Helicobacter pylori infection in children with celiac disease: Multi‐center, cross‐sectional study

Abstract

Background An inverse association has been suggested between celiac disease (CD) and Helicobacter pylori (Hp) infection in children; however, there are inconsistent data. The purpose of this multi‐center study is to evaluate the association between Hp and CD in childhood. Methods Children who underwent endoscopy between July 2016 and November 2017 in four pediatric gastroenterology centers were included in the study. Patients with a history of previous Hp eradication, antibiotic or acid‐suppressive drug therapy in the last 4 weeks, and any underlying chronic disease were excluded. The presence of Hp infection was confirmed by both histopathology and the rapid urease test. The ones who had the diagnosis of CD were compared with the children who underwent endoscopy during the same period and had another diagnosis. Duodenal histopathology of children with CD was categorized according to the modified Marsh classification. Results Of 3056 endoscopies performed in the study period, 2484 cases were eligible for the study. A total of 482 CD patients (mean age: 9.71 ± 4.63 years, 58.5% girls) and 2060 controls (mean age: 9.92 ± 4.66 years, 54.6% girls) were included in the study. The rate of Hp infection was significantly lower in CD group (26.3% vs 50.1%, P < .01). The difference was prominent even in children younger than 6 years old (P < .01). There was no correlation between Hp infection and the modified Marsh scores in CD (P > .05). Conclusion In this cross‐sectional study, where Hp infection is common even in the pediatric population, the frequency of Hp infection was significantly lower in children with CD compared with the controls. Systematic cohort studies are necessary to clarify causal association between Hp infection and the development of celiac disease.

A systematic review and meta-analysis for association of Helicobacter pylori colonization and celiac disease

“…Therefore, the full-texts of 92 remained articles were completely evaluated. Finally, 26 studies were included in the systematic review and also meta-analysis (kappa (κ) = 0.84) [11,[13][14][15][16][17][18]21,[24][25][26][27][39][40][41][42][43][44][45][46][47][48][49][50][51][52], and the others were excluded due to a reason mentioned in Fig 1 (Fig 1). In the end, there was no suitable cohort study in the included studies.…”

“…Among the studies Lebwohl et al had the highest study population with 130308 participants (included 2689 cases and 127619 controls) [14]. Most studies PLOS ONE were from Turkey (N = 6) [15][16][17][18]51,52] and Italy (N = 5) [11,27,44,45,48]. Some studies had been performed only on children [13,[15][16][17]21,44,47,51,52] or adults [18,25,27,39,43,45,48], the others evaluated both age groups [11,14,42,49,50].…”

Review: Helicobacter pylori infection in children

“…A number of studies identified correlations of H pylori infection in children with a variety of gastrointestinal diseases including autoimmune gastritis, 14 celiac disease, 15,16 and parasitic infection 17 . However, association does not prove causation and confounding factors likely account for these associations.…”

Inverse Association Between Helicobacter pylori Infection and Unexplained Isolated Terminal Ileitis: A Retrospective Study

“…[12][13][14][15] A prior multi-center, cross-sectional study has also reported that in children with celiac disease, a common autoimmune and inflammatory disease of small intestine, the frequency of H. pylori infection was remarkably lower than that of healthy controls. 16 There are limited data probing the association between H. pylori infection and ITI, leading us to perform the retrospective study investigating the potential relationship between H. pylori infection and unexplained isolated terminal ileitis (UITI).…”