Helicobacter pylori and abdominal pain

The association between recurrent abdominal pain and H. pylori infection remains controversial. Some studies have supported the link and others have not [35]. Of interest, a recent study published by Malaty et al. [36] demonstrates that younger children suffering from recurrent abdominal pain are more likely to be infected with H. pylori than older children with recurrent abdominal pain. Another study from Taiwan found that H. pylori infection is more commonly found in children with short-term (2 weeks to 3 months) recurrent abdominal pain, suggesting that perhaps short-term abdominal pain may be a feature of acute H. pylori infection [37]. On the other hand, a recent community-based cross-sectional study from Sweden of 695 children between ages 10 and 12 years showed that 18% of children were infected with H. pylori based on positive anti-H. pylori antibody tests, and that there was no increase in recurrent abdominal pain reported in this age group of children with H. pylori infection [38]. In a double-blind randomized placebo-controlled trial, symptomatic response to H. pylori eradication was determined in children with recurrent abdominal pain. The control group was put on Omeprazole and the treatment group received eradication triple therapy; there were 10 children in each group. Bacteria eradication was achieved an 8 out of 10 children in the treatment group and none in the placebo group. After 52 weeks, there was a similar reduction in the symptom index observed in both groups. A limitation of this study was the small number of patients enrolled [39]. A recent Japanese study showed that children with recurrent abdominal pain that fulfilled the Room II criteria are more likely to have H. pylori infection and a psychiatric disorder [40]. All these studies suggest that recurrent abdominal pain of childhood is a heterogeneous syndrome with unclear etiology. H. pylori infection is likely to represent only a very minor cause of recurrent abdominal pain, perhaps affecting those who are younger and have recent onset of abdominal pain. There is therefore no indication for the test-and-treat strategy for H. pylori in children with recurrent abdominal pain.

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