Muhammad Tariq Nadeem, Mazhar Abbas, Taqi Hassan, Shahid Masood.
Recurrent abdominal pain; the frequency of H. pylori infection in children.
Professional Med J Jan ;13(4):563-71.

Objective: To assess the association between the Helicobacter Pylori (H.pylori) infection and recurrent abdominal pain (RAP) by documenting the frequency of Helicobacter pylon infection in children aged 5 to 15 years in our setup. Design: A comparative study. Place and Duration of Study: The study was conducted in pediatric unit Military Hospital Rawalpindi over one year period from 1st Apr 200 to 31st Mar 2002. Subject and Methods: We divided the patients into two groups; group A or the study group and the group B or the control group. In group A, a total of 87 Children aged 5 to 15 years presenting with RAP in which no underlying cause was found on initial assessment underwent upper gastrointestinal tract (GIT) endoscopic examination. In group B (control) we included 68 children in whom upper GIT endoscopy was done for any reason other than the RAP. In both the groups the gastroduodenal biopsy samples were sent for culture and histological examination for the diagnosis of H. pylori infection. The signs and symptoms of these patients were analyzed in detail. Results: In group A, out of 87 patients who were endoscoped there were 44 female and 43 male. 54(62%) were found positive and 33(38%) were found negative for H.pylori on histopathology and culture examination of biopsy samples. In the control group (B) the frequency of H.pylori infection was 35% (24 of 68) which was significantly lower than the study group (p-value .001). The frequency of H.pylori increased significantly with advancement in age (p-value .003) and lowering of the socioeconomic status (p-value.002). The commonest endoscopic finding was antral gastritis (31 of 87; 35.6%). Antral nodularity was observed in 8(26%) out of 36 cases of antral gastritis and in 23(74%) cases there was antral erythema without nodularity. The remaining endoscopic findings were pan-gastritis (14 of 87;16%), duodenal ulcer (10 of 87;11.5%), duodenitis (4 of 87;4.6%) and gastric ulcer (2 of 87;2.3%). The less frequent findings were gastric and duodenal erosions and esophagitis (about 1% each). Their was no abnormal finding in 22(25.3%) cases. Children predominantly (52%) had the symptoms characteristics of ulcer-like dyspepsia. Recurrent epigastric pain was significantly more common in the H.pylori positive than the H. pylon negative children (44 of 87 vs 16 of 33 [p- value .001]). There was no difference for other symptom characteristics when comparing infected with non-infected children. Conclusion: The frequency of H.pylori infection is high in children with recurrent abdominal pain and there is a high degree of association between recurrent abdominal pain, endoscopic findings (chronic gastritis, duodenitis, gastric and duodenal ulcer) and the H. pylori infection.

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