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Helicobacter pylori Infection in European Children with Gastro-duodenal Ulcers and Erosions

Bontems, Patrick MD*; Kalach, Nicolas MD, PhD; Vanderpas, Jean MD, PhD; Iwanczak, Barbara MD§; Casswall, Thomas MD, PhD; Koletzko, Sibylle MD, PhD; Oderda, Giuseppina MD, PhD**; Martinez-Gomez, Maria José MD††; Urruzuno, Pedro MD‡‡; Kindermann, Angelika MD§§; Sykora, Josef MD¶¶; Veres, Gabor MD, PhD‖‖; Roma-Giannikou, Eleftheria MD, PhD***; Pehlivanoglu, Ender MD, PhD†††; Megraud, Francis MD, PhD‡‡‡; Cadranel, Samy MD*

Pediatric Infectious Disease Journal: December 2013 - Volume 32 - Issue 12 - p 1324–1329
doi: 10.1097/INF.0000000000000005
Original Studies

Background: To analyze risk factors associated with gastro-duodenal ulcers and erosions in children.

Methods: 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.

Results: 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.

Conclusions: 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.

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.

Accepted for publication June 17, 2013.

The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Patrick Bontems, Pediatric Gastroenterology-Hepatology, Queen Fabiola Children’s University Hospital, Université Libre de Bruxelles, 15 Av JJ Crocq, 1020 Brussels, Belgium. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc.