Gastroenterology

Gastroenterology

Volume 117, Issue 2, August 1999, Pages 336-341
Gastroenterology

Low rates of Helicobacter pylori reinfection in children

https://doi.org/10.1053/gast.1999.0029900336Get rights and content

Abstract

Background & Aims: Reinfection after treatment for Helicobacter pylori is uncommon in adults. It is more likely to occur in children because they acquire primary infection. The aim of this study was to determine whether children are likely to become reinfected with H. pylori and if there are any risk factors for reinfection. Methods: A prospective study of children who had documented evidence of successful treatment for H. pylori infection was performed. Sixty children were eligible for inclusion; results for 52 are presented. Children, parents, and siblings underwent [13C]urea breath tests. Details of family size and socioeconomic status were documented. Cox logistic regression analysis was used to determine the risk factors for reinfection. Results: The duration of follow-up was 103.8 patient-years (mean ± SD, 24 ±14.0 months). Forty-six (88.5%) of the index children remained clear of infection, and 6 (11.5%) children were reinfected. The mean age of those who became reinfected was 5.8 ± 5.6 years compared with 12.3 ± 3.0 years for those who remained clear of infection (P = 0.00001). Only 2 of 46 (4.3%) children older than 5 years of age were reinfected, although 80.8% had 1 infected parent and 65% of siblings were infected. Reinfection rate was 2.0% per person per year in children older than 5 years. Living with infected parents and siblings and low socioeconomic status were not risk factors for reinfection. In logistic regression analysis, age was the only risk factor for reinfection. Conclusions: Reinfection with H. pylori occurs rarely in children older than 5 years of age regardless of socioeconomic group or number of infected family members. These findings also indicate that it is not necessary to treat all family members to achieve long-term eradication of H. pylori.

Section snippets

Materials and methods

A prospective study of children treated successfully for H. pylori infection at Our Lady's Hospital for Sick Children, Dublin, Ireland, between February 1991 and July 1996 was performed. The indications for initial gastroduodenoscopy included abdominal pain, failure to thrive, vomiting, and hematemesis. H. pylori infection was diagnosed if children had a positive culture or if both histological examination and rapid urease test (Clo, Delta West, Australia) results were positive.

Children were

Results

Fifty-five of 60 eligible children participated in the study. Four children could not be contacted for follow-up, and 1 family refused to participate. There were 3 pairs of siblings in the study. All of these 6 children remained uninfected. To analyze risk factors, only 1 child from each family was included in the analysis. The oldest child was considered the index case, and results are therefore presented for 52 children. Details of the children in the study are given in Table 1.

The mean

Discussion

This is the first study to report on the risk of reinfection in children after successful treatment for H. pylori. Primary infection in adults is uncommon13, 24; therefore, it is not surprising that the reinfection rate in adults after treatment is approximately 1%/yr.14, 15, 25, 26 It is now accepted that H. pylori infection is almost always acquired in childhood.11, 13 Although the exact age of infection remains unknown, earlier studies27, 29, 28 suggest that infection occurs in

Acknowledgements

The authors thank Nurse Marie Durnin and Sister Anna Lloyd for their help in organizing this project; Philip Johnson of Bureau of Stable Isotopes Analysis, United Kingdom, for his support in carrying out urea breath tests; and Dr. Billy Bourke for his critical review of the manuscript.

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