A Long-Term Follow-up after Treatment with Colloidal Bismuth Subcitrate and Tinidazole

Abstract

The connection between dyspeptic symptoms and Helicobacter pylori infection was studied prospectively in 21 children treated for verified H. pylori infection with bismuth subcitrate and tinidazole. Gastroscopy with biopsy was performed before and a mean of 4 months after discontinuation of the treatment. A second post-treatment check with determination of H. pylori antibodies and serum pepsinogen 1 level was made a mean of 1.5 years after cessation of treatment. The therapy given cleared the bacteria in 67% of the patients. No significant difference in symptoms was observed between treatment successes and failures. The histopathologic diagnosis of H. pylori infection was accompanied by positive IgG serology in 15 (75%) of the 20 patients tested, and a decrease in antibody levels was observed in children with successful eradication. Serum pepsinogen 1 seemed to be even a better marker in the follow-up. The healing of acute and also to some extent of chronic gastritis took place closely after successful eradication. Our results suggest that healing of H. pylori-induced gastritis should be confirmed at reendoscopy only, independent of the symptoms.

What do we know about benefits of H. pylori treatment in childhood?

“…Overall, there is insufficient evidence to draw solid conclusions about health benefits from treating H. pylori infection in pediatric populations. Researchers conducting clinical trials aimed at assessing effects on children's health of eliminating H. pylori should design multicenter trials when needed for adequate numbers of subjects; such trials should include observational analysis to compare outcomes in 34 [15/44] Remained HP+ [11] 36 [4/11] HP negative at baseline [40] Percent with worsening reflux 12 [5/40] eliminated HP [44] 18 [8/44] Remained HP+ [11] 36 [4/11] HP negative at baseline [40] Mean decrease in severity score for epigastric pain Resolution of esophageal and gastric disease HP, H. pylori; ND, no data provided in report; +, positive; -, negative.…”

Helicobacter pylori Serology at Diagnosis and Follow-up of Biopsy-verified Infection in Children

“…In such cases, IgG antibody titers declined to normal levels or at least decreased by 50% at 6 months in the majority of children. If such a decrease was seen, endoscopy was not performed in the majority of cases, although Helicobacters were perhaps not totally eradicated in all cases (25). Upper gastrointestinal endoscopy is an invasive procedure performed under general anesthetic at our hospital and it was considered unethical to investigate children with no symptoms and in whom serum antibodies had declined to normal levels.…”

Results of triple eradication therapy in Japanese children: a retrospective multicenter study

“…19 The present study also suggested that H. pylori eradication improved gastrointestinal symptoms in the infected children. While it remains controversial whether H. pylori infection is associated with gastrointestinal symptoms such as abdominal pain in children, 4,21,22 the Canadian Helicobacter Study Group 5 and the European Pediatric Task Force on Helicobacter pylori 23 have both recommended that H. pylori eradication therapy be considered if a child undergoes endoscopy and the infection is identified. Our data support these recommendations, but controlled trials will be needed to confirm this hypothesis.…”