Drumm B
University College Dublin, Ireland.
Gastroenterol Clin North Am. 1993 Mar;22(1):169-82.
H. pylori is the major cause of gastritis in children and adults. Studies in children have demonstrated a specific association between H. pylori and primary gastritis. H. pylori colonization of the gastric mucosa is also important in relation to the natural history of duodenal ulcer disease. Duodenal ulcers do not appear to relapse if H. pylori is cleared from the gastric mucosa. Because of the low incidence of duodenal ulcer disease in children, a multicenter study is required to demonstrate whether this finding is true in children. To date, no specific symptoms have been associated with the presence of H. pylori gastritis in children. H. pylori gastritis may therefore be an asymptomatic condition in the majority of infected children. Further studies in relation to H. pylori gastritis and symptoms in children will be important because it should be easier to identify specific symptoms in children than in adults. H. pylori gastritis in children can be diagnosed by obtaining antral biopsy specimens for culture and histologic study during upper gastrointestinal endoscopy. Serologic study is also a sensitive and specific indicator of H. pylori infection, provided that children's sera are used to standardize the assay. Noninvasive tests such as 13C urea breath tests are very attractive for use in children but are expensive. H. pylori can be cleared from the gastric mucosa in as many as 70% of children by using a combination of metronidazole or amoxicillin with colloidal bismuth subcitrate or bismuth subsalicylate. Studies in children are important in determining the epidemiology of H. pylori. Children in Western societies are not usually colonized. Infection becomes more common with increasing age. Children in underdeveloped countries and those living in poor social conditions in Western countries are much more likely to be infected at a young age. The reason for the increased prevalence of infection among these groups is not known. There is also significant intrafamilial clustering of H. pylori infection. Again, it is unclear why the organism is clustered within households and institutions. Future studies on children will be of importance in determining whether H. pylori gastritis is a cause of specific symptoms, the epidemiology of H. pylori infection, and the possible role of the organism in the natural history of gastric cancer.
幽门螺杆菌是儿童和成人胃炎的主要病因。针对儿童的研究已证实幽门螺杆菌与原发性胃炎之间存在特定关联。胃黏膜的幽门螺杆菌定植对于十二指肠溃疡病的自然病程也很重要。如果从胃黏膜清除幽门螺杆菌，十二指肠溃疡似乎不会复发。由于儿童十二指肠溃疡病的发病率较低，因此需要开展一项多中心研究来证明这一发现是否适用于儿童。迄今为止，儿童幽门螺杆菌胃炎的存在尚未与特定症状相关联。因此，在大多数受感染儿童中，幽门螺杆菌胃炎可能是一种无症状疾病。关于儿童幽门螺杆菌胃炎及其症状的进一步研究将很重要，因为在儿童中识别特定症状应该比在成人中更容易。儿童幽门螺杆菌胃炎可通过在上消化道内镜检查期间获取胃窦活检标本进行培养和组织学研究来诊断。血清学研究也是幽门螺杆菌感染的敏感且特异指标，前提是使用儿童血清来标准化检测。诸如13C尿素呼气试验等非侵入性检测方法对儿童使用很有吸引力，但成本高昂。使用甲硝唑或阿莫西林与枸橼酸铋钾或碱式水杨酸铋联合使用，多达70%的儿童胃黏膜中的幽门螺杆菌可被清除。针对儿童的研究对于确定幽门螺杆菌的流行病学很重要。西方社会的儿童通常不会被定植。感染随着年龄增长变得更为常见。欠发达国家的儿童以及西方国家生活在贫困社会条件下的儿童在幼年时更有可能被感染。这些群体中感染患病率增加的原因尚不清楚。幽门螺杆菌感染在家庭内部也有显著的聚集现象。同样，尚不清楚该微生物为何在家庭和机构中聚集。未来针对儿童的研究对于确定幽门螺杆菌胃炎是否是特定症状的病因、幽门螺杆菌感染的流行病学以及该微生物在胃癌自然病程中可能发挥的作用将具有重要意义。
