Chapter 2 Index

A. Evaluation by system:

1. General

2. HEENT

3. Cardiopulmonary

4. GI
--Colic: A Parent’s (and Pediatrician’s) Nightmare
--Milk Intolerance vs. Milk Allergy
--Spitting vs. GE Reflux: What is the Difference?

H. Pylori Infections in Children 

Pediatric News, August 1998

Introduction: No good data exists about the incidence of H. Pylori infection in children in the US, or even how commonly children are infected with this organism.  What is agreed is that H. Pylori infects more children than we recognize, that it causes duodenal ulcers, and ultimately can lead to cancer; infection increases risk of cancer by 4-5 times.

Incidence of H. Pylori Infection:
In developing countries, the infection rate can be between 80-100%.  In a study of 185 Houston children at 12 day care centers, the prevalence of H. pylori infection ranged from 15% to 43%.  Another study estimated the figures between 6% and 20%.

Not always clear how this infection is transmitted, but some evidence that can pass from mother to child; the organism has also been isolated from houseflies. 

Risk Factors for developing H. Pylori Infections in US:

1. Attendance at day care
2. African American children; less of a problem for Hispanic children

Symptoms of H. Pylori Infection: Can vary from typical symptoms of ulcers to dyspepsia. Symptoms of gastritis or vomiting can be the only symptoms. Infection as been documented in some children who fail to thrive or have iron deficiency anemia. 

Laboratory diagnosis of H. Pylori Infection:

1. Gastric biopsy: Adult gastroenterologists still want to do a gastric biopsy to diagnose this infection.  A rapid test done on the sample of gastric mucosa is then used.
2. Breath test: This test is used by gastroenterologists to follow up on infected patients to
3. determine if the treatment is working.
4. Rapid tests: Several rapid tests are now available: Smith Kline, Abbott, and Quidel all have rapid tests that can be done on serum (moderately complex test), and on whole blood (waived).  Tests are now underway in Texas to determine what the overall incidence of infection are in children.  So far, no literature comparing the rapid tests done on blood to those done on gastric biopsy are available.

Treatment of H. Pylori Infection: Most pediatric gastroenterologists, at this point, agree that if laboratory evidence of H. Pylori Infection exists, then the children should be treated with a 14 day triple agent therapy - there is no consensus on the best treatment for this infection:

1. Acid Suppressants:

1. Bismuth Subsalicylate: 1 tsp - 1 tbsp qid varies with weight of child
2. Lansoprazole (Prevacid) 10mg-30 mg bid depending on weight
3. Omeprazole (Prilosec): 10-20 mg bid depending on weight

2. Antibiotics: Clarithromycin (15 mg/kg per day given bid);

3. Either of the following:

1. Amoxicillin 50 mg/kg/day given tid OR
2. Metronidazole 15 mg/kg/day given tid

Prevention of H. Pylori Infections: Three companies are now working on a vaccine to prevent this infection. 

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Department of Pediatrics  |  Medical College of Georgia
Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004