Age-Stratified Prevalence of Helicobacter pylori Infection in Children With Recurrent Abdominal Pain: A Prospective Observational Study

Abstract

Background Recurrent abdominal pain (RAP), often considered functional, is a frequent complaint among pediatric patients. However, the increasing availability of advanced diagnostic tools like upper and lower gastrointestinal endoscopy, tests for Helicobacter pylori, and abdominal ultrasound have highlighted many organic causes, including Helicobacter pylori (H. pylori) infection, whose prevalence in children remains unclear. Objectives To determine the age-stratified prevalence of H. pylori infection and investigate its role along with other etiologies contributing to RAP in pediatric patients. Methods This cross-sectional observational study was conducted between October 2019 and April 2021, involving 60 children aged two to 14 years who met the Rome IV criteria for RAP. Comprehensive evaluations included detailed history-taking, physical examination, and upper gastrointestinal endoscopy with biopsy. Mucosal samples from the antrum were subjected to a rapid urease test (RUT) to detect H. pylori infection. The presence of endoscopic abnormalities and their association with positive RUT results were analyzed to identify the underlying causes of RAP. Results H. pylori infection was identified in 11 (18.3%) children, with the highest prevalence among children aged seven to 12 years (n=34; 56.7%). All biopsy-positive cases showed concordant rapid urease test results (p=0.001). Organic etiologies were identified in 34 (56.7%) patients, with gastritis and gastric ulcers being the most common findings. Other causes included mesenteric lymphadenitis, urinary tract infections, duodenal ulcers, and hiatus hernia. Children with H. pylori infections predominantly exhibited endoscopic abnormalities, underscoring its role in RAP. Conclusion H. pylori infection shows a marked increase with age and is a significant organic cause of RAP. Thorough investigations, including endoscopic evaluations, are essential to uncover organic etiologies. Targeted treatment for H. pylori should be prioritized in children over seven years presenting with RAP, emphasizing the need for a systematic approach to diagnosing and managing this condition.

Keywords: children; gastritis; h. pylori; rap; rapid urease test; upper gi endoscopy.

Figure 1. Breakdown of etiological organic causes identified in the biopsy test in children with recurrent abdominal pain (RAP)

Panel A: duodenal ulcer, n=4 (6.7%); erosions in fundus, n=7 (11.7%); esophagitis, n=3 (5%); mild antral gastritis, n=2 (3.3%); proximal gastritis, n=1 (1.7%) Panel B: corresponding positive for H. pylori cases as per etiology. Duodenal ulcer, n=3 (27.3%); erosions in fundus, n=4 (36.4%)