Abstract
Helicobacter pylori infection is recognised as a cause of gastritis and peptic ulcer disease (PUD) and usually acquired during the first years of life. While there is a decline in the prevalence of H. pylori infection in northern and western European countries, the infection is still common in southern and eastern parts of Europe and Asia. Symptoms of H. pylori-related PUD are nonspecific in children and may include epigastric pain, nausea and/or vomiting, anorexia, iron deficiency anaemia and hematemesis. Besides, only a small proportion of children develop symptoms and clinically relevant gastrointestinal disease. H. pylori infection can be diagnosed either by invasive tests requiring endoscopy and biopsy or non-invasive tests including the 13C-urea breath test, detection of H. pylori antigen in stool and detection of antibodies in serum, urine and saliva. The aim of treatment is at least 90 % eradication rate of the bacteria, and a combination of two antibiotics plus a proton pump inhibitor has been recommended as first-line treatment. However, frequent use of antibiotics during childhood is associated with a decline in eradication rates and the search for new treatment strategies as well. This is an overview of the latest knowledge and evidence-based guidelines regarding clinical presentation, diagnosis and treatment of H. pylori infection in childhood.
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Abbreviations
- H. pylori :
-
Helicobacter pylori
- 13C-UBT:
-
13C-Urea breath test
- MALT:
-
Mucosa-associated lymphoid tissue
- IDA:
-
Iron deficiency anaemia
- RAP:
-
Recurrent abdominal pain
- EIA:
-
Enzyme immunoassay
- RUT:
-
Rapid urease test
- FISH:
-
Fluorescence in situ hybridization
- PUD:
-
Peptic ulcer disease
- PPI:
-
Proton pump inhibitor
References
Ahmad N, Zakaria WR, Abdullah SA, Mohamed R (2009) Characterization of clarithromycin resistance in Malaysian isolates of Helicobacter pylori. World J Gastroenterol 15:3161
Alvarez A, Moncayo JI, Santacruz JJ, Santacoloma M, Corredor LF, Reinosa E (2009) Antimicrobial susceptibility and mutations involved in clarithromycin resistance in Helicobacter pylori isolates from patients in the western central region of Colombia. Antimicrob Agents Chemother 53:4022–4024
Bakir Ozbey S, Ozakin C, Keskin M (2009) Antibiotic resistance rates of Helicobacter pylori isolates and the comparison of E-test and fluorescent in situ hybridization methods for the detection of clarithromycin resistant strains. Mikrobiyol Bul 43:227–234
Barabino A, Dufour C, Marino CE, Claudiani F, De Alessandri A (1999) Unexplained refractory iron- deficiency anemia associated with Helicobacter pylori gastric infection in children: further clinical evidence. J Pediatr Gastroenterol Nutr 28:116–119
Baysoy G, Ertem D, Ademoglu E, Kotiloglu E, Keskin S, Pehlivanoglu E (2004) Gastric histopathology, iron status and iron deficiency anemia in children with Helicobacter pylori infection. J Pediatr Gastroenterol Nutr 38:146–151
Bellack NR, Koehoorn MW, MacNab YC, Morshed MG (2006) A conceptual model of water's role as a reservoir in Helicobacter pylori transmission: a review of the evidence. Epidemiol Infect 134:439–449
Berger MY, Spee LA, Madderom MB, Pijpers M, van Leeuwen Y (2010) Association between Helicobacter pylori and gastrointestinal symptoms in children. Pediatrics 125:e651–e669
Bontems P, Devaster JM, Corvaglia L, Dezsöfi A, Van Den Borre C, Goutier S, Butzler JP, Cadranel S (2001) Twelve year observation of primary and secondary antibiotic-resistant Helicobacter pylori strains in children. Pediatr Infect Dis J 20:1033–1038
Bourke B, Ceponis P, Chiba N, Czinn S, Ferraro R, Fischbach L, Gold B, Hyunh H, Jacobson K, Jones NL, Koletzko S, Lebel S, Moayyedi P, Ridell R, Sherman P, van Zanten S, Beck I, Best L, Boland M, Bursey F, Chaun H, Cooper G, Craig B, Creuzenet C, Critch J, Govender K, Hassall E, Kaplan A, Keelan M, Noad G, Robertson M, Smith L, Stein M, Taylor D, Walters T, Persaud R, Whitaker S, Woodland R, Canadian Helicobacter Study Group (2005) Canadian Helicobacter Study Group Consensus Conference: update on the approach to Helicobacter pylori infection in children and adolescents—an evidence-based evaluation. Can J Gastroenterol 9:399–408
Brenner H, Arndt V, Stegmaier C, Ziegler H, Rothenbacher D (2004) Is Helicobacter pylori infection a necessary condition for noncardiac gastric cancer? Am J Epidemiol 159:252–258
Chang WL, Sheu BS, Cheng HC, Yang YJ, Yang HB, Wu JJ (2009) Resistance to metronidazole, clarithromycin and levofloxacin of Helicobacter pylori before and after clarithromycin-based therapy in Taiwan. J Gastroenterol Hepatol 24:1230–1235
Chi H, Bair M-J, Wu M-S, Chiu NC, Hsiao YC, Chang KY (2009) Prevalence of Helicobacter pylori infection in high-school students on Lanyu Island, Taiwan: risk factor analysis and effect on growth. J Formos Med Assoc 108:929–936
Dube C, Nkosi TC, Clarke AM, Mkwetshana N, Green E, Ndip RN (2009) Helicobacter pylori antigenemia in an asymptomatic population of Eastern Cape Province, South Africa: public health implications. Rev Environ Health 24:249–255
Dube C, Tanih NF, Ndip RN (2009) Helicobacter pylori in water sources: a global environmental health concern. Rev Environ Health 24:1–14
Elitsur Y, Tolia V, Gilger MA, Reeves-Garcia J, Schmidt-Sommerfeld E, Opekun AR, El-Zimaity H, Graham DY, Enmei K (2009) Urea breath test in children: the United States prospective, multicenter study. Helicobacter 14:134–140
Ford AC, Axon AT (2010) Epidemiology of Helicobacter pylori infection and public health implications. Helicobacter 15(Suppl 1):1–6
Francavilla R, Lionetti E, Castellaneta SP, Magistà AM, Boscarelli G, Piscitelli D, Amoruso A, Di Leo A, Miniello VL, Francavilla A, Cavallo L, Ierardi E (2005) Improved efficacy of 10-day sequential treatment for Helicobacter pylori eradication in children: a randomized trial. Gastroenterology 129:1414–1419
Francavilla R, Lionetti E, Castellaneta S, Margiotta M, Piscitelli D, Lorenzo L, Cavallo L, Ierardi E (2010) Clarithromycin resistant genotypes and eradication of H. pylori. Pediatrics 157:228–232
Fujihashi K, Koga T, van Ginkel FW, Hagiwara Y, McGhee JR (2002) A dilemma for mucosal vaccination: efficacy versus toxicity using enterotoxin-based adjuvants. Vaccine 20:2431–2438
Gatta L, Vakil N, Leandro G, Di Mario F, Vaira D (2009) Sequential therapy or triple therapy for Helicobacter pylori infection: systematic review and meta-analysis of randomized controlled trials in adults and children. Am J Gastroenterol 104:3069–3079
Gold B, Colletti RB, Abbott M, Czinn SJ, Elitsur Y, Hassall E, Macarthur C, Snyder J, Sherman PM (2000) Helicobacter pylori infection in children: recommendations for diagnosis and treatment. J Pediatr Gastroenterol Nutr 31:490–497
Guarner J, Kalach N, Elitsur Y, Koletzko S (2010) Helicobacter pylori diagnostic tests in children: review of the literature from 1999 to 2009. Eur J Pediatr 169:15–25
Guo L, Liu K, Xu G, Li X, Tu J, Tang F, Xing Y, Xi T (2012) Prophylactic and therapeutic efficacy of the epitope vaccine CTB-UA against Helicobacter pylori infection in a BALB/c mice model. Appl Microbiol Biotechnol. doi:10.1007/s00253-012-4122-0
Guy B, Hessler C, Fourage S, Haensler J, Vialon-Lafay E, Rokbi B, Millet MJ (1998) Systemic immunization with urease protects mice against Helicobacter pylori infection. Vaccine 16:850–856
Hickey DK, Aldwell FE, Tan ZY, Bao S, Beagley KW (2009) Transcutaneous immunization with novel lipid-based adjuvants induces protection against gastric Helicobacter pylori infection. Vaccine 27:6983–6990
Hishida A, Matsuo K, Goto Y, Hamajima N (2010) Genetic predisposition to Helicobacter pylori-induced gastric precancerous conditions. World J Gastrointest Oncol 15:369–379
Hojsak I, Kos T, Dumančić J, Mišak Z, Jadrešin O, Jaklin Kekez A, Lukić Grlić A, Kolaček S (2012) Antibiotic resistance of Helicobacter pylori in pediatric patients—10 years' experience. Eur J Pediatr 171:1325–1330
Houben CH, Chiu PW, Lau JY, Lee KH, Ng EK, Tam YH, Yeung CK (2008) Duodenal ulcers dominate acute upper gastrointestinal tract bleeding in childhood: a 10-year experience from Hong Kong. J Dig Dis 9:199–203
Hung KH, Sheu BS, Chang WL, Wu HM, Liu CC, Wu JJ (2009) Prevalence of primary fluoroquinolone resistance among clinical isolates of Helicobacter pylori at a University Hospital in Southern Taiwan. Helicobacter 14:61–65
Imrie C (2001) Is Helicobacter pylori infection in childhood a risk factor for gastric cancer? Pediatrics 107:373–380
International Agency for Research on Cancer, World Health Organization (1994) Infection with Helicobacter pylori. In: IARC Working Group on the Evaluation of Carcinogenic Risk to Humans (eds) Schistosomes, liver flukes and Helicobacter pylori, vol 60. AI RC, Lyon, Monogr Eval Carcinog Risks Hum, pp. 177–240
Jafri W, Yakoob J, Abid S, Siddiqui S, Awan S, Nizami SQ (2010) Helicobacter pylori infection in children: population-based age-specific prevalence and risk factors in a developing country. Acta Paediatr 99:279–282
Kato S, Fujimura S (2010) Primary antimicrobial resistance of Helicobacter pylori in children during the past 9 years. Pediatr Int 52:187–190
Koletzko S, Richy F, Bontems P, Crone J, Kalach N, Monteiro ML, Gottrand F, Celinska-Cedro D, Roma-Giannikou E, Orderda G, Kolacek S, Urruzuno P, Martínez-Gómez MJ, Casswall T, Ashorn M, Bodanszky H, Mégraud F (2006) The European Paediatric Task Force on Helicobacter pylori. Prospective multicentre study on antibiotic resistance of Helicobacter pylori strains obtained from children living in Europe. Gut 55:1711–1716
Koletzko S, Jones NL, Goodman KJ, Gold B, Rowland M, Cadranel S, Chong S, Colletti RB, Casswall T, Elitsur Y, Guarner J, Kalach N, Madrazo A, Megraud F, Oderda G, H pylori Working Groups of ESPGHAN and NASPGHAN (2011) Evidence-based guidelines from ESPGHAN and NASPGHAN for Helicobacter pylori infection in children. J Pediatr Gastroenterol Nutr 53:230–243
Konno M, Yokota S, Suga T, Takahashi M, Sato K, Fujii N (2008) Predominance of mother-to-child transmission of Helicobacter pylori infection detected by random amplified polymorphic DNA fingerprinting analysis in Japanese families. Pediatr Infect Dis J 27:999–1003
Leal YA, Flores LL, García-Cortés LB, Cedillo-Rivera R, Torres J (2008) Antibody-based detection tests for the diagnosis of Helicobacter pylori infection in children: a meta-analysis. PLoS One 3: e3751
Madani S, Rabah R, Tolia V (2000) Diagnosis of Helicobacter pylori infection from antral biopsies in pediatric patients: is urease test that reliable? Dig Dis Sci 45:1233–1237
Malfertheiner P, Megraud F, O’Morain CA, Bazzoli F, El-Omar E, Graham D, Hunt R, Rokkas T, Vakil N, Kuipers EJ (2007) Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 56:772–781
Malfertheiner P, Megraud F, O’Morain CA, Atherton J, Axon AT, Bazzoli F, Gensini GF, Gisbert JP, Graham DY, Rokkas T, El-Omar EM, Kuipers EJ, European Helicobacter Study Group. (EHSG) (2012) Management of Helicobacter pylori infection—the Maastricht IV/Florence Consensus Report. Gut 61:646–664
Megraud F (2005) Comparison of non-invasive tests to detect Helicobacter pylori infection in children and adolescents: results of a multicenter European study. J Pediatr 146:198–203
Mourad-Baars P, Hussey S, Jones NL (2010) Helicobacter pylori infection and childhood. Helicobacter 15(Suppl 1):53–59
Muhsen K, Cohen D (2008) Helicobacter pylori infection and iron stores: a systematic review and meta-analysis. Helicobacter 13:323–340
Nouraie M, Latifi-Navid S, Rezvan H, Radmard AR, Maghsudlu M, Zaer-Rezaii H, Radmard AR, Maghsudlu M, Zaer-Rezaii H, Amini S, Siavoshi F, Malekzadeh R (2009) Childhood hygienic practice and family education status determine the prevalence of Helicobacter pylori infection in Iran. Helicobacter 14:40–46
O’Connor A, Gisbert JP, McNamara D, O’Morain C (2010) Treatment of Helicobacter pylori infection 2010. Helicobacter 15(Suppl 1):46–52
Oderda G, Shcherbakov P, Bontems P, Urruzuno P, Romano C, Gottrand F, Gómez MJ, Ravelli A, Gandullia P, Roma E, Cadranel S, De Giacomo C, Canani RB, Rutigliano V, Pehlivanoglu E, Kalach N, Roggero P, Celinska-Cedro D, Drumm B, Casswall T, Ashorn M, Arvanitakis SN, European Pediatric Task Force on Helicobacter pylori (2007) Results from the pediatric European register for treatment of Helicobacter pylori (PERTH). Helicobacter 12:150–156
Ohata H, Kitauchi S, Yoshimura N, Mugitani K, Iwane M, Nakamura H, Yoshikawa A, Yanaoka K, Arii K, Tamai H, Shimizu Y, Takeshita T, Mohara O, Ichinose M (2004) Progression of chronic atrophic gastritis associated with Helicobacter pylori infection increases the risk of gastric cancer. Int J Cancer 109:138–143
Ozden A, Bozdayi G, Ozkan M, Köse S (2004) Changes in the seroepidemiological pattern of Helicobacter pylori infection over the last 10 years. Turk J Gastroenterol 15(3):156–158
Ozen A, Ertem D, Pehlivanoglu E (2006) Natural history and symptomatology of Helicobacter pylori in childhood and factors determining the epidemiology of infection. J Pediatr Gastroenterol Nutr 42:398–404
Qu XH, Huang XL, Xiong P, Zhu CY, Huang YL, Lu LG, Sun X, Rong L, Zhong L, Sun DY, Lin H, Cai MC, Chen ZW, Hu B, Wu LM, Jiang YB, Yan WL (2010) Does Helicobacter pylori infection play a role in iron deficiency anemia? A meta-analysis. World J Gastroenterol 16:886–896
Raguza D, Machado RS, Ogata SK, Granato CF, Patrício FR, Kawakami E (2010) Validation of a monoclonal stool antigen test for diagnosing Helicobacter pylori infection in young children. J Pediatr Gastroenterol Nutr 50:400–403
Rupnow MF, Chang AH, Shachter RD, Owens DK, Parsonnet J (2009) Cost-effectiveness of a potential prophylactic Helicobacter pylori vaccine in the United States. J Infect Dis 200:1311–1317
Santos IS, Boccio J, Davidsson L, Hernandez-Triana M, Huanca-Sardinas E, Janjetic M, Moya-Camarena SY, Paez-Valery MC, Ruiz-Alvarez V, Valencia ME, Valle NC, Vargas-Pinto G, Solano L, Thomas J (2009) Helicobacter pylori is not associated with anaemia in Latin America: results from Argentina, Brazil, Bolivia, Cuba, Mexico and Venezuela. Public Health Nutr 12:1862–1870
Selgrad M, Bornschein J, Rokkas T, Malfertheiner P (2010) Clinical aspects of gastric cancer and Helicobacter pylori—screening, prevention, and treatment. Helicobacter 15(Suppl 1):40–45
Sherman P, Hassall E, Hunt RH, Fallone CA, Veldhuyzen Van Zanten S, Thomson AB (1999) Canadian Helicobacter Study Group Consensus Conference on the approach to Helicobacter pylori infection in children and adolescents. Can J Gastroenterol 13:553–559
Sykora J, Siala K, Varvarovska J, Pazdiora P, Pomahacová R, Huml M (2009) Epidemiology of Helicobacter pylori infection in asymptomatic children: a prospective population-based study from the Czech Republic. Application of a monoclonal-based antigen-in-stool enzyme immunoassay. Helicobacter 14:286–297
Szajewska H, Albrecht P, Topczewska-Cabanek A (2009) Randomized, double-blind, placebo-controlled trial: effect of lactobacillus GG supplementation on Helicobacter pylori eradication rates and side effects during treatment in children. J Pediatr Gastroenterol Nutr 48:431–436
Tam YH, Yeung CK, Lee KH, Sihoe JD, Chan KW, Cheung ST, Mou JW (2008) A population-based study of Helicobacter pylori infection in Chinese children resident in Hong Kong: prevalence and potential risk factors. Helicobacter 13:219–224
Tkachenko MA, Zhannat NZ, Erman LV, Blashenkova EL, Isachenko SV, Isachenko OB, Graham DY, Malaty HM (2007) Dramatic changes in the prevalence of Helicobacter pylori infection during childhood: a 10-year follow-up study in Russia. J Pediatr Gastroenterol Nutr 45:428–432
Vandenplas Y, Brunser O, Szajewska H (2009) Saccharomyces boulardii in childhood. Eur J Pediatr 168:253–265
Weyermann M, Rothenbacher D, Brenner H (2009) Acquisition of Helicobacter pylori infection in early childhood: independent contributions of infected mothers, fathers, and siblings. Am J Gastroenterol 104:182–189
Wu DC, Wu IC, Wang SW et al (2006) Comparison of stool enzyme immunoassay and immunochromatographic method for detecting Helicobacter pylori antigens before and after eradication. Diagn Microbiol Infect Dis 56:373–378
Yang HR, Ko JS, Seo JK (2008) Does the diagnostic accuracy of the 13C-urea breath test vary with age even after the application of urea hydrolysis rate? Helicobacter 13:239–244
Yucel T, Aygin D, Sen S, Yucel O (2008) The prevalence of Helicobacter pylori and related factors among university students in Turkey. Jpn J Infect Dis 61:179–183
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Ertem, D. Clinical Practice: Helicobacter pylori infection in childhood. Eur J Pediatr 172, 1427–1434 (2013). https://doi.org/10.1007/s00431-012-1823-4
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DOI: https://doi.org/10.1007/s00431-012-1823-4