohol use were significant for men in models by sex.

Conclusion

In Turkey, Helicobacter pylori prevalence was found to be very high. Individuals who were women, elderly adults, single, had a high educational level, were living in the fruit growing region, had social security from Emekli Sandigi, were drinking bottled water, non smokers and regular alcohol consumers, were under less risk of Helicobacter pylori infection than others.

Frequency of Helicobacter pylori infection among Egyptian children presenting with gastrointestinal manifestations

BACKGROUND AND AIMS

Recurrent abdominal pain (RAP) and other gastrointestinal (GI) symptoms are common complaints among children. The role of Helicobacter pylori in the causation of these complaints remains controversial. The aim of this study was to determine the frequency of H. pylori infection among children presenting with GI manifestations and to determine the most common clinical presentation of the infection in Egyptian children.

PATIENTS AND METHODS

This prospective cross-sectional study included 150 consecutive patients aged 5-15 years who presented to the outpatient clinic of Cairo University's Specialized Pediatric Hospital with GI complaints. Screening for H. pylori infection was performed using a 13C-urea breath test (13C-UBT), and in patients whose 13C-UBT was positive, diagnosis was confirmed by visualizing the bacterium in biopsy specimens obtained by GI endoscopy.

RESULTS

RAP was the most frequent GI complaint of the study population (82%), followed by anorexia (6.7%), vomiting (6.7%), and chronic diarrhea (4.7%). Seventy percent of these patients were positive for the 13C-UBT. Ninety-one of the patients who complained of RAP had a positive 13C-UBT, whereas the remaining 32 patients who had RAP had a negative 13C-UBT, a difference that was statistically significant (P=0.023). However, no statistically significant differences were found between the 13C-UBT result among patients with anorexia, vomiting, or diarrhea (P=0.153, 1.00, and 0.447, respectively).

CONCLUSION AND RECOMMENDATIONS

Screening for H. pylori infection should be performed for school-aged children who have GI complaints, especially for those who complain of RAP.

Helicobacter Pylori Infection in a Group of Egyptian Children With Upper Gastro-Intestinal Bleeding

Background

Upper gastrointestinal bleeding is a life threatening condition in children. Common sources of upper gastrointestinal bleeding in children include mucosal lesions and variceal hemorrhage. Helicobacter pylori (H. pylori) is a Gram negative spiral-shaped bacterium that is found in the gastric mucous layer or adherent to the epithelial lining of the stomach. It causes more than 90% of duodenal ulcers and up to 70-80% of gastric ulcers. The relationship between H. pylori infection and upper GIT bleeding in children is still un-clear. This study aimed to estimate the incidence of H. pylori infection in children presented with upper GIT bleeding and correlation between H. pylori infection and endoscopic findings of the cause of bleeding.

Methods

The study included 70 children presented with upper GIT bleeding indicated for upper gastrointestinal endoscopy admitted in pediatric department, Minia University Hospital, Egypt during the period from February 2010 to December 2012. Thirty healthy children were included as a control group with age and sex matched. After medical history taking and physical examination all children were exposed for laboratory investigations (CBC, prothrombin time and concentration, liver function tests, hepatitis viral markers, blood urea and serum creatinine and Helicobacter pylori stool antigen test). Upper endoscopy was done for patients only. Patients were classified into variceal and non variceal groups according to upper endoscopy.

Results

Helico-pylori infection was significantly higher in children with non-variceal bleeding than controls (P = 0.02) and children with variceal bleeding (P = 0.03) with no significant difference between children with variceal bleeding and controls (P = 0.9). Both weights and BMIs centile were significantly lower in variceal and non-variceal groups than controls (P = 0.01 & 0.001 and 0.01 & 0.001 respectively). AST, ALT and direct bilirubin levels were significantly higher in variceal group than controls (P = 0.001, 0.004 & 0.001 respectively). Prothrombin concentration and albumin levels were significantly lower in variceal group than controls (P = 0.001 & 0.01 respectively). Hemoglobin levels were significantly lower in variceal and non-variceal groups than controls (P = 0.01 & 0.001 respectively). No significant differences were present as regards age, sex, height or platelets count between cases (variceal and non-variceal) and controls.

Conclusions

H. pylori infection is significantly higher in children with non-variceal bleeding than controls. No significant difference between children with variceal bleeding and controls. Triad of increased ALT, decreased albumin levels and negative H. pylori infection could be a significant triad in predicting variceal bleeding as a cause of upper GIT bleeding in children.

[Clinical practice guideline on the management of patients with dyspepsia. Update 2012]

The aim of the Clinical Practice Guideline (CPG) on the Management of Patients with Dyspepsia is to generate recommendations on the optimal approach to dyspepsia in the primary care and specialized outpatient setting. The main objective of this CPG is to help to optimize the diagnostic process, identifying patients with a low risk of a serious organic disease (mainly tumoral), who could be safely managed without the need for invasive diagnostic tests and/or referral to a specialist. The importance of this aim lies in the need to accurately diagnose patients with esophagogastric cancer and correctly treat peptic ulcer while, at the same time, reduce negative endoscopies in order to appropriately use the available healthcare resources. This CPG reviews the initial strategies that can be used in patients with uninvestigated dyspepsia and evaluates the possible decision to begin empirical therapy or to investigate the existence of a lesion that could explain the symptoms. This CPG also discusses functional dyspepsia, which encompasses all patients with dyspepsia with no demonstrable cause on endoscopy. Recommendations for the diagnosis and treatment of peptic ulcer and Helicobacter pylori infection are also made. To classify the scientific evidence and strengthen the recommendations, the GRADE (Grading of Recommendations Assessment, Development and Evaluation Working Group) system has been used (http://www.gradeworkinggroup.org/).

[Clinical practice guideline on the management of patients with dyspepsia. Update 2012]

The aim of the Clinical Practice Guideline (CPG) on the Management of Patients with Dyspepsia is to generate recommendations on the optimal approach to dyspepsia in the primary care and specialized outpatient setting. The main objective of this CPG is to help to optimize the diagnostic process, identifying patients with a low risk of a serious organic disease (mainly tumoral), who could be safely managed without the need for invasive diagnostic tests and/or referral to a specialist. The importance of this aim lies in the need to accurately diagnose patients with esophagogastric cancer and correctly treat peptic ulcer while, at the same time, reduce negative endoscopies in order to appropriately use the available healthcare resources.This CPG reviews the initial strategies that can be used in patients with uninvestigated dyspepsia and evaluates the possible decision to begin empirical therapy or to investigate the existence of a lesion that could explain the symptoms. This CPG also discusses functional dyspepsia, which encompasses all patients with dyspepsia with no demonstrable cause on endoscopy. Recommendations for the diagnosis and treatment of peptic ulcer and Helicobacter pylori infection are also made. To classify the scientific evidence and strengthen the recommendations, the GRADE (Grading of Recommendations Assessment, Development and Evaluation Working Group) system has been used (http://www.gradeworkinggroup.org/).

Gastrointestinal symptoms and Helicobacter pylori infection in school-age children residing in Porto Torres, Sardinia, Italy

BACKGROUND

Helicobacter pylori infection is typically acquired in childhood, and following the acute event, it is thought that most infections remain asymptomatic. H. pylori has been suggested to protect against diarrhea in childhood.

AIM

To examine the role of H. pylori in gastrointestinal symptoms in children.

MATERIALS AND METHODS

A cross-sectional sero-epidemiologic study was conducted in Porto Torres, Sardinia, Italy. Demographic information, socioeconomic factors, and the frequency of upper gastrointestinal symptoms during the previous 3 months (e.g., abdominal pain, diarrhea, nausea, heartburn, halitosis, slow digestion, belching, and weight loss) were evaluated by a questionnaire. H. pylori status was determined by ELISA.

RESULTS

Approximately 95% (N = 1741) of school children between the age of 6 and 15 years from Porto Torres participated. The sero-prevalence of H. pylori infection was 13.3% (229/1727) and similar in boys (13%) and girls (14%) (p = .57). Nausea/vomiting (odds ratio (OR) = 2.2 (95% CI = 1.2-5.1)) and diarrhea (OR = 2.1 (95% CI = 1.3-2.8)) were each significantly associated with H. pylori infection, and these associations remained significant after controlling for other study variables. There was no significant association between H. pylori and abdominal pain or heartburn (p > .25).

CONCLUSIONS

The study does not support either a role of H. pylori infection in abdominal pain in children or a protective role against diarrheal illnesses or nausea/vomiting.

Effect of Helicobacter pylori infection on growth velocity of school-age Andean children

BACKGROUND

Helicobacter pylori infection affects about half of the world's population and is usually acquired in childhood. The infection has been associated with chronic gastritis, peptic ulcer, and stomach cancer in adulthood. Little is known, however, about its consequences on child health. We examined the effect of H. pylori infection on growth among school-age children in the Colombian Andes by comparing growth velocity in the presence and absence of H. pylori infection.

METHODS

Children who were 4-8 years old in 2004 were followed up in a community where infected children received anti-H. pylori treatment (n = 165) and a comparison community (n = 161) for a mean of 2.5 years. Anthropometry measurements were made every 3 months and H. pylori status ascertained by urea breath test every 6 months. Growth velocities (cm/month) were compared across person-time with and without infection, using mixed models for repeated measures.

RESULTS

In the untreated community, 83% were H. pylori-positive at baseline and 89% were -positive at study end. The corresponding prevalences were 74% and 46%, respectively, in the treated community. Growth velocity in the pretreatment interval was 0.44 (standard deviation [SD] = 0.13) cm/month. Models that adjusted for age, sex, and height estimated that H. pylori-positive children grew on average 0.022 cm/month (95% confidence interval = 0.008 to 0.035) slower than H. pylori-negative children, a result that was not appreciably altered by adjustment for socioenvironmental covariates.

CONCLUSIONS

This study suggests that chronic H. pylori infection is accompanied by slowed growth in school-age Andean children.

Effect of Helicobacter pylori infection on growth velocity of school-age Andean children

BACKGROUND

Helicobacter pylori infection affects about half of the world's population and is usually acquired in childhood. The infection has been associated with chronic gastritis, peptic ulcer, and stomach cancer in adulthood. Little is known, however, about its consequences on child health. We examined the effect of H. pylori infection on growth among school-age children in the Colombian Andes by comparing growth velocity in the presence and absence of H. pylori infection.

METHODS

Children who were 4-8 years old in 2004 were followed up in a community where infected children received anti-H. pylori treatment (n = 165) and a comparison community (n = 161) for a mean of 2.5 years. Anthropometry measurements were made every 3 months and H. pylori status ascertained by urea breath test every 6 months. Growth velocities (cm/month) were compared across person-time with and without infection, using mixed models for repeated measures.

RESULTS

In the untreated community, 83% were H. pylori-positive at baseline and 89% were -positive at study end. The corresponding prevalences were 74% and 46%, respectively, in the treated community. Growth velocity in the pretreatment interval was 0.44 (standard deviation [SD] = 0.13) cm/month. Models that adjusted for age, sex, and height estimated that H. pylori-positive children grew on average 0.022 cm/month (95% confidence interval = 0.008 to 0.035) slower than H. pylori-negative children, a result that was not appreciably altered by adjustment for socioenvironmental covariates.

CONCLUSIONS

This study suggests that chronic H. pylori infection is accompanied by slowed growth in school-age Andean children.

Association between helicobacter pylori and gastrointestinal symptoms in children

OBJECTIVE

Recurrent abdominal pain (RAP) and other gastrointestinal (GI) symptoms are common complaints among children. The role of Helicobacter pylori in the cause of these complaints remains controversial. Nevertheless, there is an increasing pressure on primary care clinicians to screen for H pylori infection in symptomatic children. We systematically reviewed the published evidence for an association between H pylori infection and GI symptoms in children.

METHODS

Medline and Embase databases up to July 2009 were searched to identify studies that evaluated the association between H pylori and GI symptoms in children aged up to 18 years. When studies reported on abdominal pain without additional definition, thus not fulfilling Apley's criteria, we grouped these outcomes as unspecified abdominal pain (UAP). Methodologic quality was scored by using a standardized list of criteria, and crude odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and pooled.

RESULTS

Thirty-eight studies met our inclusion criteria: 23 case-control studies, 14 cross-sectional studies, and 1 prospective cohort study. The overall methodologic quality was low. Pooled ORs for the association between RAP and H pylori infection in children were 1.21 (95% CI: 0.82-1.78) in 12 case-control studies and 1.00 (95% CI: 0.76-1.31) in 7 cross-sectional studies. Meta-analysis of the association between UAP and H pylori infection in 6 hospital-based studies resulted in a pooled OR of 2.87 (95% CI: 1.62-5.09) compared with 0.99 (95% CI: 0.46-2.11) in 5 population-based studies. Two of 3 studies concerning epigastric pain reported a statistically significant positive association with H pylori infection.

CONCLUSIONS

We found no association between RAP and H pylori infection in children and conflicting evidence for an association between epigastric pain and H pylori infection. We found evidence for an association between UAP but could not confirm this finding in children seen in primary care.

Influence of Helicobacter pylori infection associated with iron deficiency anaemia on growth in pre-adolescent children

In 102 children of both genders aged between 10 and 12 years affected by iron deficiency anaemia (IDA) from various causes, a retrospective study from 1999 to 2007 has been performed to investigate possible relationships between IDA and physical growth. Patients were divided into two groups according to gender. Hb, MCV, ferritin levels, HSDS and body mass index (BMI) were recorded to confirm the diagnosis and the height standard deviation scores were also evaluated. The causes of IDA were investigated. At study entry, both groups of patients, regardless of IDA etiology, had microcytic hypochromic anaemia with low ferritin level. Anthropometric parameters were also reduced. Significant differences of anthropometric parameters were found in both groups in relationship to various causes of IDA (p<0.05) (ANOVA). We conclude that IDA may influence physical growth and etiological factors play an important role on growth delay.

[Analysis of antibiotic consumption in the pediatric population of Castile and León (Spain) from 2001 to 2005]

OBJECTIVES

To analyze trends in antibiotic use among the pediatric population of Castile and León from 2001 to 2005.

MATERIAL AND METHODS

The antibiotics prescribed to the pediatric population in primary care were processed using the CONCYLIA database. The technical unit of measurement was the defined daily dose (DDD) and the comparative indicator used was the DDD per 1000 inhabitants/day (DID).

RESULTS

Overall consumption was high (21.21 DID). Throughout the 5 years of the study we observed substantial variations, especially in 2005, the year in which consumption was highest (25.05 DID). The therapeutic subgroups most frequently prescribed were wide-spectrum penicillins (8.08 DID) and penicillins associated with beta-lactamase inhibitors (7.29 DID), followed by cephalosporins (2.81 DHD) and macrolides (2.52 DHD). The percentage of wide-spectrum penicillin prescription was higher than that of penicillins associated with beta-lactamase inhibitors between 2001 and 2002. These percentages were similar in 2003, and the percentage of wide-spectrum penicillin prescription was lower than that of penicillins associated with beta-lactamase inhibitors in the last 2 years of the study.

CONCLUSIONS

Marked differences in consumption were observed over the study period. Changes in patterns of use were found, with an increase in the use of penicillins associated with beta-lactamase inhibitors in the last 2 years of the study.