[Symptomatic Helicobacter pylori infection: prospective study of epidemiological, diagnostic and therapeutic aspects in children in Tunisia].
BACKGROUND
Epidemiology, criteria for diagnosis and treatment of Helicobacter pylori (HP)-related infection in children are still debated.


METHODS
A total of 130 children and teenagers who presented recurrent episodes of unexplained abdominal pain underwent an endoscopic examination. Gastric biopsies were studied for histology and search for HP (Giemsa and Gram staining, testing for urease and culture in an appropriate environment). Serological tests (Elisa) were performed. HP infection was considered as present when two investigations at least proved positive. Infected children were given one drug (amoxicillin, cimetidine or antiacids) or two drugs (amoxicillin plus tinidazole). Clinical and endoscopic control including histological and bacteriological studies were done for the following 12 to 18 months.


RESULTS
HP infection was present in 70 children (54%). It was associated chronic gastritis in 64 cases (91%) and with duodenal ulcer in the remaining cases (9%). Recurrent abdominal pain, anorexia, weight loss and family history of peptic diseases were significantly associated with HP infection (P < 0.05). Endoscopic examination was normal in 35 infected children (50%); nodular antritis was inconstant (30%) but always associated with HP-related infection (P < 0.001) as was atrophic or follicular chronic gastritis. Eradication of HP, associated with the disappearance of chronic gastritis, was seen in 53% of children given amoxicillin alone and in 85% of those given amoxicillin plus tinidazole, but never in those receiving cimetidine or antiacids. Relapse of the HP-related infection was observed in four children (16%), 6 to 12 months after the first episode.


CONCLUSIONS
These results show high prevalence of HP-related infections in the Tunisian children who suffer from recurrent episodes of abdominal pain. They also confirm the role of HP in the inflammatory process and the development of gastroduodenal ulcer in children.
Maherzi
A
A
Service de médecine infantile B, hôpital d'enfants, Jabbari Tunis, Tunisie.
Fendri
C
C
Ben Jilani
S
S
Bousnina
S
S
D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004381:Duodenal Ulcer / Q000150:complications; D005260:Female; D005756:Gastritis / Q000150:complications; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D011446:Prospective Studies; D014416:Tunisia / Q000453:epidemiology
L'infection symptomatique à Helicobacter pylori: étude prospective des aspects épidémiologiques, diagnostiques et thérapeutiques chez l'enfant en Tunisie.