Helicobacter pylori infection in children

Abstract

Helicobacter pylori infection is acquired essentially in childhood and may persist lifelong. The prevalence varies widely in the world according to the socioeconomic status of the populations. It is very low in developed countries, while almost all children become infected in the developing world. While the exact routes of transmission are not fully determined, it appears that a gastro-oral (via vomitus) or oral-oral (via saliva after regurgitation) is the most important, and it occurs essentially, but not exclusively, from person to person inside the families. The pathology observed in children is usually milder compared to that in adults because of downregulation of the host immune response in the youngsters. Among clinical features, peptic ulcer disease may be found as a consequence of H. pylori infection but mostly in adolescents. Recurrent abdominal pain has multiple causes and is not an indication to test noninvasively and treat H. pylori. The other diseases caused by H. pylori are sideropenic anemia, chronic idiopathic thrombocytopenic purpura, and growth retardation. Some animal data also point the benefit of H. pylori infection as protector against atopic diseases in the youngest, especially asthma. Diagnostic tests in children are those used in adulthood. However, at age below 6 years, the urea breath test can lead to nonspecific results, and serology may not be sensitive enough. Preference must be given to invasive testing. Treatment should be tailored according to susceptibility testing.