Bontems Patrick, Kalach Nicolas, Vanderpas Jean, Iwanczak Barbara, Casswall Thomas, Koletzko Sibylle, Oderda Giuseppina, Martinez-Gomez Maria José, Urruzuno Pedro, Kindermann Angelika, Sykora Josef, Veres Gabor, Roma-Giannikou Eleftheria, Pehlivanoglu Ender, Megraud Francis, Cadranel Samy
From the *Paediatric Gastroenterology-Hepatology, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium; †Saint Vincent de Paul Hospital, Clinic of Paediatrics St Antoine, Groupement des Hôpitaux de l'Institut Catholique de Lille (GH-ICL), Lille, France; ‡Medical Microbiology Laboratory, Communicable and Infectious Diseases, Scientific Institute of Public Health, Brussels, Belgium; §Department of Paediatrics, Medical University of Wroclaw, Wroclaw, Poland; ¶Department of Paediatrics, Karolinska University Hospital, Stockholm, Sweden; ‖Dr v. Hauner Children's Hospital, University Medical Center, Munich, Germany; **Department of Paediatrics, University of Piemonte Orientale, Novara, Italy; ††Department of Paediatrics, Hospital Universitario Niño Jesús; ‡‡Department of Paediatrics, Hospital 12 de Octobre, Madrid, Spain; §§Academic Medical Center, Amsterdam, The Netherlands; ¶¶Charles University in Prague, Faculty of Medicine in Pilsen, Department of Paediatrics, Prague, Czech Republic; ‖‖First Department of Paediatrics, Semmelweis University, Budapest, Hungary; ***First Department of Paediatrics of Athens University, Athens, Greece; †††Department of Paediatrics, Marmara University Hospital, Istanbul, Turkey; and ‡‡‡Inserm U853, Victor Segalen Bordeaux 2 University, Bordeaux, France.
Pediatr Infect Dis J. 2013 Dec;32(12):1324-9. doi: 10.1097/INF.0000000000000005.
To analyze risk factors associated with gastro-duodenal ulcers and erosions in children.
Open, prospective, multicenter, case-control study carried out in 11 European countries in patients with gastric or duodenal ulcers/erosions and 2 age-matched controls each. Possible risk factors were recorded. Logistic regression models were performed with adjustment for centers and age groups.
Seven-hundred thirty-two patients (244 cases, 153 with erosions only and 91 with ulcers, and 488 controls) were recruited. Children receiving antimicrobials or acid suppressive drugs before endoscopy were excluded (202 cases/390 controls remained for risk factor analysis). Helicobacter pylori was detected more frequently in cases than controls but only in 32.0% versus 20.1% in controls (P = 0.001). Independent exposure factors for gastric ulcers were male gender (P = 0.001), chronic neurologic disease (P = 0.015), chronic renal disease (P < 0.001) and nonsteroidal anti-inflammatory drug consumption (P = 0.035). Exposure factors for duodenal ulcers were H. pylori infection (P < 0.001) and steroid consumption (P = 0.031). Chronic renal disease was the only independent factor associated with gastric erosions (P = 0.026), those associated with duodenal erosions being H. pylori infection (P = 0.023), active smoking (P = 0.006) and chronic arthritis (P = 0.008). No risk factor was identified in 97/202 (48.0%) cases.
H. pylori remains a risk factor for duodenal, but not for gastric lesions in children in countries with low prevalence of infection. No risk factor could be identified in half of the children with gastro-duodenal ulcers/erosions.
分析与儿童胃十二指肠溃疡和糜烂相关的危险因素。
在11个欧洲国家开展的开放性、前瞻性、多中心病例对照研究，研究对象为患有胃或十二指肠溃疡/糜烂的患者以及与之年龄匹配的两组对照。记录可能的危险因素。采用逻辑回归模型，并对中心和年龄组进行校正。
共纳入732例患者（244例病例，其中仅糜烂153例，溃疡91例，以及488例对照）。排除在内镜检查前接受过抗菌药物或抑酸药物治疗的儿童（剩余202例病例/390例对照用于危险因素分析）。病例组幽门螺杆菌检测阳性率高于对照组，但仅为32.0%，而对照组为20.1%（P = 0.001）。胃溃疡的独立暴露因素为男性（P = 0.001）、慢性神经疾病（P = 0.015）、慢性肾脏疾病（P < 0.001）和非甾体抗炎药的使用（P = 0.035）。十二指肠溃疡的暴露因素为幽门螺杆菌感染（P < 0.001）和类固醇药物的使用（P = 0.031）。慢性肾脏疾病是与胃糜烂相关的唯一独立因素（P = 0.026），与十二指肠糜烂相关的因素为幽门螺杆菌感染（P = 0.023）、主动吸烟（P = 0.006）和慢性关节炎（P = 0.008）。97/202（48.0%）例病例未发现危险因素。
在感染率较低的国家，幽门螺杆菌仍是儿童十二指肠病变而非胃部病变的危险因素。半数胃十二指肠溃疡/糜烂儿童未发现危险因素。
