Long-term Effects of Clearing Helicobacter pylori on Growth in School-age Children

Abstract

Background A new H. pylori infection affects growth velocity negatively, and clearing the infection produces a small significant rebound, but it is not known whether height and weight in children are impacted over the long term. Methods We investigated 295 school-age children followed in two cohorts, one treated (150) and one untreated (145), from 2004 for 3.7 years with 1105 child-years of observation. Follow-up intervals were 3 months for anthropometry measurements and 6 months for H. pylori status ascertained by urea breath test. Height in centimeters and weight in kilograms were analyzed using growth models. Results A multivariate mixed model that adjusted for age, sex, father’s education and number of siblings found no significant differences in height or weight at baseline by H. pylori status. The same model showed a significant impact of clearing H. pylori across time, with increasing significant differences in average height and weight as the follow-up progressed. Conclusions Children who were always negative or who cleared the infection grew significantly faster than those who stayed positive after adjusting for other covariates. This study suggests that school age children’s growth benefits from being treated for H. pylori infection.

Helicobacter pylori Infection and Children's Growth

“…Other prospective studies found no significant association between H pylori infection and ponderal growth ( Table 2). (Table 3) Limited evidence exists on the role of H pylori eradication on children's weight (13,26,32,47). Overall all these observational studies show evidence of some benefit for gains in body weight following H pylori eradication (13,26,32,47).…”

“…Clearing H pylori infection was shown to have an increasingly significant effect on height up to 3.7 years of follow-up (26). This suggests a durable effect of clearing H pylori infection on increased height among school-age children treated for H pylori infection (26). A secondary analysis was performed for data obtained in the framework of a randomized controlled clinical trial of asymptomatic Native Alaska children of age 7 to 11 years, which assessed the role of H pylori treatment on iron deficiency.…”

“…Only few studies have investigated this important question (13,19,26,47). A study was conducted among Andean children (19,26) Ã BMI ¼ body mass index; CagA ¼ Cytotoxin-associated gene A; CI ¼ confidence interval; ELISA ¼ enzyme-linked immunosorbent assay; GI ¼ gastrointestinal; HAP ¼ height-for-age percentile; HAZ ¼ height-for-age z score; Hp ¼ Helicobacter pylori; IDA ¼ iron deficiency anemia; NCHS ¼ National Center for Health Statistics; NHANES III ¼ The Third National Health and Nutrition Examination Survey; no. ¼ number; OR ¼ odds ratio; RAP ¼ recurrent abdominal pain; SD ¼ standard deviation; SDS ¼ standard deviation score; SES ¼ socioeconomic status; UBT ¼ urea breath test; VacA ¼ vacuolating cytotoxin; WAZ ¼ weight-for-age z score; WHP ¼ weight for height percentiles.…”

What do we know about benefits ofH. pyloritreatment in childhood?

“…Mera et al (2012) compared growth in communities where H. pylori-positive children received treatment to eliminate the infection to growth in communities where no intervention was offered. 81 At the end of an average follow-up of 3.7 y, children from the community that received treatment were 1.1 kg (95% CI: 0.64, 1.64) heavier on average than children from the non-intervention community, after adjusting for age, sex, father's education, number of siblings, cohort, follow-up time, H. pylori status, and the interaction between H. pylori status and followup time. Children from the community that received treatment were also 2.98 cm (95% CI: 2.04, 3.94) taller on average than children from the non-intervention community, after adjusting for age, sex, father's education, number of siblings, and presence of helminthes or protozoa in the stool.…”

“…pylori infection in children can produce gastric lesions that weaken or destroy the gastric acid barrier, 1 interfering with micronutrient absorption, appetite, metabolism, and related factors, and thereby inhibiting growth. [79][80][81] A small number of studies have investigated the impact of treatment to eliminate H. pylori infection on growth. 83 Differences in mean scores for height (cm), weight (kilograms), and BMI standard deviation scores (SDs) were estimated based on the 1990 UK growth reference charts.…”