Helicobacter pylori should be treated in children with growth failure

ABSTRACT

Helicobacter pylori [H. pylori] infect at least 50% of the world's human population. In most children, the presence of H. pylori infection does not lead to clinically apparent disease, even when it causes chronic active gastritis. According to the last Egyptian Demographic and Health Survey [2007], 79% of children were stunted, 6% were severely stunted, and more than 3% were wasted. The aim of this study was to estimate the prevalence of H. Pylori infection in children suffering from growth failure [GF] or failure to thrive [FTT]. Also to evaluate the differences in stature and weight between infected and non-infected children and to estimate the effect of eradication of H. pylori on the rate of the children growth and their nutritional status. Fifty children [5-8 yrs. of age] suffering from GF were included in the study. Their weight or rate of weight gain was significantly below that of other children of similar age and sex. Another 20 healthy matched children with no signs of growth failure were used as control group. Complete health history, dietary history, anthropometric measurements and thorough clinical examination were undertaken for those children. Complete blood picture, hormonal assessment [if needed], and stool analysis were performed. H. pylori analysis including ELlSA test for antibodies, stool test for H. pylori antigens and/or upper endoscopy with rapid urease testing of biopsy tissues were done. Children suffering from H. pylori were treated with clarithromycin, metronidazole and omeprazole for 2 weeks. The above examinations and investigations were repeated for all the children after 6 months. Out of the 50 children, 34 were suffering from acute H. pylori infection. All of them suffered from GF in the form of wasting and/or stunting. Their dietary history showed that they all received low energy intake, low iron and zinc intake compared to the adequate dietary intake of the control group. There were signs of anemia in the form of pallor and low hemoglobin levels [42 gm %] in 52% of the children. After receiving the treatment for 2 weeks and follow-up for 6 months, H. pylori were eradicated in 91% of the infected children. The dietary intake became adequate in 73% of the children. The energy, iron and zinc intakes became within the normal limits in these children. Those children showed improvement of their Z-score for weight, height and BMI