The efficacy of treatment of Helicobacter pylori infection in a pediatric population in Israel – a study of 165 cases – מתוך כנס גאסטרו ילדים, 9 ביולי 2002


Sirota G, Rachman E, Stankiewicz H, Wilschanski M and Faber J. Division of Pediatric Gastroenterology and Gastroenterology Research Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel

Background: Recurrent abdominal pain (RAP) is a common complaint in pediatrics. In cases with proven gastric or duodenal ulcers due to Helicobacter pylori (Hp), eradication was shown to be beneficial. The value of eradicating the infection in children with RAP and no evidence of ulcer is unknown.

Triple therapy with a proton-pump inhibitor (PPI) and two different antibiotics may achieve eradication. The antibiotics of choice are still unestablished, and experience in the pediatric population is limited.

Objectives: To evaluate the role of Hp infection in the symptomatology of children with RAP, and to compare the efficacy of amoxycillin + clarithromycin vs. amoxycillin + metronidazole as the preferred treatment of the infection.

Methods: We studied retrospectively two groups of children who had undergone endoscopy for the evaluation of RAP 90 children with evidence of Hp infection and 75 without Hp. Biopsies were taken during endoscopy for rapid urease testing and histologic examination. Infection was determined by a positive rapid urease test. Triple therapy was given 14 days; 4-6 weeks after completion of treatment a 13C-urea breath test was done to assess eradication. All children were followed clinically 4 weeks after completion of treatment and afterwards if indicated. In addition, assessment of the clinical status was made at the end of the research period.

Results: Eradication of Hp was achieved in 73%. The antibiotic combination which contained metronidazole was significantly more effective than clarithromycin 86% vs. 53%, respectively (p=0.02). The rate of eradication was higher in children with a negative family history of peptic ulcer disease, and if anti Hp antibodies was in a high titer. Symptomatic improvement was achieved in 66% of children with evidence of eradication vs. 23% in children in whom the infection persisted (p<0.0001).

Conclusions: 1. RAP may be associated with Hp infection in children, and eradication is likely to cause symptomatic relief. 2. Hp eradication is more efficient by amoxycillin + metronidazole than by amoxycillin + clarithromycin.

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