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

Abstract

BackgroundUpper 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.MethodsThe 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.ResultsHelico-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.ConclusionsH. 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.

<p><em>Helicobacter pylori</em> Prevalence and Impact: A Histology-Based Report About Children from an Endemic Country</p>

“…The prevalence rate was 54% among symptomatic children, and it compares to the rates in the literature from other Arab countries. [21][22][23][24] Table 7 summarizes these histology-based studies. Jordan's high prevalence rate is similar to those of Egypt and Saudi Arabia and almost double those of Oman and Kuwait.…”

“…Studies from Kuwait, Saudi Arabia, Egypt, and Oman showed the prevalence of H. pylori to be 31%, 62%, 65% and 25 %, respectively. [21][22][23][24] In Jordan, studies estimated the HBP of H. pylori in adults to be 68%-82%, 7,25,26 and the presence of H. pylori infection was documented in 50-79% of gastric cancer biopsies in adult Jordanians. 27,28 Serology -based studies in asthmatic and healthy Jordanian children estimated H. pylori prevalence to range from 18.1% to 55.5%, respectively.…”

Helicobacter pylori gastritis in Jordanian children: persistence versus resolution

“…El-Mazary et al investigated the presence of H. pylori in Egyptian children who presented with non-variceal upper gastrointestinal bleeding. They reported a prevalence rate of 65% [39]. Another study from Oman documented the overall prevalence of biopsy proven H. pylori infection at 25% [13].…”

“…Despite the scarce data regarding H. pylori in Middle Eastern children, a cohort study conducted in Oman in 2014 showed an overall prevalence of biopsy-diagnosed H. pylori infection of about 25% [13]. Additionally, data collected in Egypt and Saudi Arabia showed prevalence levels of 65% and 62%, respectively [14,15]. As for local evidence, a study of dyspeptic children conducted in Northern Jordan revealed an 82% prevalence based on histologic evidence [16].…”