title: Helicobacter pylori Infection in European children with gastro-duodenal ulcers and erosions.
abstract: BACKGROUND
  To analyze risk factors associated with gastro-duodenal ulcers and erosions in children.
  
  
  METHODS
  Open, prospective, multicenter, case-control study carried out in 11 European countries in patients with gastric or duodenal ulcers/erosions and 2 age-matched controls each. Possible risk factors were recorded. Logistic regression models were performed with adjustment for centers and age groups.
  
  
  RESULTS
  Seven-hundred thirty-two patients (244 cases, 153 with erosions only and 91 with ulcers, and 488 controls) were recruited. Children receiving antimicrobials or acid suppressive drugs before endoscopy were excluded (202 cases/390 controls remained for risk factor analysis). Helicobacter pylori was detected more frequently in cases than controls but only in 32.0% versus 20.1% in controls (P = 0.001). Independent exposure factors for gastric ulcers were male gender (P = 0.001), chronic neurologic disease (P = 0.015), chronic renal disease (P < 0.001) and nonsteroidal anti-inflammatory drug consumption (P = 0.035). Exposure factors for duodenal ulcers were H. pylori infection (P < 0.001) and steroid consumption (P = 0.031). Chronic renal disease was the only independent factor associated with gastric erosions (P = 0.026), those associated with duodenal erosions being H. pylori infection (P = 0.023), active smoking (P = 0.006) and chronic arthritis (P = 0.008). No risk factor was identified in 97/202 (48.0%) cases.
  
  
  CONCLUSIONS
  H. pylori remains a risk factor for duodenal, but not for gastric lesions in children in countries with low prevalence of infection. No risk factor could be identified in half of the children with gastro-duodenal ulcers/erosions.
authors.affiliation: From the *Paediatric Gastroenterology-Hepatology, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium; †Saint Vincent de Paul Hospital, Clinic of Paediatrics St Antoine, Groupement des Hôpitaux de l'Institut Catholique de Lille (GH-ICL), Lille, France; ‡Medical Microbiology Laboratory, Communicable and Infectious Diseases, Scientific Institute of Public Health, Brussels, Belgium; §Department of Paediatrics, Medical University of Wroclaw, Wroclaw, Poland; ¶Department of Paediatrics, Karolinska University Hospital, Stockholm, Sweden; ‖Dr v. Hauner Children's Hospital, University Medical Center, Munich, Germany; **Department of Paediatrics, University of Piemonte Orientale, Novara, Italy; ††Department of Paediatrics, Hospital Universitario Niño Jesús; ‡‡Department of Paediatrics, Hospital 12 de Octobre, Madrid, Spain; §§Academic Medical Center, Amsterdam, The Netherlands; ¶¶Charles University in Prague, Faculty of Medicine in Pilsen, Department of Paediatrics, Prague, Czech Republic; ‖‖First Department of Paediatrics, Semmelweis University, Budapest, Hungary; ***First Department of Paediatrics of Athens University, Athens, Greece; †††Department of Paediatrics, Marmara University Hospital, Istanbul, Turkey; and ‡‡‡Inserm U853, Victor Segalen Bordeaux 2 University, Bordeaux, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Bontems
authors.forename: Nicolas
authors.initials: N
authors.lastname: Kalach
authors.forename: Jean
authors.initials: J
authors.lastname: Vanderpas
authors.forename: Barbara
authors.initials: B
authors.lastname: Iwanczak
authors.forename: Thomas
authors.initials: T
authors.lastname: Casswall
authors.forename: Sibylle
authors.initials: S
authors.lastname: Koletzko
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Oderda
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Martinez-Gomez
authors.forename: Pedro
authors.initials: P
authors.lastname: Urruzuno
authors.forename: Angelika
authors.initials: A
authors.lastname: Kindermann
authors.forename: Josef
authors.initials: J
authors.lastname: Sykora
authors.forename: Gabor
authors.initials: G
authors.lastname: Veres
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Roma-Giannikou
authors.forename: Ender
authors.initials: E
authors.lastname: Pehlivanoglu
authors.forename: Francis
authors.initials: F
authors.lastname: Megraud
authors.forename: Samy
authors.initials: S
authors.lastname: Cadranel
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005060:Europe / Q000453:epidemiology; D005260:Female; D016481:Helicobacter Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008297:Male; D010437:Peptic Ulcer / Q000453:epidemiology* / Q000382:microbiology; D011446:Prospective Studies; D012307:Risk Factors