What is the morbidity associated with Helicobacter pylori (Hp) infection?

Updated: Nov 16, 2018
  • Author: Mutaz I Sultan, MBChB, MD; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Most children infected with H pylori are asymptomatic. Antral gastritis is the most common manifestation in children. Duodenal and gastric ulcers may be associated with H pylori gastritis in adults but is uncommon in children. The risk of gastric cancers, including non-Hodgkin lymphoma (eg, mucosa-associated lymphoid tissue [MALT]) and adenocarcinoma, is increased in adults. A study by Lee et al associated eradication of H pylori infection with a reduced incidence of gastric cancer. [13, 14]

The majority of studies have reported a decrease in the incidence and/or prevalence of PUD over time, presumably because of a decrease in H pylori –associated PUD. H pylori was initially responsible for up to 95% of all gastroduodenal ulcers, but more recent studies have reported that the prevalence of H pylori in patients with PUD ranges from 36-73%, depending on ethnicity, geographic factors, and socioeconomic factors. [15]

The relationship between H pylori gastritis and recurrent abdominal pain (RAP) is controversial. The incidence of H pylori gastritis in patients with RAP is not significantly higher than the incidence of H pylori infection in the general population. Although some studies demonstrate an improvement in symptoms in children with RAP and H pylori gastritis after eradication therapy for H pylori, data from a recent double-blind controlled trial did not confirm that finding. [16] The heterogenicity of their definition of RAP and the varying study methodologies may have led to different results and conclusions. The medical positional statement of the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition regarding H pylori infection in children also found no convincing data to support the routine testing of children with RAP for H pylori. [17]

A meta-analysis reviewed published evidence for an association between H pylori infection and GI symptoms in children and found no association between RAP and H pylori infection and found conflicting evidence for an association between epigastric pain and H pylori infection. [18]

Some studies suggest that H pylori protects human subjects from developing gastroesophageal reflux disease, whereas others postulate a causative association between them. A meta-analysis of studies in adults found no association between H pylori eradication and development of new cases of gastroesophageal reflux disease in the population of dyspeptic patients. [19]

One pediatric retrospective study revealed a significantly higher prevalence of reflux esophagitis in children with H pylori infection. [20]

A meta-analysis summarized the existing literature examining the effect that H pylori has on Barrett esophagus. Only few studies without obvious selection and information bias have been conducted to examine the effect of H pylori on Barrett esophagus, but, in these, H pylori infection is associated with a reduced risk of Barrett esophagus. [21]

Controversy exists concerning the relationship of H pylori infection and somatic growth retardation in children. The gastrointestinal hormone ghrelin is a gut-brain peptide that regulates food intake in humans and has strong growth hormone–releasing activity. Decreased appetite in H pylori –infected children has been related to low plasma ghrelin levels, which returned to normal after H pylori eradication. [22]

H pylori infection has also been associated with extraintestinal manifestations, such as immune thrombocytopenic purpura. For adults with immune thrombocytopenic purpura, systematic reviews of past literature have shown an overall platelet response in more than 50% of the patients successfully treated for the infection and increased response rates in countries with a high prevalence of H pylori infection in background populations. [23]


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