Helicobacter pylori infection and childhood recurrent abdominal pain: lack of evidence for a cause and effect relationship.
BACKGROUND
Recurrent abdominal pain is a common complaint among children and adolescents. Apley's criteria - at least three discrete episodes of abdominal pain of sufficient severity to interrupt normal activities that occur over a period of three or more months - are often used to define this chronic pain syndrome.


OBJECTIVE
To summarize the extent and quality of the published evidence for a cause-and-effect relationship between Helicobacter pylori infection and childhood recurrent abdominal pain.


METHODS
The MEDLINE bibliographic database (January 1983 to July 1998) was searched to identify pertinent (English language) studies. The search was restricted to prospective, controlled studies reporting empirical data on children up to 18 years of age.


RESULTS
Six studies were identified. Five of the six were case-control studies, while the remaining study assessed the effectiveness of antibiotic therapy. Only one study was community based, with the remaining studies conducted in the tertiary hospital setting. The evidence for a causal relationship was inconsistent; of the five case-control studies reviewed, the odds ratios ranged from 0.32 to 1.80. Two studies demonstrated statistically significant results; however, the findings were conflicting. The only treatment trial was limited because of methodological flaws.


CONCLUSIONS
Current evidence suggests no association between H pylori infection and recurrent abdominal pain in children. The evidence to date indicates that routine investigation for H pylori infection in children who present with the classical symptoms of recurrent abdominal pain based on Apley's criteria is not warranted.
Macarthur
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Departments of Community Health Sciences and Paediatrics, University of Calgary, Alberta, Canada. colinmac@ucalgary.ca
D015746:Abdominal Pain / Q000453:epidemiology / Q000209:etiology; D016022:Case-Control Studies; D002648:Child; D005767:Gastrointestinal Diseases / Q000382:microbiology*; D016481:Helicobacter Infections / Q000150:complications / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D011446:Prospective Studies; D012008:Recurrence