Physician: H. Pylori Screening?

Should an internationally adopted child be screened for H. pylori?

Sonia Billadeau February 17, 2014
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The incidence of H. pylori (Helicobacter pylori) is very low in children of industrialized countries. The incidence increases by a small amount every year and it dramatically increases after the age of 20 years.

Transmission is usually by person-to-person contact, and water supply is also a common mode of transmission.

There seems to be an increased incidence of H. pylori gastritis in children with the following exposure factors:

  1. Children where a parent already has H. pylori
  2. Low socioeconomic class
  3. Children of third world countries where the water supply is contaminated
  4. Institutionalized children
  5. Certain ethnic populations such as African-American, Chinese, East Indians, and Mexicans

Clinical manifestations of H. pylori infection: Many children can be asymptomatic, or there may be acute or chronic pain. Some common symptoms of H. pylori are:

  1. Recurrent abdominal pain
  2. Nausea
  3. Heartburn
  4. Night time abdominal pain
  5. GI bleeding
  6. Meal-related stomach ache
  7. Family history of peptic ulcer disease

Chronic abdominal pain: H. pylori should be considered in all children with recurrent abdominal pain that do not respond to conventional antacid therapy or dietary manipulation.

The prevalence of H. pylori increases with age, so it is easier to diagnose in older children.

Diagnosing

There are several diagnosis methods when dealing with the possibility of H. pylori. Some are more invasive and others are less invasive. The aggressiveness of the evaluation should be determined by the age group of the child, severity of the symptoms, and the presence of any of the high risk groups.

Invasive: Endoscope

  1. Endoscopy provides physicians with a direct visualization of the stomach lining. this allows them to identify inflammation and gastritis.
  2. A tissue biopsy would also be taken and sent to the pathology lab in order to identify microscopic evidence of gastritis and inflammation.
  3. The piece of stomach tissue, obtained from the biopsy, is placed in a media and a chemical reaction occurs. If it changes colors it is considered positive (similar to the rapid strep test in a pediatric office).

Noninvasive methods:

Serologic blood testing (IgG to HP) may help detect H. pylori infection.

This type of testing is much cheaper to perform, but it is also less sensitive than the endoscopy. However, in the adult population, a serologic test is often useful in diagnosing H. pylori.

On the other hand, most pediatric gatroenterologists do not recommend treating a child based on serologic testing alone, although a positive result in a child may be more specific than in an adult because of the low prevalence rate of the pathogen.

Regarding internationally adopted children,  universal screening for H. pylori is not a routine practice since children in general have a lower incidence of H. pylori infection. But, when evaluating an internationally adopted child, it must be remembered that these children do have an increased incidence of infection when compared to children from the United States. Each case should be evaluated individually, and if there is even the slightest complaint of abdominal discomfort, these kids should be tested and referred to a pediatric gastroenterologist.

Disclaimer

The information and advice provided is intended to be general information, NOT advice on how to deal with a particular child’s situation and problem. If your child has a specific problem, you need to ask your pediatrician about it. Only after a careful history and physical exam can a medical diagnosis and treatment plan be made. This website does not constitute a physician-patient relationship.

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Sonia Billadeau


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