Helicobacter pylori Chronic Gastritis in Children and Adolescents was not Associated with Anaemia

##plugins.themes.bootstrap3.article.main##

  •   Mary de Assis Carvalho

  •   Julia Ferreira de Oliveira

  •   Renato Guilherme Correa Silva

  •   Debora Avellaneda Penatti

  •   Juliana Tedesco Dias Tedesco

  •   Nilton Carlos Machado

Abstract

Background: Helicobacter pylori (H. pylori) colonizes the gastric mucosa, leading to chronic inflammation. Epidemiological studies have demonstrated that H. pylori infection is high in areas with a high prevalence of anaemia. Consequently, patients infected with H. pylori are at a higher risk of anaemia. However, the relationship between H. pylori and anaemia remains controversial. Therefore, a study conducted among children with chronic abdominal pain with organic dyspepsia (chronic gastritis due to H. pylori and (or?) Esophagitis), and a functional disorder (Irritable Bowel Syndrome), will be appropriate.


Objective: Compare the prevalence of Anaemia in children and adolescents with chronic abdominal pain, divided into: 1) Non-ulcer dyspepsia associated with H. pylori gastritis., 2) Dyspepsia associated with chronic Esophagitis, and Irritable Bowel Syndrome.


Methods: The study was a single-centre, observational retrospective cohort. Inclusion and Exclusion Criteria. All children must be well categorized with signs and symptoms consistent with chronic abdominal pain and aged between 5-and 18 years. Exclusion criteria: genetic, metabolic, immune, cardiac, hepatic or renal diseases, neurodevelopmental delay, and previous surgery. Laboratory tests were performed for all patients: complete blood cell count, Erythrocyte Sedimentation Rate, urinalysis, stool for ova & parasites, and H. pylori serology. Another diagnostic test was decided at the discretion of the gastroenterology team. The chronic dyspeptic syndrome with non-ulcer dyspepsia associated with H. pylori if they presented both results: the rapid urease test positive and the histological examination of the gastric mucosa confirming the presence of the bacterium. Dyspepsia associated with chronic Esophagitis was based on clinical symptoms/signs and endoscopic and histologic evaluation. Patients with IBS were diagnosed according to Rome Criteria.


Results: Three hundred and seven children/adolescents: H. pylori gastritis (154, 50%), Esophagitis (41, 14%), and IBS (112, 36%) were included. There was a non-statistically significant difference in the baseline characteristics (sex, first-born child, age of mothers, age of fathers, crowding index, duration of pain symptoms, headache and limb pain, overweight/obesity and malnutrition) between the three groups. Clinical characteristics demonstrated: H. pylori and Esophagitis have epigastric pain and IBS periumbilical pain. There was a non-statistically significant difference in haemoglobin values and red cell parameters between the three groups in laboratory investigation. The prevalence of anaemia was very low, with no difference between the groups. Urinalysis and stool for ova & parasites were negative in all children.


Conclusion: Anaemia was not present in children with chronic abdominal pain, both organic and functional disorders. Age, good nutritional status, good sanitation and hygiene may have contributed to the results in this study.


Keywords: Anaemia, Esophagitis, Helicobacter pylori, gastritis, Irritable bowel syndrome

References

Warren JR, Marshall B Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancet. 1983; 321(8336): 1273–1275.

Marshall B, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet. 1984; 323(8390): 1311–1315.

Kusters JG, van Vliet AH, Kuipers E. Pathogenesis of Helicobacter pylori infection. Clin Microbiol Rev. 2006; 19(3): 449–490.

Zabala Torrres B, Lucero Y, Lagomarcino AJ, Orellana-Manzano A, George S, Torres JP, et al. Review: prevalence and dynamics of Helicobacter pylori infection during childhood. Helicobacter. 2017; 22.

Qu X-H, Huang X-L, Xiong P, Zhu CY, Huang YL, Lu LG, et al. Does Helicobacter pylori infection play a role in iron deficiency anemia? A meta-analysis. World J Gastroenterol. 2010; 16: 886–896.

Huang X, Qu X, Yan W, Huang Y, Cai M, Hu B, et al. Iron deficiency anaemia can be improved after eradication of Helicobacter pylori. Postgrad Med J 2010; 86: 272–278.

Yuan W, Li Yumin D, Yang L. Iron deficiency anemia in Helicobacter pylori infection: meta-analysis of randomized controlled trials. Scand J Gastroenterol. 2010; 45: 665–676.

Pacifico L, Osborn JF, Tromba V, Romaggioli S, Bascetta S, Chiesa C. Helicobacter pylori infection and extragastric disorders in children: a critical update. World J Gastroenterol 2014; 20: 1379–1401.

Muhsen K, Cohen D. Helicobacter pylori infection and iron stores: a systematic review and meta-analysis. Helicobacter. 2008; 13: 323–340.

Hudak L, Jaraisy A, Haj S, Muhsen K. An updated systematic review and meta-analysis on the association between Helicobacter pylori infection and iron deficiency anemia. Helicobacter. 2017; 22(1). e12330. doi: 10.1111/hel.12330.

Di Lorenzo C, Colletti RB, Lehmann HP, Boyle JT, Gerson WT, Hyams JS, et al. Chronic abdominal pain in children: A clinical report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2005; 40: 245–8.

Machado NC, Carvalho MA, Moreira FL. Dor Abdominal Recorrente. In: Pediatria Clínica. / Departamento de Pediatria, Faculdade de Medicina de Botucatu - 1a ed. - Petrópolis, RJ: EPUB (Editora de Publicações Biomédicas). 2006. (Portuguese).

World Health Organization 2017. Nutritional anaemias: tools for effective prevention and control. Geneva: World Health Organization; 2017.

World Health Organization. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Heal Organ Tech Rep Ser 1995; 854:1-452.

de Onis M, Onyango AW, Borghi E, Siyad A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007; 85: 660–7.

World Health organization. WHO AnthroPlus for personal computers Manual: Software for assessing growth of the world’s children and adolescents. Geneva. [Internet] 2009 Available from: http://www.who.int/childgrowth/software/en/

de Onis M, Lobstein T. Defining obesity risk status in the general childhood population: Which cut-offs should we use? International Journal of Pediatric Obesity. 2010; 5(6): 458-460.

Chelimsky G, Czinn SJ. Techniques for the evaluation of dyspepsia in children. J Clin Gastroenterol. 2001; 33: 11–3.

Carvalho MA, Machado NC, Ortolan EVP, Rodrigues MAM. Upper gastrointestinal histopathological findings in children and adolescents with nonulcer dyspepsia with Helicobacter pylori infection. J Pediatr Gastroenterol Nutr. 2012; 55: 523–9.

Correa Silva R, Machado N, Carvalho M, Rodrigues M. Helicobacter pylori infection is high in paediatric nonulcer dyspepsia but not associated with specific gastrointestinal symptoms. Acta Paediatr.2016; 105: e228–31.

Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999; 45(2): 172-80.

Knuff TE, Benjamin SB, Worsham GF, Hancock JE, Castell DO. Histologic evaluation of chronic gastroesophageal reflux. An evaluation of biopsy methods and diagnostic criteria. Dig Dis Sci. 1984; 29(3): 194-201.

Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2006; 130: 1527–37.

Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2016; 150: 1456–68.

Wenzhen Y, Yumin L, Kehu Y, Bin M, Quailing G, Donghai W, et al. Iron deficiency anemia in Helicobacter pylori infection: metaanalysis of randomized controlled trials. Scandinavian Journal of Gastroenterology. 2010; 45(6): 665-676.

Parkinson AJ, Gold BD, Bulkow L, Wainwright RB, Swaminathan B, Khanna B. High Prevalence of Helicobacter pylori in the Alaska Native Population and Association with Low Serum Ferritin Levels in Young Adults. Clin Diagn Lab Immunol. 2000; 7(6): 885-888.

Seo JK, Ko JS, Choi KD. Serum ferritin and Helicobacter pylori infection in children: a sero-epidemiologic study in Korea. J Gastroenterol Hepatol. 2002; 17: 754-7.

Choe YH, Oh YJ, Lee NG, Imoto I, Adachi Y, Toyoda N, Gabazza EC. Lactoferin sequestration and its contribution to iron deficiency anemia in Helicobacter pylori infected gastric mucosa. J Gastroenterol Hepatol. 2003; 18: 980–5.

Yang YJ, Sheu BS, Lee SC, Yang HB, Wu JJ. Children of Helicobacter pylori-infected Dyspeptic Mothers are predisposed to H. pylori Acquisition with Subsequent Iron Deficiency and Growth Retardation. Helicobacter. 2005; 10(3): 249-55.

Baggett HC, Parkinson AJ, Muth PT, Gold BD, Gessner BD. Endemic iron deficiency associated with Helicobacter pylori infection among school-aged children in Alaska. Pediatrics. 2006; 117(3): e396-404.

Cardenas VM, Mulla ZD, Ortiz M, Graham DY. Iron deficiency and Helicobacter pylori infection in the United States. Am J Epidemiol. 2006; 163(2): 127-34.

Di Girolamo AM, Perry GS, Gold BD, Parkinson A, Provost EM, Parvanta I, Grummer-Strawn LM. Helicobacter pylori, anemia, and iron deficiency: relationships explored among Alaska native children. Pediatr Infect Dis J. 2007; 26(10): 927-34.

Muhsen K, Barak M, Shifnaidel L, Nir A, Bassal R, Cohen D. Helicobacter pylori infection is associated with low serum ferritin levels in Israeli Arab children: A seroepidemiologic study. J Pediatr Gastroenterol Nutr. 2009; 49: 262-4.

Muhsen K, Barak M, Henig C, Alpert G, Ornoy A, Cohen D. Is the association between Helicobacter pylori infection and anemia age dependent? Helicobacter. 2010; 15(5): 467-72.

Hoseinzadeh M, Khosravi A, Sayemiri K, Rasoli MH, Mohaveri A. The antibody titers to Helicobacter pylori in 7 - 12 year old iron deficiency anemic children, in Ilam. J Res Med Sci. 2010; 15(6): 324-30.

Choi JW. Does Helicobacter pylori infection relate to iron deficiency anemia in prepubescent children less than 12 years of age? Acta Paediatr. 2003; 92(8): 970-2.

Santos IS, Boccio J, Davidson L, Hernandez-Triana M, Huanca-Sardinas E, Janjetic M, et al. Helicobacter pylori is not associated with anemia in Latin America: results from Argentina, Brazil, Bolivia, Cuba, Mexico and Venezuela. Public Health Nutrition. 2009; 12(10): 1862-1870.

Araf LN, Pereira CA, Machado RS, Raguza D, Kawakami E. Helicobacter pylori and iron-deficiency anemia in adolescents in Brazil. J Pediatr Gastroenterol Nutr 2010; 51(4): 477-80.

Vendt N, Kool P, Teesalu K, Lillemäe K, Maaroos HI, Oona M. Iron deficiency and Helicobacter pylori infection in children. Acta Paediatrica. 2011; 100: 1239-43.

Zamani A, Shariat M, Yazdi ZO, Bahremand S, Asbagh PA, Dejakam A. Relationship between Helicobacter pylori infection and serum ferritin level in primary school children of Tehran-Iran. J Pak Med Assoc 2011; 61(7): 658-61.

Sandström G, Rödjer S, Kaijser B, Börjesson M. Helicobacter pylori Antibodies and Iron Deficiency in Female Adolescents. PLoS One. 2014; 9(11): e113059

Süoglu OD, Gökçe S, Saglam AT, Sökücü S, Saner G. Association of Helicobacter pylori infection with gastroduodenal disease, epidemiologic factors and iron-deficiency anemia in Turkish children undergoing endoscopy, and impact on growth. Pediatr Int. 2007; 49: 858-863.

Queiroz DMM, Harris PR, Sanderson IR, Windle HJ, Walker MM, Rocha AMC, et al. Iron Status and Helicobacter pylori Infection in Symptomatic Children: An International Multi- Centered Study. PLoS ONE. 2013; 8(7): e68833.

Sarker SA, Mahmud H, Davidsson L, Alam NH, Ahmed T, Alam N, et al. Causal relationship of Helicobacter pylori with iron-deficiency anemia or failure of iron supplementation in children. Gastroenterology. 2008; 35: 1534-42.

Zahmatkeshan M, Karimi M, Geramizadeh B, Eslaminasab S, Esmailnejad A, Safarpour AR. Association between Helicobacter pylori Infection and Iron Deficiency Anemia in School-aged Iranian Children. Indian Pediatr. 2019; 56(5): 387-389.

World Health Organization. World prevalence of anemia 1993-2005. WHO Global Database on Anemia. World Health Organization. [Internet] Available from: http://whqlibdoc.who.int/publications/2008/9789 241596657_eng.pdf

Calam J, Gibbons A, Healey ZV, Bliss P, Arebi N. How does Helicobacter pylori cause mucosal damage? Its effect on acid and gastrin physiology. Gastroenterology. 1997; 113: S43–S49.

Zhang ZW, Patchett SE, Perrett D, Katelaris PH, Domizio P, Farthing MJG. The relation between gastric vitamin C concentrations, mucosal histology, and CagA seropositivity in the human stomach. Gut. 1998; 43: 322–326.

Baysoy G, Ertem D, Ademoğlu E, Kotiloğlu E, Keskin S, Pehlivanoğlu E. Gastric histopathology, iron status and iron deficiency anemia in children with Helicobacter pylori infection. J Pediatr Gastroenterol Nutr. 2004; 38(2): 146-51.

Harris PR, Serrano CA, Villagrán A, Walker MM, Thomson M, Duarte I, Windle HJ, Crabtree JE. Helicobacter pylori-associated hypochlorhydria in children, and development of iron deficiency. J Clin Pathol. 2013; 66: 343-7.

Pellicano R, Rizzetto M. Is hepcidin the bridge linking Helicobacter pylori and anemia of chronic infection? A research proposal. Panminerva Med. 2004; 46(3): 165-9.

Mourad-Baars P, Hussey S, Jonel NL. Helicobacter pylori Infection and childhood. Helicobacter. 2010; 15: 53-9.

Nogueira-de-Almeida CA, Ued FDV, Del Ciampo LA, Martinez EZ, Ferraz IS, Contini AA, Cruz FCSD, Silva RFB, Nogueira-de-Almeida ME, Lamounier JA. Prevalence of childhood anaemia in Brazil: still a serious health problem: a systematic review and meta-analysis. Public Health Nutr. 2021; 24(18): 6450-6465.

Bordin DS, Voynovan IN, Andreev DN, Maven IV. Current Helicobacter pylori Diagnostics. Diagnostics (Basel). 2021; 11(8): 1458.

Jones NL, Koletzko S, Goodman K, Bontems P, Cadranel S, Casswall T, ESPGHAN, NASPGHAN. Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016). J Pediatr Gastroenterol Nutr. 2017; 64(6): 991-1003.

Downloads

Download data is not yet available.

##plugins.themes.bootstrap3.article.details##

How to Cite
Carvalho, M. de A. ., de Oliveira, J. F., Silva, R. G. C., Penatti, D. A., Tedesco, J. T. D. ., & Machado, N. C. (2022). Helicobacter pylori Chronic Gastritis in Children and Adolescents was not Associated with Anaemia. European Journal of Medical and Health Sciences, 4(4), 6–11. https://doi.org/10.24018/ejmed.2022.4.4.1332