title: Helicobacter PyloriInfection in a Group of Egyptian Children With Upper Gastro-Intestinal Bleeding.
abstract: BACKGROUND
  Upper gastrointestinal bleeding is a life threatening condition in children. Common sources of upper gastrointestinal bleeding in children include mucosal lesions and variceal hemorrhage. Helicobacter pylori (H. pylori) is a Gram negative spiral-shaped bacterium that is found in the gastric mucous layer or adherent to the epithelial lining of the stomach. It causes more than 90% of duodenal ulcers and up to 70-80% of gastric ulcers. The relationship betweenH. pyloriinfection and upper GIT bleeding in children is still un-clear. This study aimed to estimate the incidence ofH. pyloriinfection in children presented with upper GIT bleeding and correlation betweenH. pyloriinfection and endoscopic findings of the cause of bleeding.
  
  
  METHODS
  The study included 70 children presented with upper GIT bleeding indicated for upper gastrointestinal endoscopy admitted in pediatric department, Minia University Hospital, Egypt during the period from February 2010 to December 2012. Thirty healthy children were included as a control group with age and sex matched. After medical history taking and physical examination all children were exposed for laboratory investigations (CBC, prothrombin time and concentration, liver function tests, hepatitis viral markers, blood urea and serum creatinine andHelicobacter pyloristool antigen test). Upper endoscopy was done for patients only. Patients were classified into variceal and non variceal groups according to upper endoscopy.
  
  
  RESULTS
  Helico-pyloriinfection was significantly higher in children with non-variceal bleeding than controls (P = 0.02) and children with variceal bleeding (P = 0.03) with no significant difference between children with variceal bleeding and controls (P = 0.9). Both weights and BMIs centile were significantly lower in variceal and non-variceal groups than controls (P = 0.01 & 0.001 and 0.01 & 0.001 respectively). AST, ALT and direct bilirubin levels were significantly higher in variceal group than controls (P = 0.001, 0.004 & 0.001 respectively). Prothrombin concentration and albumin levels were significantly lower in variceal group than controls (P = 0.001 & 0.01 respectively). Hemoglobin levels were significantly lower in variceal and non-variceal groups than controls (P = 0.01 & 0.001 respectively). No significant differences were present as regards age, sex, height or platelets count between cases (variceal and non-variceal) and controls.
  
  
  CONCLUSIONS
  H. pyloriinfection is significantly higher in children with non-variceal bleeding than controls. No significant difference between children with variceal bleeding and controls. Triad of increased ALT, decreased albumin levels and negativeH. pyloriinfection could be a significant triad in predicting variceal bleeding as a cause of upper GIT bleeding in children.
authors: Pediatric Department, Minia University, Minia city, Minia, Egypt.
authors: Abdel-Azeem M
authors: AM
authors: El-Mazary
authors: Pediatric Department, Minia University, Minia city, Minia, Egypt.
authors: Mostafa A
authors: MA
authors: Elfoly
authors: Tropical-Medicine Department, Minia University, Minia city, Minia, Egypt.
authors: Magdy F
authors: MF
authors: Ahmed
authors: Clinical-Pathology Department, Minia University, Minia city, Minia, Egypt.
authors: Waleed M
authors: WM
authors: Abdel-Hamed
authors: Pediatric Department, Minia University, Minia city, Minia, Egypt.
authors: Zmzm M
authors: ZM
authors: Hassan
keywords: GIT bleeding; Helicobacter-pylori; Non-variceal bleeding; Variceal