NEW YORK (Reuters Health) - The prevalence of Helicobacter pylori infection in children and adolescents decreased by more than half over the past 30 years but the infections remain prevalent globally, particularly in low- and middle-income countries, a systematic review and meta-analysis shows.
As reported in The Lancet Child and Adolescent Health, Dr. Peige Song of Zhejiang University School of Medicine in Hangzhou and colleagues searched the literature from inception through October 25, 2021 for observational population-based studies that reported the prevalence of H. pylori infection in children ages 18 or younger.
Ninety-eight articles with 632 data points from more than 152,000 children were included.
The overall global prevalence was 32.3%, which varied by diagnostic test - i.e., 28.6% for serology versus 35.9% for urea breath or stool antigen tests.
Regardless of the diagnostic test, the prevalence was significantly higher in low- and middle-income countries than in high-income countries (43.2% vs. 21.7%) and in older versus younger children (41.6% in 13-18-year-olds vs. 33.9% in 7-12-year-olds vs. 26.0% in 0-6-year-olds).
Pediatric H. pylori infection was significantly associated with lower economic status (odds ratio, 1.63); more siblings or children (1.84); room sharing (1.89); no sewage system access (1.60); having an H. pylori-infected mother (3.31) or sibling (3.33); drinking unboiled or non-treated water (1.52); and older age (OR per year, 1.27).
The prevalence in young people fell by more than half from 42.2% before 2000 to 19.3% in 2010 and later.
Prevalence did not differ between boys and girls, but was significantly higher in rural versus urban areas.
The authors conclude, "Our findings can help to guide further research and the development and implementation of preventive and therapeutic measures to reduce H. pylori infection in children."
Dr. Ali Andre Mencin, Chief of the Division of Pediatric Gastroenterology, Hepatology and Nutrition at NewYork-Presbyterian and Columbia University Irving Medical Center in New York City, and Director of the Pediatric Fatty Liver Clinic and Pediatric Endoscopy at Columbia, commented on the study in an email to Reuters Health.
"We know that H. pylori infection is common, with reported prevalence of up to 50% of the world population, but pediatric data are lacking," he said. "The study confirms that prevalence of infection varies based on geography and income status in children as well as adults. Poor sanitation and crowded living conditions are the likely cause of increased infection rates."
"One interesting finding was a reduced prevalence in papers published since 2010," he noted. "This could be related to improved living conditions, but it is difficult to know the true cause without a prospectively designed study."
"As the researchers point out," he said, "the main limitation is related to the varied methods of data collection for the pooled analysis. It is not possible to determine true cause and effect based on the risk factors identified, given the retrospective nature of the study."
"Given the potential for the long-term development of ulcer or cancer-related H. pylori disease," he added, "this study highlights the importance of identifying measures to reduce infection rates either through improved sanitation, better treatments or preventive strategies such as vaccination."
Dr. Song did not respond to requests for a comment.
SOURCE: https://bit.ly/3oHKXgq and https://bit.ly/3gETlJh The Lancet Child and Adolescent Health, online January 24, 2022.
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