Helicobacter pylori
infection causes
gastritis and
peptic ulcers and is associated with the development of
gastric cancer. Approximately 50% of the world population is infected with H pylori , with the highest prevalence rates in developing countries. In the vast majority of individuals,
infection is acquired during childhood with those of low socioeconomic means and having infected family members being at highest risk for early childhood acquisition. Definitive routes of transmission of the
infection are unclear, with evidence suggesting oral-oral, gastric-oral, and fecal-oral routes. If untreated, H pylori
infection is lifelong. Although clinical disease typically occurs decades after initial
infection acquisition, children infected with H pylori may have
gastritis,
ulcers, mucosal-associated lymphoid type
lymphoma, and, rarely, gastric
atrophy with/without intestinal
metaplasia (ie, both precursor lesions for
gastric cancer). Controversy persists regarding testing for and treating H pylori , if found, in the large number of children who present with recurrent
abdominal pain. Because young children (ie, younger than 5 years of age) who are treated and cured of their H pylori
infection may be at risk for
reinfection, the current recommendations do not recommend treatment unless an
ulcer or gastric
atrophy is present. However, despite the lack of clinical evidence, the trend is to more aggressively screen children for the presence of H pylori and to treat those children who are found to have the
infection. H pylori
infection can be eradicated by antimicrobial
therapy plus a
proton pump inhibitor, but no treatment regimen is 100% effective. Multiple drugs, frequent dosing, and length of treatment often contribute to poor patient compliance, and
antibiotic eradication
therapy is associated with increasing drug resistance.