Affiliation:
1. Pediatrics University Clinic, Medical School University of Lisbon Lisbon Portugal
2. National Institute of Health Ricardo Jorge, Department of Infectious Diseases National Reference Laboratory for Gastrointestinal Infections Lisbon Portugal
3. Biomathematics Laboratory, Medical School University of Lisbon Lisbon Portugal
4. Pediatric Gastroenterology Unit, Department of Pediatrics Santa Maria University Hospital –CHULN, Lisboa, Portugal, Lisbon Academic Medical Center Lisbon Portugal
Abstract
AbstractBackgroundHelicobacter pylori infection acquisition occurs mainly in childhood and may be a critical factor in developing long‐term complications. In contrast to other developed countries, previous studies have reported a relatively high H. pylori infection prevalence in Portugal, both in children and adults. However, there are no recent data concerning pediatric population.Materials and MethodsWe performed a retrospective observational study concerning an 11 years period (2009, 2014, 2019), that included patients under 18 years old who underwent upper endoscopy at a pediatric tertiary center. Demographic, clinical‐pathological, and microbiological data were collected.ResultsFour hundred and sixty one children were included. The average age was 11.7 ± 4.4 years. In total, H. pylori infection was confirmed in 37.3% of cases (histology and/or culture) and a decreasing infection trend was observed (p = .027). The most common indication for endoscopy was abdominal pain, which was a good predictor of infection. Antral nodularity was present in 72.2% of the infected children (p < .001). In the oldest age groups, moderate/severe chronic inflammation, H. pylori density and lymphoid aggregates/follicles were positive predictors for the presence of antral nodularity. For all ages, the presence of antral nodularity, neutrophilic activity in the antrum and corpus and lymphoid follicles/aggregates in the antrum were positive predictors for the presence of H. pylori infection. Among the 139 strains tested for antibiotic susceptibility, 48.9% were susceptible to all tested antibiotics. Resistance to clarithromycin, metronidazole, and both was detected in 23.0%, 12.9%, and 6.5% of the strains, respectively; furthermore, resistance to ciprofloxacin and to amoxicillin was observed in 5.0% and 1.4% of the strains, respectively.ConclusionsThe present study reports (for the first time in Portugal) a significant decreasing trend in the prevalence of pediatric H. pylori infection, although it remains relatively high compared to the recently reported prevalence in other South European countries. We confirmed a previously recognized positive association of some endoscopic and histological features with H. pylori infection, as well as a high prevalence rate of resistance to clarithromycin and to metronidazole.The clinical relevance of these findings requires confirmation with further studies at a national level, taking into account the high incidence rate of gastric cancer in Portugal and the potential need for country‐specific intervention strategies.
Subject
Infectious Diseases,Gastroenterology,General Medicine
Cited by
2 articles.
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