Diagnosis of Helicobacter Pylori in children – An Update

 

Infection with Helicobacter pylori (H. Pylori) is acquired in early childhood. The prevalence is higher in developing countries compared to developed countries including Australia. Complications are fewer in children with less than 10% of hose infected develop peptic ulcer disease (PUD) confirmed by endoscopy. A recent meta-analysis concluded that H. pylori infection in the absence of PUD is not associated with abdominal pain in children. Also as per European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) and North American Society for Paediatric Gastroenterology Hepatology and Nutrition (NASPGHAN), “test and treat policy” is not recommended for children with abdominal symptoms. There is no clear evidence to prove causality of other extra-gastric symptoms including otitis media, upper respiratory infections, dental diseases,food allergies, sudden infant death syndrome and short stature. H.pylori has been considered to be a significant risk factor for certain types of gastric malignancies especially in young age (less than 45 years old). However, apart from a few case reports of mucosa-associated lymphoid tissue (MALT) lymphoma, no other H.pylori associated malignancies are reported in children. Screening could be considered for children with first degree relative with gastric cancer at a young age. As they would have similar genetic makeup and environmental exposure to their relatives and eradication of H.pylori if detected may prove to be beneficial. Iron deficiency anaemia is commonly seen in children with poor socioeconomic conditions and dietary inadequacy. Oral iron therapy has shown to be effective in most of the cases. But iron deficiency anaemia refractory to oral iron therapy needs to be investigated further for an underlying gastrointestinal cause. H.pylori infection needs to
be screened for in addition to coeliac disease and other gastrointestinal disorders. For diagnosis of H.pylori infection, gastric biopsies for histopathology in addition to culture and/or rapid urease test should be obtained in these children. There is no role for antibodies in serum, urine or saliva for diagnosis or confirmation of eradication as specific antibodies can remain positive for months after the infection is resolved. Urea breath test remains a highly sensitive, specific and accurate test for H.pylori infection, but hard to perform in a young child. Stool antigen of H.Pylori is more practical for
children unable to cooperate for the breath test. Urea breath test and stool antigen could be effectively used for confirmation of eradication after therapy.

 

Conclusion:

  1. Test and treat strategy for H.pylori not recommended for children with abdominal symptoms.
  2.  Indications for screening for H.Pylori
    • Refractory iron deficiency anaemia
    • History of first degree relatives with gastric cancers
  3. Stomach biopsies on endoscopy required to confirm a diagnosis
  4. No role of serum antibodies or stool antigen for diagnosis of H.pylori infection.

 

Author competing interests- no relevant disclosures. Questions? Contact the author on 9340 8355

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