Associations of Helicobacter pylori seropositivity and gastric inflammation with pediatric asthma

Abstract

Objective Controversy exists regarding an association between Helicobacter pylori infection and asthma in children. We examined the hypotheses of inverse associations of H. pylori seroprevalence and pepsinogen (PG) levels, as markers of gastric inflammation, with asthma in children. Methods A hospital‐based case‐control study was conducted among children aged 4.8 to 17.3 years in Israel. Confirmed asthma cases (n = 75) were recruited through a pulmonary clinic, and controls (n = 160) without asthma were enrolled. Using enzyme‐linked immunosorbent assays we measured the presence of H. pylori immunoglobulin G (IgG) antibodies, IgG antibodies to cytotoxin‐associated gene A antigen (CagA) (virulent factor), serum PG levels and exposure to other enteric pathogens (Shigella flexneri). Multivariable logistic regression models were applied. Results H. pylori IgG seropositivity was 25% and 40% among cases and controls, respectively (P = .03). H. pylori CagA IgG seropositivity was associated with reduced risk of asthma (adjusted odds ratio [OR], 0.33 [95% CI, 0.11‐0.95] but not for the CagA negative serology (adjusted OR, 0.70 [95% CI, 0.32‐1.54]). Children who were H. pylori seropositive with a PGI:PGII of ≤6.78 (severe gastric inflammation) had a lower likelihood of asthma (adjusted OR, 0.31 [95% CI, 0.10‐0.89]) than did seronegative children. Exposure to Shigella flexneri did not differ between cases and controls, nor according to H. pylori seropositivity. Among the asthmatic children, pulmonary function did not differ according to H. pylori seropositivity. Conclusions H. pylori infection and its related gastric inflammation may have a protective role in the risk of pediatric asthma and further research into a potential causal pathway is required.

Helicobacter pylori infection causes both protective and deleterious effects in human health and disease

“…H. pylori infection and obesity may interact to affect risk of asthma and allergy, but the causal pathway linking these is unclear ( 66 , 79 , 80 ). In a case-control study using the second Nord-Trøndelag Health Study (HUNT), abdominal obesity and H. pylori infection were associated with reduced risk of asthma and allergy ( 70 ).…”

Pediatric gastritis on point-of-care ultrasound

“…In our country, H. pylori continues to be carried by about a third of all children,[ 3 4 ] with a high burden of peptic ulcer disease. [ 5 ] Physicians caring for children are strongly advised against treating before endoscopic confirmation of H. pylori infection.…”

Helicobacter pylori and the intestinal microbiome among healthy school‐age children

“…pylori seroprevalence with pediatric asthma. 20 Intriguingly, epidemiological research has consistently indicated that a rich microbial environment in early life confers protection against the development of asthma, 63 atopic diseases, 64 and food allergies, 65 pointing towards a possible interconnection between H. pylori, intestinal microbiome perturbations, and immune-mediated diseases in childhood. Interestingly, a recent large-scale study 66 showed that maternal carriage of Prevotella copri during pregnancy strongly predicted the absence of food allergy in the offspring.…”

“…18,19 Conversely, the risk of asthma is lower among H. pylori infected children than uninfected ones. 20 Therefore, it seems that H. pylori infection might play a role in children's health and development. Emerging evidence also links between the gut microbiome and children's health.…”