[Helicobacter pylori infection: what are the specific questions in childhood?]

Abstract

The most recent knowledge on Helicobacter pylori infection, especially in epidemiology, have focused attention on the first years of life, recent data suggesting that acquisition of infection occurs during infancy. If the mode of infection is still a matter of debate, recent results suggest that the source of H. pylori is intrafamilial. Two non invasive tests have been recently evaluated in childhood. Urea breath test appears to be highly accurate in children above four years of age both for diagnosis and control of eradication. More recently, a commercial stool antigen test has been shown to be also accurate in children. However data are still lacking on its accuracy in young children. Infection remains often asymptomatic in children, and except for ulcer disease (which is rare in childhood) relationship between abdominal pain and H. pylori infection is not demonstrated. Three recent paediatric statements recommend endoscopy with biopsies as the preferred method of diagnosis in children with upper digestive symptoms suggestive of organic disease. Non invasive tests should only be used to confirm successful eradication. There are insufficient data in the literature to give treatment recommendations in childhood. Association of PPI and 2 antibiotics for 1 to 2 weeks give eradication rates lower than 80%. Lack of observance and resistance to antibiotics could explain these poor results. Numerous questions remain to be answered such as natural history of the infection, and should have important implication for both clinical practice and future strategies of prevention.