E S P G H A N 32nd Annual Meeting; Warsaw, Poland, June 2-5, 1999
Abdominal pain is a common complaint in children. The contribution of H. pylori (HP) gastritis to symptoms in the absence of ulcer disease is not clear. Methods: Children (4-18 y) with a defined pain score on a 4 weeks diary (items: abdominal pain, heartburn, nausea, vomiting each graded 0 to 3, stool pattern) were enrolled at 9 tertiary centers in Germany. Diagnostic work up included 13C-urea-breath test (UBT), upper endoscopy in all UBTpos and in UBTneg with suspected organic disease. HPpos patients received a 1 week triple-therapy (omeprazole 1 mg/kg, clarithromycin 20 mg/kg, amoxicillin 50 mg/kg), compliance and side effects were monitored. One month after therapy in HP infected children or end of diagnostic work up in HP negative patients, a 2nd diary was written. After 2 months, UBT was performed in HPpos. Results: Of 207 children (63 non-German), 89 were HPpos, 56 were labeled "functional pain" (FP) and 62 had other diseases (OD). Endoscopy revealed no gastric or duodenal erosions/ulcers in any of 33 Hpneg children, but 2 gastric and 7 duodenal ulcers in 89 HPpos children. HP infected patients were significantly older (median 11 y) than patients with FP (8.7 y) and OD (9.5 y) and more often non-German (60 % vs. 11 % & 7 %). The median number of days with abdominal pain during the first diary period were equal between FP (17 d) and HPpos (17 d). Children with ulcer disease had a significant shorter history of pain (median 2 months) compared to children with non-ulcer HP (12 m), FP (9 m) and OD (12 m). Non-ulcer HP were not significantly different compared to FP and OD regarding epigastric tenderness, constipation, diarrhea, nausea, heartburn, vomiting. After triple therapy, UBT was negative in 28/30 (93 %) German vs. 36/48 (75 %) non-German patients. At follow up, symptoms were gone/improved in 55/63 (87 %) children with successfully treated infection, but also in 13/14 (93 %) with failed therapy and 39/49 (80 %) with FP. Conclusions: In children, symptom assessment and presence of epigastric tenderness do neither distinguish between non-ulcer HP gastritis, functional pain and other disorders, nor between successful or failed eradication therapy. Reasons for the high failure rate in non-Germans need to be determined.