Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Orlando, October 22-24, 1998
EFFECT OF COMMONLY PRESCRIBED CHILDHOOD MEDICATIONS ON THE DETECTION OF HELICOBACTER PYLORI (Hp) IN GASTRIC BIOPSIES
The aim of this study is to evaluate the effect of medications commonly prescribed to children for many reasons (otitis media, asthma, etc) on a- the diagnosis of Hp in cases of gastritis, and b- the effect of these medications on the gastric inflammatory response. Methods: Pathology reports on the first (diagnostic) biopsy of all patients with histological diagnoses of chronic gastritis (1/92 to 7/97) were reviewed, excluding those with other established causes of gastritis. The detection or not of Hp by experienced pathologists, using standard methods, was recorded, as well as the type of inflammatory response. Clinical records were reviewed for history of any medications prior to, and results of the CLO test at endoscopy. Results: Of the patients selected in the study, 23% (n=206) were Hp+ in the pathology study, 21% (n=125) by the CLO test, and 26% (n=206) using the combination of both tests. There was no significant difference in age and gender between the Hp+ and Hp- patients. Of the pre-endoscopy drugs, antibiotics and steroids, used in 21 (12%) and 11(6%) patients respectively, decreased the histological detectability of Hp significantly (P=0.026, and 0.049 respectively). The effect of the CLO test was not significant. When either histology or CLO test was used to diagnose Hp, pre-medication with sucralfate decreased the detectability of Hp (P=0.044). Other medications like bronchodilators, acid reducing agents and antacids did not have an effect. Aside from decreased Hp detectability, the biopsies from pre-medicated patients showed a shift of the inflammatory response towards less neutrophils (i.e., less activity), and more plasma cells and eosinophils. Conclusions: Commonly prescribed childhood medications may alter the diagnostic value of the inflammatory response and decrease the detectability of Hp in gastric biopsies. The combined use of tissue detection and CLO test did not decrease the impact of these medications.
Esophagus/Stomach© 1998 Lippincott Williams & Wilkins, Inc.