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Treatment ofHelicobacter pylori-associated gastroduodenal disease in children

Clinical evaluation of antisecretory vs antibacterial therapy

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Abstract

The charts of 54 children diagnosed with antralH. pylori were reviewed, to establish the incidence of gastroduodenal inflammation and compare therapeutic efficacies of antisecretory vs. antibacterial therapy. Histology demonstrated normal mucosa in three cases (6%) and gastric/duodenal inflammation (≥ Whitehead grade 3) in 51 biopsies (94%). 23/43 children (53%) initially responded to H2-blockers; however, by 10 mo, 13 had relapsed clinically. All of these patients subsequently responded to amoxicillin plus bismuth subsalicylate. Of the 20 children who failed to enter remission after an initial course of H2-blockers, all became symptom-free after treatment with amoxicillin/bismuth. Compared to antisecretory agents, antibacterial treatment induced clinical remission in 11/11 patients (p<0.001), who remained symptom-free for 10±0.2 mo. Clinical remissions were maintained in significantly more patients following amoxicillin/bismuth vs. H2-blockers (44/54 vs. 10/43 courses,p<0.001); and, the cumulative probability of remaining asymptomatic was significantly greater in the antibiotic group (p<0.001). These data suggest that gastric colonization byH. pylori is highly predictive of mucosal pathology in children. Initial therapy should be directed toward achieving bacterial eradication, as opposed to gastric acid suppression.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Gastroenterology and Nutrition, New York Medical College, 10595, Valhalla, New York

    Christian Rosioru MD,  Mark S. Glassman MD, Stuart H. Berezin MD, Howard E. Bostwick MD, Michael Halata MD & Steven M. Schwarz MD

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  1. Christian Rosioru MD
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  2. Mark S. Glassman MD
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  3. Stuart H. Berezin MD
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  4. Howard E. Bostwick MD
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  5. Michael Halata MD
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  6. Steven M. Schwarz MD
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Rosioru, C., Glassman, M.S., Berezin, S.H. et al. Treatment ofHelicobacter pylori-associated gastroduodenal disease in children. Digest Dis Sci 38, 123–128 (1993). https://doi.org/10.1007/BF01296783

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  • DOI: https://doi.org/10.1007/BF01296783

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