The primary goal of clinical investigation is to identify the cause of upper gastrointestinal symptoms rather than H pylori infection. Therefore, we recommend against a test and treat strategy. Decreasing eradication rates with previously recommended treatments call for changes to first-line therapies and broader availability of culture or molecular-based testing to tailor treatment to the individual child.

No abstract

Helicobacter pylori infection is typically acquired in early childhood, and a predominantly intrafamilial transmission has been postulated. To what extent family members share the same strains is poorly documented. Our aim was to explore patterns of shared strains within families by using molecular typing. Family members of H. pylori-infected 10-to 12-year-old index children identified in a school survey were invited to undergo gastroscopy. Bacterial isolates were typed with random amplified polymorphic DNA and PCRrestriction fragment length polymorphism of the genes ureA-B, glmM, or flaA. The presence or absence of the cag pathogenicity island, a bacterial virulence factor, was determined by PCR. GelCompar II software, supplemented with visual inspection, was used in the cluster analysis. In 39 families, 104 individuals contributed 208 bacterial isolates from the antrum and corpus. A large proportion, 29 of 36 (81%) of the offspring in a sibship, harbored the same strain as at least one sibling. Mother-offspring strain concordance was detected in 10 of 18 (56%) of the families. Of 17 investigated father-offspring relations in eight families, none were strain concordant. Spouses were infected with the same strains in 5 of 23 (22%) of the couples. Different strains in the antrum and corpus were found in 8 of 104 (8%) of the subjects. Our family-based fingerprinting study demonstrates a high proportion of shared strains among siblings. Transmission between spouses seems to be appreciable. The data support mother-child and sib-sib transmission as the primary transmission pathways of H. pylori.Helicobacter pylori colonizes half of the world's population, and the infection is associated with chronic gastritis, peptic ulcer, gastric cancer, and gastric lymphoma. In-depth knowledge of the transmission patterns may constitute important information for future intervention strategies.In the absence of consistent and verified environmental reservoirs, a predominantly person-to-person transmission has been postulated. H. pylori infection is associated with poor living conditions, and possible transmission routes are fecaloral, oral-oral, or gastro-oral, but firm evidence is lacking (36). The infection clusters in families and is usually acquired in early childhood. A child's risk of being infected is largely determined by the presence or absence of infected family members. Having an infected mother has been suggested to be a more prominent risk factor than having an infected father (30,35). Indications of sib-sib transmission have been reported (14). Transmission between spouses occurs but its significance is unclear (5, 9, 19).Molecular typing of pathogens can corroborate and further characterize the transmission pathways suggested by epidemiologic data based on infection status. Shared strains among individuals indicate person-to-person transmission or acquisition from a common source. Unrelated individuals harbor distinct H. pylori isolates (1), while clonal lineages can be discerned within families (2,7,11,16,20,22,24,2...

Treatment with antirotavirus immunoglobulin of bovine colostral origin is effective in the management of children with acute rotavirus diarrhea.