ASSOCIATION OF HELICOBACTER PYLORI INFECTION WITH DIARRHEAL ILLNESS IN CHILDREN
Papakonstantinou D.1, Palaiologou N.3, Koutsaftiki C.2, Mammas J.2, Myriokefalitakis N.2, Spyrakou U.1
1Medical Diagnostic Laboratories, Athens, Greece
2Penteli Children’s Hospital, Athens, Greece
3Children’s Hospital Aglaia Kyriakou, Athens Greece
Introduction - Objectives
Helicobacter pylori is a Gram-negative microaerophilic bacterium adapted to survive in the stomach of humans where it can cause a variety of clinical conditions, among them peptic ulcer disease, gastric cancer, MALT lymphoma and other gastro-intestinal or extragastric manifestations . The infection might be accompanied by hypochlorhydria, which predisposes the infected individuals to enteric infections from other enteropathogens .
Since the infection is acquired mainly in early childhood , we examined the possible association of H. pylori with specific diarrheal illness in hospitalized children.
Patients & Methods
The study was conducted between July and August 2009 in two pediatric hospital departments in Athens. Fecal samples were obtained and examined from 85 subjects (44 boys and 41 girls) admitted to the hospitals, aged from 1 month to 12 years (median: 2 years). Among them 34 suffered from acute diarrheal illness and 51 from other non-diarrheal diseases. Detection of H. pylori antigen in stool was performed by the immunochromatograhic assay of Novamed Ltd (Jerusalem, Israel) .
The overall prevalence of H pylori infection in this hospital population was found 29.4%. There was no sex difference between H. pylori positive and negative children (p=0.97).
Of the 34 children suffered from acute diarrheal illness, 18 were found positive in H. pylori infection (52.9%). On the other hand, only 7 (13.7%) out of 51 children with other non-diarrheal diseases were H. pylori positive. The results showed a strong association between diarrheal diseases and H. pylori infection. (p< 0.001). No significant differences were found in H. pylori detection between patients suffered from various diarrheal syndromes (bacterial or viral gastroenteritis, parasitic diseases etc.)
Rotavirus was detected in four and adenovirus in two children suffering from acute gastroenteritis. Various bacterial enteropathogens were isolated from 15 patients. Two of the latter were found to be Campylobacter jejuni positive. There was no association of the H. pylori infection with any specific enteric pathogen. A possible limitation of this study is that the socioeconomic status of the children had not been examined.
Our findings suggest that gastric infection with Helicobacter pylori might increase the risk of diarrheal disease in children and/or both conditions might have the same route of transmission.
1. Papakonstantinou D. Prevalence of Helicobacter pylori in children admitted to paediatric hospitals in Athens. MSc thesis no 490583. LSHTM. London 2009, pp. 11-13 & 25-26
2. Suerbaum S, Michetti P. Helicobacter pylori Infection. N Engl J Med 2002, 347(15):1175-1186 (Abstract)
3. Windle HJ, Kelleher D, Crabtree JE. Childhood Helicobacter pylori infection and growth impairment in developing countries: A Vicious cycle? Pediatrics 2007, 119:754-759 (Full text)
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