Helicobacter pylori Infection: Clinical, Endoscopic, and Histological Findings in Lebanese Pediatric Patients

Abstract

Background. Helicobacter pylori (H. pylori) is a common and universally distributed bacterial infection. However, in children, active gastritis and ulcer are rarely seen. Objectives. The aims of this study were to establish the prevalence of H. pylori infection and to compare the clinical, endoscopic, and histopathological findings between infected and noninfected pediatric patients at Makassed General Hospital. Methods. Patients aged between 1 month and 17 years who underwent upper gastrointestinal endoscopy from January 2011 to January 2017 were included. The diagnosis of H. pylori was confirmed by a CLO test and/or its presence on biopsy specimens. Demographic data, clinical characteristics, endoscopic and histopathological findings, and gastritis score were recorded retrospectively. Results. During the study period, 651 children underwent upper gastrointestinal endoscopy. The main indication was abdominal pain (61%). The prevalence of H. pylori infection was 16.5%. The infection was most commonly seen among children aged between 6 and 10 years (43%). A large number of family members were associated with increased risk of infection (4.8±1.5 versus 5.2±1.8; p<0.05). Epigastric pain was more associated with H. pylori (61.3% versus 14.6% in noninfected patients; p<0.05). Nodular gastritis was commonly seen in infected patients (41.5% vs. 7.9%; p<0.05). Mild and moderate gastritis was seen more in infected versus noninfected patients (mild: 53.8% vs. 14%; moderate: 27.4% vs. 2.4%, respectively). Conclusion. Although epigastric pain was associated with H. pylori, other diagnoses should be considered since the infection are rarely symptomatic in children. Antral nodularity was associated with H. pylori infection; however, its absence does not preclude the diagnosis.

Time trend prevalence of helicobacter pylori infection and endoscopic findings in symptomatic children in Portugal: A retrospective study based on three time points in 2009, 2014, and 2019

“…In our study, we observed a variety of indications for endoscopic examination. As well as in the study recently conducted by Ahmad et al, among others, the most frequent indication was abdominal pain 10,31,43 . However, in contrast to that study and similarly to Yao‐ Yong et al, we observed a statistically significant association between abdominal pain and the H. pylori infection positivity 42,45–47 .…”

“…Previous studies that assessed the association between endoscopic findings and the H. pylori status, observed that nodular gastritis is a predominant gastric manifestation in H. pylori ‐infected children 10,14,30 . According to literature, antral nodularity is a good predictor of H. pylori infection in children 48 .…”

“…According to the ESPGHAN/NASPGHAN guidelines, the current gold standard for H. pylori infection diagnosis in symptomatic children is upper gastrointestinal endoscopy with biopsies for culture, histology, and rapid urease test 7,8 . Nodularity is one of the most common endoscopic findings in H. pylori ‐infected children 9–11 and may be present in 67% of H. pylori ‐infected children, according to Prieto et al 12 Several studies have pointed out the specificity of nodular gastritis for high‐grade H. pylori colonization and chronic active gastritis in H. pylori‐ infected children 13,14 . The presence of lymphoid aggregates and lymphoid follicles is frequent in H. pylori ‐infected children due to the immunological response in chronic gastritis 9,10,15,16 …”

“…13,14 The presence of lymphoid aggregates and lymphoid follicles is frequent in H. pyloriinfected children due to the immunological response in chronic gastritis. 9,10,15,16 Gastric cancer is the fifth most common cancer and the third leading cause of cancer death worldwide, and H. pylori infection is recognized as the main associated causal factor. Accordingly to the the Global Cancer Observatory in 2020, Portugal remains among the European countries with the highest incidence rates and estimated age-standardized mortality rate.…”

Paediatric Gastrointestinal Endoscopy in a Nigerian Tertiary Hospital

“…About two-thirds (66.7%) of children with gastritis had a positive result for Helicobacter pylori in Lagos, [11] while 87.7% and 84.9% of Helicobacter pylori-positive Lebanese children had chronic and active gastritis respectively. [18] The proportion of Helicobacter pylori positivity in the children with gastritis in the present study was not determined. Hiatus hernia was the second commonest finding in this study, comparable with that of Adeniyi et al in Lagos.…”