Advances in Clinical and Experimental Medicine

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Advances in Clinical and Experimental Medicine

2017, vol. 26, nr 7, October, p. 1131–1136

doi: 10.17219/acem/60581

Publication type: review article

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

Clinical differences of Helicobacter pylori infection in children

Barbara M. Iwańczak1,A,B,C,D,E,F, Anna M. Buchner2,B,C,D,E,F, Franciszek Iwańczak1,B,C,D,E,F

1 Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Poland

2 Division of Gastroenterology, University of Pennsylvania, Philadelphia, USA


Helicobacter pylori infection is widely spread all over the world. The prevalence of H. pylori infection in the world varies and depends on numerous factors such as age, ethnicity, geographical and socioeconomic status. Humans have been in a symbiotic relationship with this bacterium for thousands of years. However 10–20% of people infected with H. pylori are likely to develop gastroduodenal diseases such as peptic ulcer disease, iron deficiency anemia, gastric mucosal atrophy, metaplasia, dysplasia, MALT lymphoma, or gastric adenocarcinoma. Most of these diseases develop as the infection progresses and they are likely to occur later in life among the elderly. In the following years, the use of modern molecular techniques has led to the discovery of new Helicobacter strains and their genotypic differentiation. Newly discovered Helicobacter microorganisms can colonize human gastrointestinal tract and bile ducts. This article summarizes the distinct features of H. pylori infection in children including its prevalence, clinical manifestation, indications for treatment and recommended schemes of eradication.

Key words

children, treatment, epidemiology, Helicobacter pylori, clinical presentation

References (67)

  1. Linz B, Balloux F, Moodley Y, et al. An African origin for the intimate association between humans and Helicobacter pylori. Nature. 2007;445:915–918.
  2. Warren JR. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancet. 1983;1(8336):1273–1275.
  3. Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984;1(8390):1311–1315.
  4. Peterson WL. Helicobacter pylori and peptic ulcer disease. N Engl J Med. 1991;324:1043–1048.
  5. Blaser MJ, Berg DE. Helicobacter pylori genetic diversity and risk of human disease. J Clin Invest. 2001;107:767–773.
  6. Schistosomes, liver flukes and Helicobacter pylori: IARC Working Group on the Evaluation of Carcinogenic Risks to Humans: Lyon, 7–14 June 1994. IARC Monogr Eval Carcinog Risks Hum. 1994;61:1–241.
  7. Blaser MJ. Heterogenecity of Helicobacter pylori. Eur J Gastroenterol Hepatol. 2012;9(suppl 1):3–6.
  8. Biernat M, Gościniak G. Gatunki Helicobacter izolowane z przewodu pokarmowego człowieka. Adv Clin Exp Med. 2006:15;113–120.
  9. Gzyl A, Augustynowicz E, Dzierżanowska D, et al. Genotypes of Helicobacter pylori in Polish population. Acta Microbiol Pol. 1999;48:261–275.
  10. Iwańczak B, Biernat M, Iwańczak F, Grabińska J, Matusiewicz K, Gościniak G. The clinical aspects of Helicobacter heilmannii infection in children with dyspeptic symptoms. J Physiol Pharmacol. 2012;63:133–136.
  11. Moyaert H, Franceschi F, Roccarina D, Ducatelle R, Haesebrouck F, Gasbarrini A. Extragastric manifestations of Helicobacter pylori infection: Other Helicobacters. Helicobacter. 2008;13(suppl 1):47–57.
  12. Calvet X, Ramírez Lázaro MJ, Lehours P, Mégraud F. Diagnosis and epidemiology of Helicobacter pylori infection. Helicobacter. 2013;18(suppl 1),5–11.
  13. Hunt RH, Xiao SD, Megraud F, et al. World Gastroenterology Organization. Helicobacter pylori in developing countries: World Gastroenterology Organisation Global Guideline. J Gastrointestin Liver Dis. 2011;20:299–304.
  14. Łaszewicz W, Iwańczak F, Iwańczak B, Task Force of the Polish Society of Gastroenterology, Task Force of the Polish Society of Gastroenterology. Seroprevalence of Helicobacter pylori infection in Polish children and adults depending on socioeconomic status and living conditions. Adv Med Sci. 2014;59:147–150.
  15. Goh KL, Chan WK, Shiota S, Yamaoka Y. Epidemiology of Helicobacter pylori infection and public health implications. Helicobacter. 2011;16(suppl 1):1–9.
  16. Jafri W, Yakoob J, Abid S, Sidduqui S, Awan S, Nizami SQ. Helicobacter pylori infection in children: Population-based age-specific prevalence and risk factors in a developing country. Acta Paediatr. 2010:99;279–282.
  17. Rowland M, Daly L, Vaughan M, Higgins A, Bourke B, Drumm B. Age-specific incidence of Helicobacter pylori. Gastroenterology. 2006;130:65–72.
  18. Strebel K, Rolle-Kampczyk U, Richter M, Kindler A, Richter T, Schlink U. A rigorous small area modelling-study for the Helicobacter pylori epidemiology. Sci Total Environ. 2010;408:3931–3942.
  19. Porras C, Nodora J, Sexton R, et al. Epidemiology of Helicobacter pylori infection in six Latin American countries (SWOG Trial S0701). Cancer Causes Control. 2013; 24:209–215.
  20. Bastos J, Carreira H, La Vecchia C, Lunet N. Childcare attendance and Helicobacter pylori infection: Systematic review and meta-analysis. Eur J Cancer Prev. 2013;22:311–319.
  21. Mégraud F, Coenen S, Versporten A, et al. Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption. Gut. 2013;62:34–42.
  22. Kosunen TU, Aromaa A, Knekt P, et al. Helicobacter antibodies in 1973 and 1994 in the adult population of Vammala, Finland. Epidemiol Infect. 1997;119;29–34.
  23. Perez Perez GI, Salomaa A, Kosunen TU. Evidence that cagA(+) Helicobacter pylori strains are disappearing more rapidly than cagA(-) strains. Gut. 2002;50:295–298.
  24. Andreasson A, Talley N, Engstrand L. The prevalence Helicobacter pylori positive in the general population in Sweden has decreased from 38 per cent to 16 per cent since 1989. UEG Journal 2014;(abstract PO 508).
  25. Rosenstock S, Jørgensen T, Andersen L, Bonnevie O. Seroconversion and seroreversion in IgG antibodies to Helicobacter pylori: A serology based prospective cohort study. J Epidemiol Community Health. 2000;54;444–450.
  26. Biernat MM, Gościniak G, Iwańczak B. Prevalence of Helicobacter pylori cagA, vacA, iceA, babA2 genotypes in Polish children and adolescents with gastroduodenal disease. Postepy Hig Med Dosw. 2014;22:1015–1021.
  27. Iwanczak B, Laszewicz W, Iwanczak F, et al. Genotypic and clinical differences of seropositive Helicobacter pylori children and adults in the Polish population. J Physiol Pharmacol 2014;65:801–807.
  28. Urita Y, Watanabe T, Kawagoe N, et al. Role of infected grandmothers in transmission of Helicobacter pylori to children in a Japanese rural town. J Paediatr Child Health. 2013;49:394–398.
  29. Calvet X, Ramírez Lázaro MJ, Lehours P, Mégraud F. Diagnosis and epidemiology of Helicobacter pylori infection. Helicobacter. 2013;18(suppl 1):5–11.
  30. Vanderpas J, Bontems P, Miendje Deyi VY, Cadranel S. Follow-up of Helicobacter pylori infection in children over two decades (1988–2007): Persistence, relapse and acquisition rates. Epidemiol Infect. 2014;142:767–775.
  31. Kumagai T, Malaty HM, Graham DY, et al. Acquisition versus loss of Helicobacter pylori infection in Japan: Results from an 8-year birth cohort study. J Infect Dis. 1998;178:717–721.
  32. Backert S, Clyne M. Pathogenesis of Helicobacter pylori infection. Helicobacter. 2011;16:19–25.
  33. Konturek PC, Konturek JS, Brzozowski T. Helicobacter pylori infection in gastric carcinogenesis. J Physiol Pharmacol. 2009;60:3–21.
  34. Parsonnet J, Friedman GD, Orentreich N, Vogelman M. Risk for gastric cancer in people with cagA positive or cagA negative Helicobacter pylori infection. Gut. 1997;40:297–301.
  35. Krzysiek-Maczka G, Targosz A, Ptak-Belowska A, et al. Molecular alterations in fibroblasts exposed to Helicobacter pylori: A missing link in bacterial inflammation progressing into gastric carcinogenesis? J Physiol Pharmacol. 2013;64:77–87.
  36. Targosz A, Brzozowski T, Pierzchalski P, et al. Helicobacter pylori promotes apoptosis, activates cyclooxygenase (COX)-2 and inhibits heat shock protein HSP70 in gastric cancer epithelial cells. Inflamm Res. 2012;61:955–966.
  37. de Sablet T, Piazuelo MB, Shaffer CL, et al. Phylogeographic origin of Helicobacter pylori is a determinant of gastric cancer risk. Gut. 2011;60:1189–1195.
  38. González CA, Figueiredo C, Lic CB, et al. Helicobacter pylori cagA and vacA genotypes as predictors of progression of gastric preneoplastic lesions: A long-term follow-up in a high-risk area in Spain. Am J Gastroenterol. 2011;106:867–874.
  39. Bontems P, Kalach N, Vanderpas J, et al. Helicobacter pylori infection in European children with gastro-duodenal ulcers and erosions. Pediatr Infect Dis J. 2013;32:1324–1329.
  40. Asfeldt AM, Steigen SE, Løchen ML, et al. The natural course of Helicobacter pylori infection on endoscopic findings in a population during 17 years of follow-up: The Sørreisa gastrointestinal disorder study. Eur J Epidemiol. 2009;24:649–658.
  41. Blaser MJ, Falkow S. What are the consequences of the disappearing human microbiota? Nat Rev Microbiol. 2009;7:887–894.
  42. DuBois S, Kearney DJ. Iron-deficiency anemia and Helicobacter pylori infection: A review of the evidence. Am J Gastroenterol. 2005;100:453–459.
  43. Muhsen K, Cohen D. Helicobacter pylori infection and iron stores: A systematic review and meta-analysis. Helicobacter. 2008;13:323–340.
  44. Qu XH, Huang XL, Xiong P, et al. Does Helicobacter pylori infection play a role in iron deficiency anemia? A meta-analysis. World J Gastroenterol. 2010;16:886–896.
  45. Harris PR, Serrano CA, Villagrán A, et al. Helicobacter pylori-associated hypochlorhydria in children, and development of iron deficiency. J Clin Pathol. 2013;66:343–347.
  46. Chen Y, Blaser MJ. Helicobacter pylori colonization is inversely associated with childhood asthma. J Infect Dis. 2008;198:553–560.
  47. Lu J, Wang CM, Xu ST, et al. Role of Helicobacter pylori infection in the pathogenesis and clinical outcome of childhood acute idiopathic thrombocytopenic purpura. Zhonghua Xue Ye Xue Za Zhi. 2013;34:41–44.
  48. Xiong LJ, Tong Y, Wang ZL, Mao M. Is Helicobacter pylori infection associated with Henoch-Schonlein purpura in Chinese children? A meta-analysis. World J Pediatr. 2012;8:301–308.
  49. Wang Q, Yu C, Sun Y. The association between asthma and Helicobacter pylori: A meta-analysis. Helicobacter. 2013;18:41–53.
  50. Karimi A, Fakhimi-Derakhshan K, Imanzadeh F, Rezaei M, Cavoshzadeh Z, Maham S. Helicobacter pylori infection and pediatric asthma. Iran J Microbiol. 2013;5:132–135.
  51. Koletzko S, Jones NL, Goodman KJ, et al. Evidence-based guidelines from ESPGHAN and NASPGHAN for Helicobacter pylori infection in children. J Pediatr Gastroenterol Nutr. 2011;53:230–243.
  52. Koletzko S, Konstantopoulos N, Bosman D, et al. Evaluation of a novel monoclonal enzyme immunoassay for detection of Helicobacter pylori antigen in stool from children. Gut. 2003;52:804–806.
  53. Guarner J, Kalach N, Elitsur Y, Koletzko S. Helicobacter pylori diagnostic tests in children: Review of the literature from 1999 to 2009. Eur J Pediatr. 2010;169:15–25.
  54. Graham DY, Opekun AR, Hammoud F, et al. Studies regarding the mechanism of false negative urea breath tests with proton pump inhibitors. Am J Gastroenterol. 2003;98:1005–1009.
  55. Graham DY, Shiotani A. New concepts of resistance in the treatment of Helicobacter pylori infections. Nat Clin Pract Gastroenterol Hepatol. 2008;5:321–331.
  56. Malfertheiner P, Megraud F, O’Morain CA, et al. Management of Helicobacter pylori infection – the Maastricht IV: Florence Consensus Report. Gut. 2012;61:646–664.
  57. Iwańczak F, Iwańczak B. Treatment of Helicobacter pylori infection in the aspect of increasing antibiotic resistance. Adv Clin Exp Med. 2012;21:671–680.
  58. Song Z, Zhou L, Wang Y, et al. A study to explore Hp antibiotic resistance and efficacy of eradication therapy in China (multicenter, nation-wide, randomized, control study). Helicobacter. 2011(16)(suppl 1)(abstract PO 7.05):117.
  59. Wu DC, Hsu PI, Wu JY. Sequential and concomitant therapy with four drugs is equally effective for eradication of H. pylori infection. Clin Gastroenterol Hepatol. 2010:8;36–41.
  60. Moon BS, An B, Kim H, et al. Antibiotic resistance and eradication rate of Helicobacter pylori strains isolated in Korean patients. Helicobacter. 2011;16(suppl 1)(abstract PO 7.13):119.
  61. Mégraud F. H. pylori antibiotic resistance: Prevalence, importance and advances in testing. Gut. 2004;53:1374–1384.
  62. Martinez Gonzalez B, Papadokos K, Konstontoilaki A, et al. Primary antibiotic resistance and Helicobacter pylori: Virulence factors is there an association? Helicobacter. 2011;16(suppl 1)(abstract PO 7.07):118.
  63. Bontems P, Kalach N, Oderda G, et al. Sequential therapy versus tailored triple therapies for Helicobacter pylori infection in children. J Pediatr Gastroenterol Nutr. 2011;53:646–650.
  64. Albrecht P, Kotowska M, Szajewska H. Sequential therapy compared with standard triple therapy for Helicobacter pylori eradication in children: A double-blind, randomized, controlled trial. J Pediatr. 2011;159:45–49.
  65. Liou JM, Chen CC, Chen MJ, et al. Sequential versus triple therapy for the first-line treatment of Helicobacter pylori: A multicenter, open-label, randomized trial. Lancet. 2013;381:205–213.
  66. Fuccio L, Minardi ME, Zagari RM, Grilli D, Magrini N, Bazzoli F. Meta-analysis: Duration of first-line proton-pump inhibitor based triple therapy for Helicobacter pylori eradication. Ann Intern Med. 2007;147:553–562.
  67. Schwarzer A, Urruzuno P, Iwańczak B, et al. New effective treatment regimen for children infected with a double-resistant Helicobacter pylori strain. J Pediatr Gastroenterol Nutr. 2011;52;424–428.