Sedlácková M, Malaty H, Volf V, Frühauf P, Marx D, Soucek A, Graham D Y
Klinika dĕtského a dorostového lékarství 1. LF UK a VFN, Praha.
Cas Lek Cesk. 2003 Feb;142(2):102-5.
There exist only inconsistent results of studies on the relationship between Helicobacter pylori (H. pylori) infection and functional dyspepsia and/or recurrent abdominal pain in children and adolescents. The answer could bring a comparison of the epidemiological features of H. pylori infection between children and adolescents with dyspepsia and/or recurrent abdominal pain (symptomatic) and without these symptoms (asymptomatic), living in the Czech republic.
Study includes children and adolescents (2-18 years) with upper gastrointestinal symptoms visiting paediatric gastroenterology department between 1994 and 1999. Age, sex, socioeconomic level matched control (asymptomatic) group consisted of children and adolescents visiting the general paediatric service with symptoms not related to the upper gastrointestinal tract. Demographic and socioeconomic factors, including parent(s) educational level, place of residence, living conditions, type of drinking water and pets in their household were evaluated. Serum of the children and adolescents was tested for H. pylori IgG by enzyme linked immunosorbent assay. In addition, the symptomatic children and adolescents underwent endoscopic examination and biopsies from gastric antrum and corpus were taken for the quick urease test, histology/histoscopy, and H. pylori cultivation. H. pylori infection in this group was stated when at least two tests were positive. Altogether 829 children and adolescents were examined, 624 cases were symptomatic and 205 represented controls (asymptomatic). The prevalence of infection was 33% among symptomatic children vs. 7.5% among controls (OR = 6.2, p.001) and was similar among boys and girls (32% vs. 34.5%, respectively). H. pylori prevalence increased with age among symptomatic children (10% for children below 6 years and 37% between 11 to 16 years) (p.001). In contrary, prevalence tended to fall with age among asymptomatic children (11% in children below 6 years vs. 6% in children over 10 years (OR = 2.0, 95% CI = 0.7-6.2). In both groups, an inverse correlation between H. pylori occurrence and mother's educational level was observed. The H. pylori incidence was 10% among asymptomatic children who drank water from municipal water supply or from a well vs. 3% among those who drank bottled water (OR = 4, 95% CI = 1.1 to 18, p.05).
H. pylori infection was more prevalent among symptomatic children and adolescents vs. asymptomatic children and adolescents within the same population. H. pylori incidence increased with age among symptomatic children and adolescents and tended to fall among controls, showing deep differences between the two groups. With exception of the bottled water drinking, presence of any other factor studied represented significant risk for acquiring the H. pylori infection.
关于幽门螺杆菌（H. pylori）感染与儿童及青少年功能性消化不良和/或反复腹痛之间的关系，研究结果并不一致。该问题的答案有助于比较捷克共和国患有消化不良和/或反复腹痛（有症状）以及无这些症状（无症状）的儿童和青少年中幽门螺杆菌感染的流行病学特征。
该研究纳入了1994年至1999年间因上消化道症状就诊于儿科胃肠病科的儿童及青少年（2至18岁）。年龄、性别、社会经济水平相匹配的对照组（无症状）由因与上消化道无关的症状就诊于普通儿科门诊的儿童及青少年组成。评估了人口统计学和社会经济因素，包括父母的教育水平、居住地点、生活条件、饮用水类型以及家中宠物情况。采用酶联免疫吸附试验检测儿童及青少年血清中的幽门螺杆菌IgG。此外，有症状的儿童及青少年接受了内镜检查，并从胃窦和胃体取活检组织进行快速尿素酶试验、组织学/组织镜检查以及幽门螺杆菌培养。当至少两项检测呈阳性时，判定该组存在幽门螺杆菌感染。总共检查了829名儿童及青少年，其中624例有症状，205例为对照组（无症状）。有症状儿童的感染率为33%，而对照组为7.5%（比值比 = 6.2，p < 0.001），且男孩和女孩的感染率相似（分别为32%和34.5%）。有症状儿童中幽门螺杆菌感染率随年龄增长而升高（6岁以下儿童为10%，11至16岁儿童为37%）（p < 0.001）。相反，无症状儿童中的感染率随年龄增长呈下降趋势（6岁以下儿童为11%，10岁以上儿童为6%（比值比 = 2.0，95%可信区间 = 0.7 - 6.2））。在两组中，均观察到幽门螺杆菌感染与母亲教育水平呈负相关。饮用市政供水或井水的无症状儿童中幽门螺杆菌感染率为10%，而饮用瓶装水的儿童中感染率为3%（比值比 = 4，95%可信区间 = 1.1至18，p < 0.05）。
在同一人群中，有症状的儿童及青少年中幽门螺杆菌感染比无症状的儿童及青少年更为普遍。有症状的儿童及青少年中幽门螺杆菌感染率随年龄增长而升高，而对照组中则呈下降趋势，显示出两组之间的显著差异。除饮用瓶装水外，所研究的任何其他因素的存在均代表感染幽门螺杆菌的重大风险。
