RECURRENT ABDOMINAL PAIN

THE FREQUENCY OF H. PYLORI INFECTION IN CHILDREN

Abstract

Objective: To assess the association between the Helicobacter Pylori (H.pylori) infection and
recurrent abdominal pain (RAP) by documenting the frequency of Helicobacter pylori infection in children aged 5 to 15
years in our setup. Design: A comparative study. Place and Duration of Study: The study was conducted in pediatric
unit Military Hospital Rawalpindi over one year period from 1st Apr 200 to 31st Mar 2002. Subject and Methods: We
divided the patients into two groups; group A or the study group and the group B or the control group. In group A, a
total of 87 Children aged 5 to 15 years presenting with RAP in which no underlying cause was found on initial
assessment underwent upper gastrointestinal tract (GIT) endoscopic examination. In group B (control) we included 68
children in whom upper GIT endoscopy was done for any reason other than the RAP. In both the groups the
gastroduodenal biopsy samples were sent for culture and histological examination for the diagnosis of H. pylori
infection. The signs and symptoms of these patients were analyzed in detail. Results: In group A, out of 87 patients
who were endoscoped there were 44 female and 43 male. 54(62%) were found positive and 33(38%) were found
negative for H.pylori on histopathology and culture examination of biopsy samples. In the control group (B) the
frequency of H.pylori infection was 35% (24 of 68) which was significantly lower than the study group (p-value .001).
The frequency of H.pylori increased significantly with advancement in age (p-value .003) and lowering of the
socioeconomic status (p-value.002). The commonest endoscopic finding was antral gastritis (31 of 87; 35.6%). Antral
nodularity was observed in 8(26%) out of 36 cases of antral gastritis and in 23(74%) cases there was antral erythema
without nodularity. The remaining endoscopic findings were pan-gastritis (14 of 87;16%), duodenal ulcer (10 of
87;11.5%), duodenitis (4 of 87;4.6%) and gastric ulcer (2 of 87;2.3%). The less frequent findings were gastric and
duodenal erosions and esophagitis (about 1% each).Their was no abnormal finding in 22(25.3%) cases. Children
predominantly (52%) had the symptoms characteristics of ulcer-like dyspepsia. Recurrent epigastric pain was
significantly more common in the H.pylori positive than the H. pylori negative children (44 of 87 vs 16 of 33 [p-value
.001]). There was no difference for other symptom characteristics when comparing infected with non-infected children.
Conclusion: The frequency of H.pylori infection is high in children with recurrent abdominal pain and there is a high degree of association between recurrent abdominal pain, endoscopic findings (chronic gastritis, duodenitis, gastric and
duodenal ulcer) and the H. pylori infection.