ABSTRACT
Recurrent abdominal pain [RAP] is a common pediatric diagnostic problem. Upper gastrointestinal [UGI] endoscopy is sometimes performed as a part of the evaluation. Although gastritis and/or Helicobacter pylori [H pylori] infection is often present, it is not known if they contribute to the symptomatology. H pylori infection is primarily acquired in childhood. However, the role of H pylori infection in children with RAP is still unclear and controversial. H pylori infection can be detected by a variety of methods. Diagnostic tests for H pylori are based either on direct demonstration of the organism or indirectly by detecting a by-product [of the urease reaction] or by demonstrating antibodies. H pylori infection can be eradicated by a twice-daily, triple-drug regimen comprised of a proton pump inhibitor plus two antibiotics [clarithromycin plus amoxicillin or metronidazole], but experience with such therapy in the pediatric population is limited. The study aimed to determine the prevalence of H pylori among children with RAP; to evaluate the contribution of various diagnostic tests [biopsy based tests [histology, Gram's staining, culture, and rapid urease test] and serology] for the detection of H pylori; and to assess the efficacy of the triple-drug regimen of omeprazole amoxicillin, and clarithromycin in H pylori-positive children. Thirty children with RAP without identifiable cause of pain [17 males and 13 females; age ranged from 5 to 15 years with a mean of 10.3 years] underwent UGI endoscopy and four antral gastric mucosal biopsy specimens were taken and subjected to rapid urease test [RUT], Gram's staining, histology and culture for H pylori. Sera were assayed for H pylori lgG antibodies by ELISA. These children were selected from those attending the pediatric gastroenterology outpatient clinic of Pediatric Department of Tanta University Hospitals who were referred for UGI endoscopic evaluation of chronic upper abdominal pain. H pylori-positive children were treated by a triple-drug regimen of oral omeprazole amoxicillin and clarithromycin for 14 days and they were re-evaluated clinically and by repeating the previous investigations at one month after the end of treatment. The study revealed that 12 [40%] children of the examined population, were found to be positive by all used tests and considered H pylori-positive, the remaining 18 [60%] children were H pylori-negative. Compared with H pylori-negative children, H pylori-positive children were more often from large families and lower socioeconomic classes and had growth impairment. H pylori culture had a high efficiency for detecting H pylori and gave a sensitivity of 100%, a specificity of 96% and an accuracy of 98%. It was evident that values of endoscopy and serology were low and those for culture were high. In the present study, a positive correlation was observed between histological gastritis and the presence of H pylori organism whether seen histologically by Gram's staining [76%] or by culture [71%] of the organism. Also, it was found that culture was highly associated with active gastritis but the association with inactive gastritis was less pronounced. It was found that there were highly significant correlations between the results of the different used laboratory tests and that of gastric H pylori culture in studied patients with RAP. Among the H pylori-negative children, abnormal results for UGI endoscopy, histology, Gram's stain, urease test and serology were 22.2%, 27.8%, 16.7%, 27.8%, and 33.3% respectively but none had positive culture. The used triple-drug regimen eradicated H pylori in 9 of 12 [75%] of H pylori-positive children with concomitant histological resolution and recovery from abdominal pain at one month after the end of treatment. H pylori is common [40%] among children with RAP and a significant association possibly exists between H pylori infection and RAP in children and H pylori culture could be used as a "gold standard" test and use of a combination of diagnostic methods is helpful in accurate diagnosis of H pylori infection. The used triple-drug regimen proved successful in H pylori eradication, gastritis healing, and symptoms relief. long-term population based studies are needed to identify the exact prevalence and clinical significance of H pylori infection in Egyptian children. To ensure the effectiveness of the recommended treatment, further studies are required with a long-term follow-up period in a larger group of children undergoing UGI endoscopy for exclusion of an organic cause of RAP