Consequences of Helicobacter pylori infection in children

Table 1 Prevalence of gastric atrophy in children

Author (yr)/country	Updated Sydney System	Mean age (range, yr)	No. of patients		Gastric atrophy and/or intestinal metaplasia (%)
			H. pylori+	H. pylori-	H. pylori+	H. pylori-
Whitney et al[28] (2000)/USA	Yes	10.7 (1-21)	42	0	Antral: 16.6/0	-/-
					Fundic: 2.3/0
Kolho et al[33] (2000)/Finland	Not reported	9.5 (2-16)	71	0	0/0	-/-
Campbell et al[34] (2001)/Gambia	Yes	1.4 (-/-)	21	16	0/0	0/0
Guiraldes et al[35] (2002)/Chile	No	12.2 (5-17)	59	14	0/0	0/0
Oztürk et al[36] (2003)/Turkey	Yes	12.2 (6-16)	18	9	Antral: 72.2/77.7	11.1/0
Guarner et al[29] (2003)/USA	Yes	- (1-17)	19	45	Antral: 52.6/15.7	22.2/0
					Fundic: 0/5.2	0/0
Usta et al[37] (2004)/Turkey	Yes	11.8 (4-17)	175	0	2.2/1.1	-/-
Levine et al[38] (2004)/Israel	Not reported	14.2 (-/-)	55	40	0/0	2.5/0
Ricuarte et al[27] (2005)/Colombia, Korea	No	12.0 (4-18)	97	18	16.4	1
		14.0 (8-18)	10	48	0	0
Kato et al[39] (2006)/Japan	Yes	11.3 (1-16)	131	65	Antral: 51.9/4.6	10.8/4.6
					Fundic: 34.8/0	8.3/4.2
Tutar et al[30] (2009)/Turkey	Yes	1.3 (0.1-2.0)	40	112	2.5/0	0/0
Kalach et al[40] (2009)/France	Yes	5.3 (0.1-17.7)	66	553	0/0	0.2/0.2

¹Atrophic mucosa: 31% as intestinal metaplasia; 63% as pseudopyloric metaplasia; 6% as both. H. pylori: Helicobacter pylori.

Table 2 Randomized trials of Helicobacter pylori eradication for iron deficiency anemia and iron deficiency in children

Author (yr)/country	No. of children with IDA/H. pylori	Follow-up (No. of children)	Outcome
			IDA	ID
Choe et al[89] (1999)/Korea	43/25	8 wk (18)	Hb increased with: eradication + iron, eradication + placebo vs iron + placebo (P = 0.0086)	No significant differences in serum iron or ferritin
Sarker et al[106] (2008)/Bangladesh	260/200	3 mo (260)	IDA persisted with: eradication + iron, 11%; eradication alone, 33%; iron alone, 0%; placebo, 45%	ID persisted with: eradication + iron, 19%; eradication alone, 65%; iron alone, 7%; placebo, 78%
Gessner et al[105] (2006)/Alaska	219/219	14 mo (201)	IDA persisted with: eradication + iron, 22%; iron alone, 14%	ID persisted with: eradication + iron, 65%; iron alone, 72%
Fagan et al[104] (2009)/Alaska	219/219	40 mo (176)	IDA persisted with: eradication + iron, 5%; iron alone, 19%	ID persisted with: eradication + iron, 52%; iron alone, 58%

Hb: Hemoglobin; ID: Iron deficiency; IDA: Iron deficiency anemia; H. pylori: Helicobacter pylori.

Table 3 Cross-sectional studies on the association between Helicobacter pylori infection and growth retardation

Author (yr)/country	Total No. of patients (H. pylori+)	Age (range,yr)	Diagnostic test	Conclusion
Perri et al[114] (1997)/Italy	216 (49)	3-14	Urea breath test	H. pylori infection was associated with growth delay, and poor socioeconomic status
Oderda et al[115] (1998)/Italy	134 with short stature (27)	5-13	Serology	No association with short stature
	134 controls (18)	5-13
Quiñonez et al[116] (1999)/Guatemala	211 (107)	5-10	Serology	No association with height for age and nutritional status
Choe et al[90] (2000)/Korea	375 (63)	10-15	Serology	H. pylori infection accompanied by IDA, rather than H. pylori infection per se, was associated with delayed pubertal growth
Richter et al[117] (2001)/Germany	3315 (213)	5-7	Urea breath test	H. pylori infection was associated with growth delay
Ertem et al[118] (2002)/Turkey	327 (162)	3-12	Urea breath test	H. pylori infection was associated with short stature independently of poor living standards
Sood et al[119] (2005)/UK	257 (97)	-	Urea breath test	No association with height and weight z scores, after adjustment for socioeconomic status and ethnicity
Süoglu et al[120] (2007)/Turkey	70 (35)	4-16	Endoscopy	H. pylori infection and IDA had a significant effect on height z scores, after adjustment for economic status
Mohammad et al[121] (2008)/Egypt	286 (208)	6-15	Urea breath test	H. pylori infection affected both body weight and height
Soylu et al[122] (2008)/Turkey	108 with dyspepsia (57)	7-17	Endoscopy	No association with anthropometry. But, dyspeptic children had worse nutritional status compared to controls, regardless of H. pylori status
	50 healthy controls	8-17
Cherian et al[123] (2009)/Australia	182 (149)	< 16	Stool antigen	No association with BMI or other anthropometric measures
Gulcan et al[124] (2010)/Turkey	181 with RAP (121)	6-15	Endoscopy, 181	RAP associated with gastric mucosal injury had a negative effect on BMI independent of H. pylori infection
	309 asymptomatic (110)	6-15	Serology, 309	RAP originating from H. pylori infection affected both BMI and linear growth

BMI: Body mass index; RAP: Recurrent abdominal pain; IDA: Iron deficiency anemia; H. pylori: Helicobacter pylori.