Helicobacter pylori Infection in Children. Antimicrobial Resistance and Treatment Response.
BACKGROUND
The aim of this study was to determine the appropriateness of the recent recommendations for managing Helicobacter pylori infection in children in a university hospital in Southern Europe. Antimicrobial resistance and response to eradication therapy were also determined.


METHODS
The presence of H. pylori was studied in 143 children: by gastric biopsy culture (GBC), (13)C-urea breath test (UBT) and stool antigen immunochromatography test (SAIT) in 56 children; by GBC and UBT in 20, by GBC and SAIT in 18, and by GBC alone in 49. Antimicrobial susceptibility was determined by E-test. Infection was defined as a positive culture or positivity in both UBT and SAIT. Disease progression was studied in 118 patients. First evaluation of symptoms was carried out at 3-6 months after diagnosis and/or after treatment of the infection.


RESULTS
H. pylori was detected in 74 from the 143 children analyzed (100% GBC positive, 98.1% UBT positive, and 58.1% SAIT positive). The main symptom was chronic abdominal pain (n = 121). Macroscopic antral nodularity was observed in 29.7% of infected patients and in 5.8% of uninfected patients, respectively. Resistance to clarithromycin and metronidazole was found in 34.7 and 16.7%, respectively. Eradication when susceptible antimicrobials were used occurred in 78.7% (48/61) versus 37.5% (3/8) when the treatment included a drug with resistance (p = .024). In patients with recurrent abdominal pain, symptoms resolved in 92.9% (39/42) patients with HP eradication versus 42.9% (6/14) without HP eradication (p < .001).


CONCLUSIONS
Treated patients often failed to meet the criteria established in the guidelines for H. pylori diagnostic screening and treatment because most of them had only recurrent abdominal pain, but remission of their symptoms was associated with H. pylori eradication.
Servicio de Microbiología-IIS Biodonostia, Hospital Universitario Donostia, San Sebastián, Spain.|Biomedical Research Centre Network for Respiratory Diseases (CIBERES), San Sebastián, Spain.
Milagrosa
M
Montes
Servicio de Cirugía Infantil, Hospital Universitario Donostia, San Sebastián, Spain.
Flor N
FN
Villalon
Servicio de Pediatría, Hospital Universitario Donostia, San Sebastián, Spain.
Francisco J
FJ
Eizaguirre
Servicio de Pediatría, Hospital Universitario Donostia, San Sebastián, Spain.
Maider
M
Delgado
Servicio de Pediatría, Hospital Universitario Donostia, San Sebastián, Spain.
Ignacio M
IM
Muñoz-Seca
Servicio de Microbiología-IIS Biodonostia, Hospital Universitario Donostia, San Sebastián, Spain.
María
M
Fernández-Reyes
Servicio de Microbiología-IIS Biodonostia, Hospital Universitario Donostia, San Sebastián, Spain.|Biomedical Research Centre Network for Respiratory Diseases (CIBERES), San Sebastián, Spain.|Department of Preventive Medicine and Public Health, Faculty of Medicine, Basque Country University (UPV/EHU), San Sebastián, Spain.
Emilio
E
Pérez-Trallero
D000293:Adolescent; D000658:Amoxicillin / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001944:Breath Tests; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005060:Europe; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome; D014508:Urea / Q000378:metabolism
D000890:Anti-Infective Agents; D008795:Metronidazole; D000658:Amoxicillin; D014508:Urea; D017291:Clarithromycin
Children; Helicobacter; clarithromycin resistance; diagnosis; symptom remission; treatment