Helicobacter pylori and peptic disease in the pediatric patient

As in adults, the data accumulated in past years on peptic disease in children demonstrate the specific association between the disease and H pylori colonization in the gastric mucosa. In addition, evidence suggests that the treatment of peptic ulcer by combinations that eradicate the bacteria changes the natural history of peptic ulcer, thus diminishing significantly the recurrence of the disease. The diagnosis of H pylori infection relies on the combination of direct and indirect methods. The direct methods include different staining methods, and culture of the bacteria from endoscopic specimens. Urease tests, serology, and ¹³C, ¹⁴C- breath tests are used as indirect methods, mainly for follow-up and as evidence for the success of treatment. At the present time, no evidence shows that H pylori infection is associated with a specific clinical picture. The attempt to associate H pylori gastritis with the entity of RAP did not gain enough support. Children with H pylori colonization are often asymptomatic. Several regimens of treatment were used to eradicate H pylori in children. The treatment is usually based on combinations that include H₂ blockers or a bismuth salt and antibacterial agents, such as amoxicillin and metronidazole. Recently, omeprazole and clarithromycin were shown also to be efficient for the purpose. Treatment schedules of 4 weeks and more have recently been reduced to 1 week. In general, the authors' impression is that pediatricians tend to overtreat H pylori infection. Is this policy justified? Future research will provide the answer. Epidemiologic studies demonstrate that environmental and genetic factors determine the susceptibility toward colonization with H pylori. Future research will provide the knowledge of possible reservoir of the organism, better treatment modalities, the possible role of the organism in development of gastric malignancies, and host factors that are important in the evolution of H pylori infection.