Department of Pediatrics, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Department of General Medicine and Community Health Science, Hyogo College of Medicine, Sasayama, Hyogo, Japan.
Adv Exp Med Biol. 2019;1149:107-120. doi: 10.1007/5584_2019_361.
About one-third of all children worldwide is infected with H. pylori and its prevalence is low in developed and high in developing countries. H. pylori is mainly acquired during childhood and transmission of the bacterium commonly proceeds from person to person, especially among family members. The most frequent transmission route is from the mother to children. Various gastrointestinal and extra-gastrointestinal diseases are reported to be associated with H. pylori in children and adolescents, but the strongest recommendation for testing and treating is introduced only with children and adolescents having peptic ulcer disease. Iron deficiency anemia and chronic immune thrombocytopenic purpura are also considered for testing and treating, but the effectiveness is somewhat controversial. Invasive diagnosis is recommended, whereas none of the available diagnostic tests have 100% accuracy for reliable diagnosis, and therefore at least two or more tests should be performed. Urea breath test is the most reliable among the non-invasive tests. Because the number of antibiotics-resistant H. pylori strains is increasing, it is desirable to conduct a drug susceptibility test before treatment and to select the corresponding regime. H. pylori has been proven to be a major cause of gastric cancer and 'screen-and-treat' strategies are recommended in communities at high risk of gastric cancer. However, the application to children and adolescents is controversial. An effective vaccine is desirable, but not yet available. Screen-and-treat for adolescents has started in a few areas in Japan, where conditions are well established. New prevention strategies for gastric cancer are awaited worldwide.
全世界约有三分之一的儿童感染了幽门螺杆菌，其流行率在发达国家较低，在发展中国家较高。幽门螺杆菌主要在儿童时期感染，细菌的传播通常是人与人之间进行的，尤其是在家庭成员之间。最常见的传播途径是母亲传染给孩子。据报道，儿童和青少年的各种胃肠道和胃肠道外疾病与幽门螺杆菌有关，但仅对患有消化性溃疡病的儿童和青少年进行检测和治疗的建议最强。缺铁性贫血和慢性免疫性血小板减少性紫癜也被认为可以进行检测和治疗，但疗效存在一定争议。推荐进行有创诊断，然而，目前尚无任何诊断测试对可靠诊断具有 100%的准确性，因此应至少进行两项或更多测试。非侵入性测试中最可靠的是尿素呼气试验。由于抗生素耐药的幽门螺杆菌菌株数量不断增加，在治疗前进行药敏试验并选择相应的治疗方案是可取的。幽门螺杆菌已被证明是胃癌的主要病因，在胃癌高发社区推荐“筛查和治疗”策略。然而，在儿童和青少年中的应用存在争议。需要一种有效的疫苗，但目前尚未上市。在日本的一些地区已经开始对青少年进行筛查和治疗，这些地区的条件已经得到很好的建立。全世界都在等待新的胃癌预防策略。
