Effect of Helicobacter pylori eradication on the natural history of duodenal ulcer disease

Abstract

Background-Duodenal ulcer disease is strongly associated with Helicobacter pylori infection of the gastric mucosa. Eradication of H pylori from the gastric mucosa in adults is associated with long term healing of ulcers. Aims-To follow a cohort of children with duodenal ulcer disease for a minimum of two years after the eradication of H pylori. Patients and methods-Over a three year period, all children diagnosed with duodenal ulcer disease had their symptoms documented and their H pylori status evaluated. The histories of these children were carefully screened to determine previous symptoms and to document previous treatment regimens. Results-Sixteen children were diagnosed with ulcers and 15 were available for treatment and long term follow up. The median age at which symptoms first occurred was 10.5 years (range, 6-14) and the median duration of symptoms was 24 months (range, 2-60). Ten of the children had been treated with H 2 receptor antagonists for a median of 3.5 months (range, 1-60). Duodenal ulcers healed in all children after eradication of H pylori and all children have remained asymptomatic for a median of 37 months (range, 26-62). No child has required subsequent admission to hospital. Conclusion-Eradication of H pylori is very eVective in the long term healing of duodenal ulcer disease. H pylori eradication should be the standard treatment for all infected children who present with duodenal ulcer disease. (Arch Dis Child 1998;79:502-505)

Peptic Ulcer

“…Quando são excluídos os casos com úlcera relacionados a drogas antiinflamatórias, o H. pylori é detectado em quase todos os ulcerosos. Cinqüenta e cinco a 100% das crianças com úlcera duodenal e cerca de 40% daquelas com úlcera gástrica são infectadas 8,[19][20][21] . Das 76 crianças com úlcera duodenal por nós investigadas 69 tinham úlcera duodenal primária e, dentre elas, 83% e 91%, respectivamente, eram H. pylori positivas.…”

“…Esses achados demonstram ser a bactéria o fator mais freqüente dentre os descritos na etiopatogenia da úlcera duodenal. Mas, a evidência definitiva da sua participação como fator etioló-gico é que o tratamento com antimicrobianos altera substancialmente a evolução da doença, com taxas de recidiva da lesão ulcerada duodenal caindo para próximo de zero naqueles em que o microorganismo foi erradicado 19,20,22 . Entretanto, o H. pylori parece não ter participação essencial na patogênese da úlcera gástrica da criança, com taxas de infecção similares àquela dos não ulcerosos.…”

Is peptic ulcer a common cause of upper gastrointestinal symptoms?

“…The widespread application of endoscopic techniques, the identi®cation of Helicobacter pylori and the use of new pharmacological agents have shown a dramatic impact on the clinical course of peptic ulcer disease over the last decade [1,8,14,18]. Although peptic ulcer is considered uncommon in childhood, the new diagnostic tools have contributed to a more ecient documentation and management of the disease [2,5,10,20].…”

Current Therapy forHelicobacter pyloriInfection in Children and Adolescents

“…It is clear that successful eradication of H pylori results in a permanent cure of ulcer disease and a lifetime free from medications (24). Although there are no multicentre, randomized, controlled treatment trials evaluating the efficacy of H pylori eradication on ulcer disease in children, the data are quite compelling in favour of eradication in these patients (41).…”