Helicobacter pylori, gastroduodenal disease, and recurrent abdominal pain in children.
OBJECTIVE
To assess the evidence for a cause-and-effect relationship between Helicobacter pylori infection and antral gastritis, peptic ulcer disease, and recurrent abdominal pain in children.


METHODS
A MEDLINE search from January 1983 through July 1994 was used to identify pertinent English-language publications. Current Contents and selected specialty journals were searched manually. Editorials, reviews, case reports, abstracts, and letters to the editor were excluded.


METHODS
All studies in children (ie, 0 to 18 years) were included.


METHODS
Hill's criteria for causal inference were used to determine the strength of the evidence for a causal relationship.


RESULTS
In total, 45 studies (case series, cross-sectional surveys, and treatment trials) were retrieved. The rate ratio of antral gastritis in children with H pylori infection (compared with uninfected children) ranged from 1.9 to 71.0 (median, 4.6). The prevalence of H pylori infection in children with duodenal ulcer was high (range, 33% to 100%; median, 92%) compared with children with gastric ulcer (range, 11% to 75%; median, 25%). Prevalence rates of infection in children with recurrent abdominal pain were inconsistent (range, 0% to 81%; median, 22%), with lower rates in children meeting Apley's criteria (range, 0% to 9%; median, 6%).


CONCLUSIONS
There is strong evidence for an association between H pylori infection and antral gastritis and duodenal ulcer disease in children; however, data from randomized, double-blind, placebo-controlled treatment trials are required. There is weak evidence for an association with gastric ulcer and weak or no evidence for an association with recurrent abdominal pain.
Division of General Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
C
C
Macarthur
N
N
Saunders
W
W
Feldman
D015746:Abdominal Pain / Q000209:etiology* / Q000382:microbiology; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005756:Gastritis / Q000382:microbiology* / Q000503:physiopathology; D016481:Helicobacter Infections / Q000503:physiopathology*; D016480:Helicobacter pylori; D006801:Humans; D010437:Peptic Ulcer / Q000382:microbiology* / Q000503:physiopathology; D012008:Recurrence