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Childhood Helicobacter pylori Infection: Treatment and Prevention

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A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Global Pediatric Health".

Deadline for manuscript submissions: closed (5 January 2023) | Viewed by 40636

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Dr. Lorena Elena Melit

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Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Gheorghe Marinescu Street, No. 38, 540136 Târgu Mureș, Romania
Interests: pediatrics; pediatric gastroenterology; nutrition; helicobacter pylori infection
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Special Issue Information

Dear Colleagues,

As we all know, Helicobacter pylori is the most common infection worldwide and associated with an increased risk of gastric cancer, being defined as a class I carcinogen by the World Health Organization. This infection is usually acquired during childhood, and if left untreated its persistence into adulthood is imminent. The development of effective prophylactic and therapeutic strategies represents a crucial need in pediatrics, being the single opportunity to decrease the incidence of gastric carcinogenesis during adulthood. Considering the complex pathway from simple infection towards gastric carcinogenesis, influenced by both host and bacterial features, multidisciplinary teamwork is required in order to clearly define the role of each component in this process and to face the challenge of preventing or successfully treating this infection.

Dr. Lorena Elena Melit
Guest Editor

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Keywords

helicobacter pylori
pediatrics
gastritis
treatment
prevention

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Published Papers (10 papers)

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Research

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8 pages, 539 KiB

Open AccessArticle

The Prevalence of Liver Cytolysis in Children with Helicobacter pylori Infection

by Ancuta Lupu, Ingrith Crenguta Miron, Anca Lavinia Cianga, Andrei Tudor Cernomaz, Vasile Valeriu Lupu, Cristina Gavrilovici, Iuliana Magdalena Stârcea, Elena Tarca, Dragos Catalin Ghica and Silvia Fotea

Children 2022, 9(10), 1498; https://doi.org/10.3390/children9101498 - 30 Sep 2022

Cited by 5 | Viewed by 2080

Abstract

(1) Background: The relationship between Helicobacter pylori (H. pylori) infection and liver disease has been discussed for many years, but the association between the infection and liver cytolysis in children has been insufficiently explored. In our study, we evaluate this relationship in a pediatric population from the northeast of Romania. (2) Methods: A retrospective study of children with H. pylori infection and liver cytolysis was conducted on a group of 1757 children, admitted to a pediatric gastroenterology regional center in northeast Romania over 3 years. (3) Results: Liver cytolysis syndrome was present in 112 children of both sexes. Of the 112 children, 20 children (17.9%) also had H. pylori infection. In the statistical analysis, we noted a significant association between liver cytolysis syndrome and H. pylori infection (χ²; p < 0.001). (4) Conclusions: This relationship requires further in-depth studies that also consider certain parameters that may influence the results of these correlations. In addition, we point out the need for further analyses evaluating, in terms of the histopathological changes in each liver disease, the efficacy of H. pylori eradication. Full article

(This article belongs to the Special Issue Childhood Helicobacter pylori Infection: Treatment and Prevention)

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9 pages, 252 KiB

Open AccessArticle

The Effectiveness of Different Eradication Schemes for Pediatric Helicobacter pylori Infection—A Single-Center Comparative Study from Romania

by Oana-Maria Rosu, Nicoleta Gimiga, Gabriela Stefanescu, Ileana Ioniuc, Elena Tataranu, Gheorghe G. Balan, Laura-Mihaela Ion, Doina Anca Plesca, Cristina Gabriela Schiopu and Smaranda Diaconescu

Children 2022, 9(9), 1391; https://doi.org/10.3390/children9091391 - 14 Sep 2022

Cited by 2 | Viewed by 2402

Abstract

Introduction: In Romania, studies on the pediatric population regarding H. pylori infection or bacterial resistance to antibiotics are limited. Eradication treatment of this infection still raises important problems in medical practice. This study aims to compare the effectiveness of three eradication therapies used against H. pylori infection in the pediatric population. Methods: The prospective study enrolled children aged 6–17 years who were first diagnosed with H. pylori infection. Patients received a randomized treatment either the therapy with clarithromycin (CLR), the therapy with metronidazole (MTZ) or sequential therapy. The effectiveness of the eradication treatment was evaluated after 4–8 weeks from the end of the therapy by testing fecal antigen. Results: 149 patients were enrolled over 18 months. The eradication rates were 49.5% for the treatment scheme with proton pump inhibitor (PPI) + amoxicillin (AMO) + MTZ, 26.7% for PPI + AMO + CLR and 23.8% for sequential therapy. MTZ therapy was superior to CLR therapy, but sequential therapy was not. Side effects were recorded for PPI + AMO + CLR with 39.6%, followed by sequential therapy 37.7%, and only 22.6% for PPI + AMO + MTZ. Conclusions: Therapy with MTZ can achieve a higher eradication rate as a first-line treatment in the case of H. pylori infection. Taking into account that Romania is in an area with increased resistance to CLR, MTZ therapy could be a promising alternative. Full article

(This article belongs to the Special Issue Childhood Helicobacter pylori Infection: Treatment and Prevention)

8 pages, 255 KiB

Open AccessEditor’s ChoiceArticle

The Relationship between Anemia and Helicobacter Pylori Infection in Children

by Ancuta Lupu, Ingrith Crenguta Miron, Anca Lavinia Cianga, Andrei Tudor Cernomaz, Vasile Valeriu Lupu, Dragos Munteanu, Dragos Catalin Ghica and Silvia Fotea

Children 2022, 9(9), 1324; https://doi.org/10.3390/children9091324 - 30 Aug 2022

Cited by 13 | Viewed by 4092

Abstract

(1) Background: Many studies suggest that Helicobacter pylori (H. pylori) infection is associated with a higher prevalence of anemia. The aim of this study is to explore this fact for a pediatric population from the northeast of Romania; (2) Methods: A correlational retrospective study between infection with H. pylori and anemia was performed on a group of 542 children in a pediatric gastroenterology regional center in Northeast Romania; (3) Results: Out of 542 children with confirmed H. pylori infection, microcytic hypochromic anemia was present in 48 children, of whom 7 (14.5%) also had iron deficiency.; (4) Conclusions: The study results demonstrate a significant association of H. pylori infection with iron-deficiency anemia and iron deficiency in children in accordance with the results established in the published literature. Although the direct relationship between them it is not clear yet, prevention represents one of the first clinical measures that need to be implemented when encountering a refractory moderate to severe iron-deficiency anemia and, especially, when associated with gastrointestinal tract symptoms. Full article

(This article belongs to the Special Issue Childhood Helicobacter pylori Infection: Treatment and Prevention)

Review

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17 pages, 395 KiB

Open AccessReview

Current Worldwide Trends in Pediatric Helicobacter pylori Antimicrobial Resistance

by Reka Borka Balas, Lorena Elena Meliț and Cristina Oana Mărginean

Children 2023, 10(2), 403; https://doi.org/10.3390/children10020403 - 18 Feb 2023

Cited by 10 | Viewed by 2656

Abstract

Helicobacter pylori (H. pylori) has acquired several resistance mechanisms in order to escape the currently used eradication regimens such as mutations that impair the replication, recombination, and transcription of DNA; the antibiotics capability to interact with protein synthesis and ribosomal activity; the adequate redox state of bacterial cells; or the penicillin-binding proteins. The aim of this review was to identify the differences in pediatric H. pylori antimicrobial-resistance trends between continents and countries of the same continent. In Asian pediatric patients, the greatest antimicrobial resistance was found to metronidazole (>50%), probably due to its wide use for parasitic infections. Aside from the increased resistance to metronidazole, the reports from different Asian countries indicated also high resistance rates to clarithromycin, suggesting that ciprofloxacin-based eradication therapy and bismuth-based quadruple therapy might be optimal choices for the eradication of H. pylori in Asian pediatric population. The scarce evidence for America revealed that H. pylori strains display an increased resistance to clarithromycin (up to 79.6%), but not all studies agreed on this statement. Pediatric patients from Africa also presented the greatest resistance rate to metronidazole (91%), but the results in terms of amoxicillin remain contradictory. Nevertheless, the lowest resistance rates in most of the African studies were found for quinolones. Among European children, the most frequent antimicrobial resistance was also noticed for metronidazole and clarithromycin (up to 59% and 45%) but with a predominance for clarithromycin as compared to other continents. The differences in antibiotic use among continents and countries worldwide is clearly responsible for the discrepancies regarding H. pylori antimicrobial-resistance patterns, emphasizing the crucial role of global judicious antibiotic use in order to control the increasing resistance rates worldwide. Full article

(This article belongs to the Special Issue Childhood Helicobacter pylori Infection: Treatment and Prevention)

18 pages, 427 KiB

Open AccessEditor’s ChoiceReview

Worldwide Prevalence and Risk Factors of Helicobacter pylori Infection in Children

by Reka Borka Balas, Lorena Elena Meliț and Cristina Oana Mărginean

Children 2022, 9(9), 1359; https://doi.org/10.3390/children9091359 - 6 Sep 2022

Cited by 30 | Viewed by 8744

Abstract

Helicobacter pylori is usually acquired during childhood. The reports from the last two decades pointed out a decrease in H. pylori prevalence across geographical areas worldwide compared to previously reported data. Most of the studies performed in America found an overall H. pylori infection prevalence of approximately 50%. The most important risk factors in America include being male, poor adherence or difficult access to treatment, and the lack of in-home water service. Despite the descending trend in prevalence worldwide, the overall prevalence in Africa remains very high (70%). Nevertheless, the prevalence of H. pylori in children without gastrointestinal who underwent screening was reported to be only 14.2%. The main risk factors in Africa are having a traditional pit or no toilet, poverty, birth order, source of drinking water, or being a farmer. Asia seems to have the widest variations in terms of H. pylori prevalence. Several risk factors were reported in Asia to be associated with this infection, such as lower income and educational level, house crowding, rural residence, ethnicity, the use of tanks as water supplies, alcohol drinking, active smoking, eating spicy food or raw uncooked vegetables, poor living conditions and sanitation. The overall prevalence of H. pylori infection in European children is almost 25%. Portugal has the highest prevalence of all European countries at 66.2% in children 13 years of age. The risk factors in European individuals consist of living in rural areas, eating unwashed fruits and vegetables, not washing hands after school, low parental education and unemployment, and short education duration. Further studies are required to identify the precise mechanisms involved in the discrepancies of H. pylori prevalence worldwide. Full article

(This article belongs to the Special Issue Childhood Helicobacter pylori Infection: Treatment and Prevention)

28 pages, 522 KiB

Open AccessEditor’s ChoiceReview

Helicobacter pylori-Related Extraintestinal Manifestations—Myth or Reality

by Cristian Dan Mărginean, Cristina Oana Mărginean and Lorena Elena Meliț

Children 2022, 9(9), 1352; https://doi.org/10.3390/children9091352 - 4 Sep 2022

Cited by 17 | Viewed by 4425

Abstract

It is well documented that Helicobacter pylori (H. pylori) can cause both gastrointestinal and extraintestinal manifestations. The latter one represents a major burden in terms of diagnosis and treatment. H. pylori-associated systemic subclinical inflammation is mostly responsible for the development of extraintestinal manifestations, and its early eradication might result in preventing all adverse events related to their occurrence. Thus, it was suggested that H. pylori might be associated with iron deficiency anemia, thrombocytopenia (immune thrombocytopenic purpura), Schonlein Henoch purpura, failure to thrive, vitamin B12 deficiency, diabetes mellitus, body mass index, cardiovascular diseases, as well as certain neurological conditions. Nevertheless, studies showed both pros and cons in terms of the role of H. pylori in the development of previously mentioned clinical entity underlining the crucial need for further studies on these topics. Although most of these extraintestinal manifestations occur during adulthood, we must not forget that H. pylori infection is acquired mainly during childhood, and thus its early diagnosis and eradication might represent the cornerstone in the prevention of H. pylori-induced inflammatory status and consequently of all related extraintestinal conditions. Full article

(This article belongs to the Special Issue Childhood Helicobacter pylori Infection: Treatment and Prevention)

16 pages, 393 KiB

Open AccessEditor’s ChoiceReview

Old and New Aspects of H. pylori-Associated Inflammation and Gastric Cancer

by Andreea Ligia Dincă, Lorena Elena Meliț and Cristina Oana Mărginean

Children 2022, 9(7), 1083; https://doi.org/10.3390/children9071083 - 20 Jul 2022

Cited by 29 | Viewed by 4788

Abstract

H. pylori is involved in the development of 80% of gastric cancers and 5.5% of all malignant conditions worldwide. Its persistence within the host’s stomach causes chronic inflammation, which is a well-known hallmark of carcinogenesis. A wide range of cytokines was reported to be involved in the initiation and long-term persistence of this local and systemic inflammation. IL-8 was among the first cytokines described to be increased in patients with H. pylori infection. Although, this cytokine was initially identified to exert a chemoattracting effect that represents a trigger for the activation of inflammatory cells within H.-pylori-infected mucosa, more recent studies failed in encountering any association between IL-8 and H. pylori infection. IL-6 is a multifunctional, pleiotropic and multipotent cytokine involved in mediating the interaction between innate and adaptive immunity with a dichotomous role acting as both a proinflammatory and an anti-inflammatory cytokine depending on the signaling pathway. IL-1α functions as a promoter of angiogenesis and vascular endothelial cell proliferation in gastric carcinoma since it is closely related to H.-pylori-induced inflammation in children. IL-1β is an essential trigger and enhancer of inflammation. The association between a low IL-1β level and an increased TNF-α level might be considered a risk factor for peptic ulcer disease in the setting of H. pylori infection. IL-10 downregulates both cytotoxic inflammatory responses and cell-mediated immune responses. H. pylori uses the immunosuppressive role of IL-10 to favor its escape from the host’s immune system. TGFβ is a continuous inflammatory mediator that promotes the adherence of H. pylori to the host’s cells and their subsequent colonization. The role of H.-pylori-induced inflammatory responses in the onset of gastric carcinogenesis seems to represent the missing puzzle piece for designing effective preventive and therapeutic strategies in patients with H.-pylori-associated gastric cancer. Full article

(This article belongs to the Special Issue Childhood Helicobacter pylori Infection: Treatment and Prevention)

16 pages, 372 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Traditional and Modern Diagnostic Approaches in Diagnosing Pediatric Helicobacter pylori Infection

by Cristina Oana Mărginean, Lorena Elena Meliț and Maria Oana Săsăran

Children 2022, 9(7), 994; https://doi.org/10.3390/children9070994 - 1 Jul 2022

Cited by 16 | Viewed by 3560

Abstract

Helicobacter pylori (H. pylori) is the most common bacterial infection worldwide, is usually acquired during childhood and is related to gastric carcinogenesis during adulthood. Therefore, its early proper diagnosis and subsequent successful eradication represent the cornerstones of gastric cancer prevention. The aim of this narrative review was to assess traditional and modern diagnostic methods in terms of H. pylori diagnosis. Several invasive and non-invasive methods were described, each with its pros and cons. The invasive diagnostic methods comprise endoscopy with biopsy, rapid urease tests, histopathological exams, cultures and biopsy-based molecular tests. Among these, probably the most available, accurate and cost-effective test remains histology, albeit molecular tests definitely remain the most accurate despite their high costs. The non-invasive tests consist of urea breath tests, serology, stool antigens and non-invasive molecular tests. Urea breath tests and stool antigens are the most useful in clinical practice both for the diagnosis of H. pylori infection and for monitoring the eradication of this infection after therapy. The challenges related to accurate diagnosis lead to a choice that must be based on H. pylori virulence, environmental factors and host peculiarities. Full article

(This article belongs to the Special Issue Childhood Helicobacter pylori Infection: Treatment and Prevention)

16 pages, 367 KiB

Open AccessFeature PaperEditor’s ChoiceReview

The Challenges of Eradicating Pediatric Helicobacter pylori Infection in the Era of Probiotics

by Lorena Elena Meliț, Cristina Oana Mărginean and Maria Oana Săsăran

Children 2022, 9(6), 795; https://doi.org/10.3390/children9060795 - 28 May 2022

Cited by 11 | Viewed by 4019

Abstract

Helicobacter pylori (H. pylori), the most common infection of childhood, results in life-threatening complications during adulthood if left untreated. Most of these complications are related to H. pylori-induced chronic inflammation. The dysbiosis caused by H. pylori is not limited to the gastric microenvironment, but it affects the entire gastrointestinal tract. Eradication of H. pylori has recently become a real challenge for clinicians due to both the persistent increase in antibiotic resistance worldwide and the wide spectrum of side effects associated with the eradication regimens resulting; therefore, there is an urgent need for more effective and less noxious treatment options. Thus, probiotics might be a promising choice in both adults and children with H. pylori infection since their role in improving the eradication rate of this infection has been proved in multiple studies. The positive effects of probiotics might be explained by their abilities to produce antimicrobial compounds and antioxidants, alter local gastric pH, and subsequently decrease H. pylori colonization and adherence to gastric epithelial cells. Nevertheless, if used alone probiotics do not considerably increase the eradication rate. Full article

(This article belongs to the Special Issue Childhood Helicobacter pylori Infection: Treatment and Prevention)

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8 pages, 579 KiB

Open AccessCase Report

Not Every Dyspepsia Is Related to Helicobacter pylori—A Case of Esophageal Inlet Patch in a Female Teenager

by Lorena Elena Meliț, Andreea Ligia Dincă, Reka Borka Balas, Simona Mocanu and Cristina Oana Mărginean

Children 2023, 10(2), 229; https://doi.org/10.3390/children10020229 - 28 Jan 2023

Cited by 1 | Viewed by 2567

Abstract

Helicobacter pylori infection is one of the main causes of dyspepsia, but it is not the only cause. Esophageal inlet patches are areas of heterotopic gastric mucosa within the esophagus and are commonly located in the cervical part of the esophagus. We report the case of a 16-year-old female, previously known to display symptoms of anxiety, who was admitted to our clinic for dyspeptic symptoms lasting for approximately 1 month in spite of the treatment with proton pump inhibitors. The clinical exam revealed only abdominal tenderness in the epigastric area, while routine laboratory tests showed no abnormalities. The upper digestive endoscopy revealed a well-circumscribed salmon-pink-colored oval lesion of approximately 10 mm in the cervical esophagus, along with hyperemia of the gastric mucosa and biliary reflux. The histopathological exam established the diagnosis of esophageal inlet patch with heterotopic antral-type gastric mucosa and also revealed regenerative changes within the gastric mucosa. We continued to treat the patient with proton pump inhibitors, as well as ursodeoxycholic acid, with favorable evolution. Although rare or underdiagnosed, esophageal inlet patches should never be underestimated and all gastroenterologists should be aware of their presence when performing an upper digestive examination in a patient with dyspeptic symptoms. Full article

(This article belongs to the Special Issue Childhood Helicobacter pylori Infection: Treatment and Prevention)

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