Çocuklarda Helicobacter pylori Enfeksiyonunda Risk Faktörleri ve Klinik Bulgular

Yıl 2022, , 290 - 295, 30.06.2022

Gülin Erdemir , Tanju Özkan , Taner Özgür , Hanife Ayşegül Arsoy Sevim Çakar

https://doi.org/10.34087/cbusbed.1060153

Öz

Giriş ve Amaç: Helicobacter pylori(H.pylori) enfeksiyonu tüm dünyada en yaygın kronik enfeksiyonlardan biridir. Gelişmekte olan ülkelerde bulaş genellikle çocukluk döneminde olmaktadır. Düşük sosyoekonomik seviyede yaşayanlarda daha sık görülmektedir. Tamamen asemptomatik olabileceği gibi, gastrointestinal ve ekstraintestinal semptomlarla karşımıza çıkabileceği de bilinmektedir. Bu çalışmada çocuklarda H.pylori seroprevalansının saptanması, risk faktörleri ve semptomların değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Çalışmaya Bursa ilinde beş farklı ilköğretim okulundan randomizasyonla 6-16 yaş arası 489 öğrenci alındı. Kabul eden ailelerden sosyoekonomik bilgileri ve çocuklarındaki semptomları sorgulayan anketleri doldurmaları istendi. Okullara gidilerek çocukların antropometrik ölçümleri yapıldı. H.pylori İmmunglobulin G (IgG) çalışılmak üzere çocuklardan 5 ml kan örneği alındı. Çocuklar H.pylori IgG pozitifliğine göre 2 gruba ayrılarak sosyoekonomik özellikler ve semptomlar karşılaştırıldı.
Bulgular: Çalışmaya 489 öğrenci alındı, %48,7 kız ve %51,3 erkekti. Yaş ortalaması 9,9±2,3 yıldı. H. pylori seropozitifliği %44 çocukta saptandı. Kızların %52,1’i, erkeklerin %36,3’ü seropozitif bulundu (p=0,0001). Sosyoekonomik faktörlerden babanın eğitim düzeyi azaldıkça çocukta H. pylori sıklığının arttığı saptandı (p=0,005). H. pylori seropozitif olanlarda boy ve vücut ağırlığı Z skorları negatif olanlara göre anlamlı olarak düşüktü (p=0,012 ve p=0,03;sırasıyla). Yaş gruplarına göre bakıldığında H.pylori seropozitiflerde 6-10 yaşta vücut ağırlığının ( p=0,03), 10 yaşından büyüklerde ise boy uzunluğunun (p=0,04) daha geri olduğu saptandı.
Sonuç: Bursa ilinde ilköğretim çağında saptanan H.pylori seropozitivite sıklığı Türkiye verileri ile uyumludur. Vücut ağırlığı ve boy uzunluğunun seropozitiflerde daha geri olduğu görülmüştür. Seropozitivitenin 10 yaştan küçük çocuklarda vücut ağırlığını, 10 yaştan büyük olanlarda ise boy uzunluğunu ön planda etkilediği görülmüştür. Sonuç olarak çocuklarda H.pylori, bulaş sonrası asemptomatik kalabilen ancak çocuklarda büyümeyi olumsuz etkilediği unutulmaması gereken önemli bir faktördür.

Anahtar Kelimeler

çocuk, helicobacter pylori, büyüme, epidemiyoloji

Destekleyen Kurum

yok

Proje Numarası

yok

The risk factors and clinical findings in pediatric helicobacter pylori Infection

Öz

Objective: Helicobacter pylori (H.pylori) infection is one of the most common chronic infections in the world. In developing countries, new infections more commonly occur in childhood and lasts for life unless treated. H pylori infection is more prevalent in low socioeconomic conditions. The infection may remain asymptomatic or it may cause
gastrointestinal and extra intestinal symptoms. The aim of this study is to determine the prevalence, associated risk factors and symptoms of H.pylori infection in healthy school children.
Materials and Methods: The study included randomly selected 489 students aged 6-16 years, from five colleges in Bursa city. Informed consent was taken from the parents and they were asked to fill out the questionnaire forms about their socioeconomical conditions and child’s symptoms. School visits were organized for anthropometric measurements of each student and to collect blood samples for testing H.pylori Immunoglobulin G (IgG). The children were grouped according to H pylori seropositivity and groups were compared according to socioeconomical and clinical characteristics. Results: This study group included 251 girls (48.7%) and 248 boys (51.3%), the mean age was 9.9±2.3 years. Forty-four percent of the children were H.pylori seropositive, of whom 52.1% were girls and 36.3% were boys (p=0.0001). Paternal education was an independent risk factor for H.pylori infection and was inversely correlated with seropositivity (p=0.005). The body weight and height were significantly lower in seropositives in comparison to negative ones (p=0.012 and p=0.03, respectively). The analysis according to age groups revealed that seropositivity was associated with low weight in children younger than the age of 10 years (p=0.03), and with short stature in the older group (p=0.04).
Conclusion: The H.pylori seropositivity of school children in Bursa city was consistent with Turkey data. Our results showed that both body weight and height of school children were negatively affected by H.pylori infection. While weight is affected primarily in younger ages, height was impaired in older ones. In conclusion, H.pylori infection is generally asymptomatic in childhood but it should be kept on mind that it has unfavorable consequences on child’s growth.

Anahtar Kelimeler

child, helicobacter pylori, growth, epidemiology

Proje Numarası

yok

Kaynakça

• 1. Goodwin, C.S, Worsley, B.W, Microbiology of Helicobacter pylori, Gastroenterology Clinics of North America, 1993, 22, 5–19.
• 2. Kusters, J.G, van Vliet, A.H ve ark, Pathogenesis of Helicobacter pylori infection, Clinical Microbiology Reviews, 2006, 19, 449–490.
• 3. Abbas, M, Sharif, F.A ve ark., Prevalence and Associated Symptoms of Helicobacter pylori Infection among School children in Kassala State, East of Sudan, Interdisciplinary Perspectives on Infectious Diseases, 2018, 4325752.
• 4. Öztekin, M, Yılmaz, B, ve ark., Overview of Helicobacter pylori Infection: Clinical Features, Treatment, and Nutritional Aspects, Diseases, 2021, 9(4), 66.
• 5. Neyzi, O, Günoz,, H ve ark. Türk çocuklarında vücut ağırlığı, boy uzunluğu, baş çevresi ve vücut kitle indeksi referans değerleri, Çocuk Sağlığı ve Hastalıkları Dergisi, 2008, 51, 1–14. Group on the Evaluation of Carcinogenic Risks to Humans, 1994, 61, 1-241
• 7. Hooi, J.K.Y, Lai, W.Y ve ark., Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis, Gastroenterology, 2017, 153(2), 420-429.
• 8. Lucero, Y, Lagomarcino, A.J ve ark., Helicobacter pylori, clinical, laboratory, and noninvasive biomarkers suggestive of gastric damage in healthy school-aged children: A case-control study, The International Journal of Infectious Diseases, 2021, 103, 423-430.
• 9. Iwańczak, B.M, Buchner, A.M ve ark., Clinical differences of Helicobacter pylori Infection in children. Advances in Clinical and Experimental Medicine, 2017, 26(7), 1131-1136.
• 10. Aminde, J.A, Dedino, G.A ve ark., Helicobacter pylori infection among patients presenting with dyspepsia at a primary care setting in Cameroon: seroprevalence, five-year trend and predictors, BMC Infectious Diseases, 2019, 19, 30.
• 11. She, R.C, Wilson, A.R, ve ark., Evaluation of Helicobacter pylori Immunoglobulin G (IgG), IgA, and IgM serologic testing compared to stool antigen testing, Clinical and Vaccine Immunology, 2009, 16(8), 1253-5.
• 12. Ozden, A, Bozdayi, G ve ark. ,Changes in the seroepidemiological pattern of Helicobacter pylori infection over the last 10 years, Turkish Journal of Gastroenterology, 2004,15(3), 156-8.
• 13. Ertem, D, Harmanci, H ve ark. Helicobacter pylori infection in Turkish preschool and school children: role of socioeconomic factors and breast feeding, Turkish Journal of Pediatrics, 2003, 45(2), 114-22.
• 14. Manfredi, M, Gaiani, F ve ark., How and when investigating and treating Helicobacter pylori infection in children, Acta Biomedica , 2018, 89(8-S), 65-71.
• 15. Hwang, H, Dwyer, J, ve ark., Helicobacter pylori infection, food preservation and gastric cancer risk: are there new roles for preventative factors? Nutrition Reviews, 1994, 52, 75–83. 16. Shinchi, K, Ishii, H, ve ark., Relationship of cigarette smoking, alcohol use, and dietary habits with Helicobacter pylori infection in Japanese men, Scandinavian Journal of Gastroenterology , 1997, 32, 651–5.
• 17. Mard, S.A, Khadem Haghighian, H ve ark., Dietary factors in relation to Helicobacter pylori infection, Gastroenterology Research and Practice , 2014, 826910.
• 18. Eslami, O, Shahraki, M ve ark., Association of Helicobacter pylori infection with metabolic parameters and dietary habits among medical undergraduate students in southeastern of Iran, Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences, 2017, 22.
• 19. Assaad, S, Chaaban, R ve ark., Dietary habits and Helicobacter pylori infection: a cross sectional study at a Lebanese hospital, BMC Gastroenterology, 2018,18, 48.
• 20. Alimohammadi, H, Fouladi, N, ve ark., Childhood recurrent abdominal pain and Helicobacter pylori infection, Islamic Republic of Iran, The Eastern Mediterranean Health Journal , 2017,22, 860‐864.
• 21. Correa Silva RGS, Machado NC ve ark. Helicobacter pylori infection is high in paediatric nonulcer dyspepsia but not associated with specific gastrointestinal symptoms, Acta Paediatrica, 2016,105,e228–31.
• 22. Spee, L.A.A, Madderom, M.B ve ark., Association between Helicobacter pylori and gastrointestinal symptoms in children, Pediatrics, 2010,125, e651–69.
• 23. Windle, H.J, Kelleher, D. ve ark., Childhood Helicobacter pylori infection and growth impairment in developing countries: a vicious cycle?, Pediatrics, 2007, 119, e754–9
• 24. Gulcan, M, Ozen, A ve ark., Impact of H. pylori on Growth: is the infection or mucosal disease related to growth impairment? Digestive Diseases and Sciences, 2010, 55, 2878-86.
• 25. Soylu, O.B, Ozturk, Y, Helicobacter pylori infection: effect on malnutrition and growth failure in dyspeptic children, European Journal of Pediatrics, 2008, 167, 557–62.
• 26. Thomas, J.E, Dale, A ve ark., Early Helicobacter pylori colonisation: the association with growth faltering in the Gambia, Archives of Disease in Childhood, 2004, 89(11), 49–54.
• 27. Mera, RM, Correa, P ve ark., Effects of a new Helicobacter pylori infection on height and weight in Columbian children, ,, 2006, 16, 347–51.
• 28. Sullivan, P.B, Thomas, J.E ve ark., Helicobacter pylori in Gambian children with chronic diarrhoea and malnutrition, Archives of Disease in Childhood, 1990, 65, 189–91.
• 29. Richter, T, Richter, T ve ark., Five- to 7-year-old children with Helicobacter pylori infection are smaller than Helicobacter-negative children: a cross-sectional population-based study of 3,315 children, Journal of Pediatric Gastroenterology and Nutrition , 2001, 33, 472–5.
• 30. Pacifico, L, Osborn, J.F ve ark., Helicobacter pylori infection and extragastric disorders in children: a critical update, World Journal of Gastroenterology, 2014, 20, 1379–401.
• 31. Mera, R.M, Bravo, L.E ve ark., Longterm effects of clearing Helicobacter pylori on growth in schoolage children, The Pediatric Infectious Disease Journal, 2012, 31, 263–6.
• 32. André, M.N Fialho, Andréa, B.C, Braga, ve ark., The association between Helicobacter pylori infection and height in children from an urban community in north-east Brazil, Annals of Tropical Paediatrics, 2007, 27(1), 55-61,
• 33. Perri, F, Pastore,, M ve ark. Helicobacter pylori infection and growth delay in older children, Archives of Disease in Childhood, 1997, 77(1), 46-49