Abstract. To evaluate the hypothesis that gastric infection with Helicobacter pylori increases risk for diarrheal disease in children, we conducted a yearlong prospective study among 160 orphanage children Ͻ 5 years of age in Nonthaburi, Thailand. Serum samples collected at six-month intervals were examined by ELISA for antibodies to H. pylori, and children were followed daily for the development of diarrhea. Seven percent of children were seropositive on enrollment, 59% were seronegative, and 34% were indeterminate. Among the seronegative children, seroconversion occurred at a rate of 7% per six months. Forty-six percent of children developed 214 total episodes of diarrhea. By age group, children Ͻ 18 months, 18-24 months and Ͼ 24 months of age experienced 2.6, 1.1, and 0.2 mean diarrhea episodes per six months. The incidence of diarrhea was not significantly different between children by H. pylori serostatus. We conclude that H. pylori infection was not associated with an increased risk of diarrheal disease.In 1983, Warren and Marshall identified Helicobacter pylori in gastric biopsies from patients in Australia.1 This organism has subsequently been shown to play an important role in gastritis and peptic ulcer disease in industrialized and developing countries worldwide. 2,3 Acute infection is associated with hypochlorhydria, which persists for several months after exposure. [3][4][5] In addition, there is strong evidence that chronic H. pylori infection is associated with atrophic gastritis and gastric carcinoma. 3,6 Antibodies to H. pylori are more prevalent and are acquired at a younger age among people in developing countries than among people living in industrialized countries. 7,8 In a recent study in rural and urban communities in Thailand, Ͼ50% of children had serologic evidence of infection by eight years of age. 7 At an orphanage in Bangkok, Thailand, where enteric infections were hyperendemic, 74% of the children between one and four years of age were seropositive for H. pylori. 9 The high prevalence of H. pylori among children in developing countries and the association with hypochlorhydria have suggested that this infection may predispose to acute or persistent diarrheal disease. 10 In a retrospective study from the Gambia, infants with chronic diarrhea and malnutrition were significantly more likely to have serologic evidence of H. pylori infection compared to agematched healthy controls and malnourished children without diarrhea.11 Additionally, in a retrospective study from Bangladesh, the odds of H. pylori seropositivity among subjects with severe cholera were significantly higher than in agematched controls. 12 Prospective studies correlating the incidence of diarrhea with H. pylori infection have not been published. To determine if H. pylori infection increases the risk of diarrheal disease, we conducted a prospective study of the correlation between this infection and diarrheal disease in an orphanage in Nonthaburi, Thailand.
MATERIALS AND METHODSThis study was conducted in the Pakkred Babi...