Pediatrics University Clinic, Medical School, University of Lisbon, Lisbon, Portugal.
National Institute of Health Ricardo Jorge, Department of Infectious Diseases, National Reference Laboratory for Gastrointestinal Infections, Lisbon, Portugal.
Helicobacter. 2023 Aug;28(4):e12963. doi: 10.1111/hel.12963. Epub 2023 Mar 10.
Helicobacter pylori infection acquisition occurs mainly in childhood and may be a critical factor in developing long-term complications. In contrast to other developed countries, previous studies have reported a relatively high H. pylori infection prevalence in Portugal, both in children and adults. However, there are no recent data concerning pediatric population.
We performed a retrospective observational study concerning an 11 years period (2009, 2014, 2019), that included patients under 18 years old who underwent upper endoscopy at a pediatric tertiary center. Demographic, clinical-pathological, and microbiological data were collected.
Four hundred and sixty one children were included. The average age was 11.7 ± 4.4 years. In total, H. pylori infection was confirmed in 37.3% of cases (histology and/or culture) and a decreasing infection trend was observed (p = .027). The most common indication for endoscopy was abdominal pain, which was a good predictor of infection. Antral nodularity was present in 72.2% of the infected children (p < .001). In the oldest age groups, moderate/severe chronic inflammation, H. pylori density and lymphoid aggregates/follicles were positive predictors for the presence of antral nodularity. For all ages, the presence of antral nodularity, neutrophilic activity in the antrum and corpus and lymphoid follicles/aggregates in the antrum were positive predictors for the presence of H. pylori infection. Among the 139 strains tested for antibiotic susceptibility, 48.9% were susceptible to all tested antibiotics. Resistance to clarithromycin, metronidazole, and both was detected in 23.0%, 12.9%, and 6.5% of the strains, respectively; furthermore, resistance to ciprofloxacin and to amoxicillin was observed in 5.0% and 1.4% of the strains, respectively.
The present study reports (for the first time in Portugal) a significant decreasing trend in the prevalence of pediatric H. pylori infection, although it remains relatively high compared to the recently reported prevalence in other South European countries. We confirmed a previously recognized positive association of some endoscopic and histological features with H. pylori infection, as well as a high prevalence rate of resistance to clarithromycin and to metronidazole. The clinical relevance of these findings requires confirmation with further studies at a national level, taking into account the high incidence rate of gastric cancer in Portugal and the potential need for country-specific intervention strategies.
幽门螺杆菌感染主要发生在儿童时期，可能是导致长期并发症的关键因素。与其他发达国家不同，此前的研究报告称，葡萄牙儿童和成人的幽门螺杆菌感染率均相对较高。然而，目前尚无关于儿科人群的最新数据。
我们进行了一项回顾性观察研究，涉及 11 年的时间（2009 年、2014 年、2019 年），纳入了在一家儿科三级中心接受上消化道内镜检查的 18 岁以下患者。收集了人口统计学、临床病理和微生物学数据。
共纳入 461 例儿童。平均年龄为 11.7±4.4 岁。总体而言，37.3%的病例（组织学和/或培养）证实存在幽门螺杆菌感染，且感染呈下降趋势（p=0.027）。内镜检查最常见的指征是腹痛，这是感染的良好预测指标。感染儿童中，胃窦结节的发生率为 72.2%（p<0.001）。在年龄较大的组中，中度/重度慢性炎症、幽门螺杆菌密度和淋巴滤泡/滤泡阳性预测胃窦结节的存在。对于所有年龄组，胃窦结节、胃窦和胃体的中性粒细胞活性以及胃窦的淋巴滤泡/滤泡阳性预测幽门螺杆菌感染的存在。在检测抗生素敏感性的 139 株菌株中，48.9%对所有测试抗生素均敏感。克拉霉素、甲硝唑和两者的耐药率分别为 23.0%、12.9%和 6.5%；此外，5.0%和 1.4%的菌株对环丙沙星和阿莫西林耐药。
本研究报告（葡萄牙首次报告），儿童幽门螺杆菌感染的流行率呈显著下降趋势，但与最近报告的其他南欧国家的流行率相比，仍相对较高。我们证实了一些内镜和组织学特征与幽门螺杆菌感染之间的先前公认的正相关性，以及克拉霉素和甲硝唑耐药率较高。这些发现的临床意义需要在全国范围内进一步研究证实，同时考虑到葡萄牙胃癌的高发率和可能需要特定于国家的干预策略。
