Malaty H M
Department of Medicine, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas 77030, USA.
Paediatr Drugs. 2000 Sep-Oct;2(5):357-65. doi: 10.2165/00128072-200002050-00003.
Helicobacter pylori is now recognised to be typically acquired during childhood. Studies also indicate that the infection is frequently lost in childhood; however, it is still unclear whether this is related to the use of antibacterials, the natural history of the infection, or both. H. pylori colonises gastric mucosa and is causally related to chronic gastritis and peptic ulcer disease in both children and adults. Successful eradication of H. pylori has resulted in the healing of duodenal ulcers and the lowering of the ulcer relapse rate in children. Therapy to cure the infection should be started in all children with peptic (duodenal or gastric) ulcer who are still infected. The ideal anti-H. pylori regimen should be safe, cheap, easy to comply with, well tolerated by children and able to achieve a high cure rate. Although US data are lacking, it is anticipated that the treatment regimen for children should be similar to that in adults (a triple therapy regimen that combines a proton pump inhibitor with 2 antimicrobial agents for 14 days). It is inappropriate to prescribe anti-H. pylori therapy without a firm diagnosis. The use of multiple antibacterials in a paediatric patient with an ulcer but without H. pylori infection cannot provide any benefit to the patient or the community. Such an approach only provides the possibility for adverse effects, for example development of antibacterial resistance among bystander bacteria. It is very important to confirm the diagnosis of H. pylori infection. The [13C]urea breath test is the noninvasive method of choice to determine H. pylori status in children and the ideal test for post-therapy testing. There is a need for post-therapy confirmation because of the likelihood of poor outcome for some treatment regimens, which is why post-therapy testing should be the standard of care. There is weak and inconsistent evidence of an association between H. pylori infection and recurrent abdominal pain (RAP) in children, in part because of the unclear definition of RAP in the literature. Therefore, there is still considerable debate regarding the treatment of infected children with RAP.
目前认为幽门螺杆菌通常在儿童期获得感染。研究还表明，该感染在儿童期常自行清除；然而，尚不清楚这是与使用抗菌药物有关、与感染的自然病程有关，还是两者皆有关。幽门螺杆菌定植于胃黏膜，与儿童和成人的慢性胃炎及消化性溃疡病存在因果关系。成功根除幽门螺杆菌可使儿童十二指肠溃疡愈合，并降低溃疡复发率。所有仍感染幽门螺杆菌的消化性（十二指肠或胃）溃疡儿童均应开始进行治愈感染的治疗。理想的抗幽门螺杆菌治疗方案应安全、便宜、易于依从、儿童耐受性良好且治愈率高。尽管缺乏美国的数据，但预计儿童的治疗方案应与成人相似（一种将质子泵抑制剂与两种抗菌药物联合使用14天的三联疗法方案）。在没有明确诊断的情况下开具抗幽门螺杆菌治疗是不合适的。在未感染幽门螺杆菌的溃疡儿科患者中使用多种抗菌药物对患者或社区均无益处。这种方法只会带来不良反应的可能性，例如导致旁观者细菌产生抗菌药物耐药性。确认幽门螺杆菌感染的诊断非常重要。[13C]尿素呼气试验是确定儿童幽门螺杆菌感染状况的首选非侵入性方法，也是治疗后检测的理想方法。由于某些治疗方案可能效果不佳，因此需要进行治疗后确认，这就是为什么治疗后检测应成为标准治疗措施的原因。关于幽门螺杆菌感染与儿童复发性腹痛（RAP）之间的关联，证据薄弱且不一致，部分原因是文献中对RAP的定义不明确。因此，对于感染幽门螺杆菌的RAP儿童的治疗仍存在相当大的争议。
