Erasmus MC, Department of General Practice, PO Box 2040, 3000 CA Rotterdam, Netherlands.
Pediatrics. 2010 Mar;125(3):e651-69. doi: 10.1542/peds.2010-0941. Epub 2010 Feb 15.
Recurrent abdominal pain (RAP) and other gastrointestinal (GI) symptoms are common complaints among children. The role of Helicobacter pylori in the cause of these complaints remains controversial. Nevertheless, there is an increasing pressure on primary care clinicians to screen for H pylori infection in symptomatic children. We systematically reviewed the published evidence for an association between H pylori infection and GI symptoms in children.
Medline and Embase databases up to July 2009 were searched to identify studies that evaluated the association between H pylori and GI symptoms in children aged up to 18 years. When studies reported on abdominal pain without additional definition, thus not fulfilling Apley's criteria, we grouped these outcomes as unspecified abdominal pain (UAP). Methodologic quality was scored by using a standardized list of criteria, and crude odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and pooled.
Thirty-eight studies met our inclusion criteria: 23 case-control studies, 14 cross-sectional studies, and 1 prospective cohort study. The overall methodologic quality was low. Pooled ORs for the association between RAP and H pylori infection in children were 1.21 (95% CI: 0.82-1.78) in 12 case-control studies and 1.00 (95% CI: 0.76-1.31) in 7 cross-sectional studies. Meta-analysis of the association between UAP and H pylori infection in 6 hospital-based studies resulted in a pooled OR of 2.87 (95% CI: 1.62-5.09) compared with 0.99 (95% CI: 0.46-2.11) in 5 population-based studies. Two of 3 studies concerning epigastric pain reported a statistically significant positive association with H pylori infection.
We found no association between RAP and H pylori infection in children and conflicting evidence for an association between epigastric pain and H pylori infection. We found evidence for an association between UAP but could not confirm this finding in children seen in primary care.
反复发作的腹痛（RAP）和其他胃肠道（GI）症状是儿童常见的主诉。幽门螺杆菌（H. pylori）在这些症状的病因中的作用仍存在争议。然而，初级保健临床医生在有症状的儿童中筛查 H. pylori 感染的压力越来越大。我们系统地回顾了已发表的证据，以评估 H. pylori 感染与儿童 GI 症状之间的关联。
检索了截至 2009 年 7 月的 Medline 和 Embase 数据库，以确定评估 H. pylori 与 18 岁以下儿童 GI 症状之间关联的研究。当研究报告腹痛而无其他定义时，即未满足 Apley 标准，我们将这些结果归类为未特指的腹痛（UAP）。使用标准化的标准清单对方法学质量进行评分，并计算并汇总了未经调整的优势比（OR）及其 95%置信区间（CI）。
38 项研究符合纳入标准：23 项病例对照研究、14 项横断面研究和 1 项前瞻性队列研究。整体方法学质量较低。12 项病例对照研究中 RAP 与 H. pylori 感染之间的汇总 OR 为 1.21（95%CI：0.82-1.78），7 项横断面研究中为 1.00（95%CI：0.76-1.31）。对 6 项基于医院的研究中 UAP 与 H. pylori 感染之间的关联进行的荟萃分析得出，与 5 项基于人群的研究中 0.99（95%CI：0.46-2.11）相比，汇总 OR 为 2.87（95%CI：1.62-5.09）。3 项研究中有 2 项报告上腹痛与 H. pylori 感染有统计学显著的正相关。
我们未发现 RAP 与儿童 H. pylori 感染之间存在关联，并且关于上腹痛与 H. pylori 感染之间的关联存在相互矛盾的证据。我们发现 UAP 与 H. pylori 感染之间存在关联，但无法在初级保健中看到的儿童中证实这一发现。
