Pediatric H. Pylori Infections

How does H. pylori cause damage?

It is believed that H. pylori's shape and characteristics cause the damage that leads to ulcers.

Because of their shape and the way they move, the bacteria can penetrate the stomach's protective mucous lining where they produce the enzyme urease, which generates substances that neutralize the stomach's acids. This weakens the stomach's protective mucus, makes the stomach cells more susceptible to the damaging effects of acid and pepsin, and leads to sores or ulcers in the stomach or duodenum (first part of the small intestine).

The bacteria can also attach to stomach cells, further weakening the stomach's defensive mechanisms and producing local inflammation. For reasons not completely understood, H. pylori can also stimulate the stomach to produce more acid.

What causes an H. pylori infection?

Researchers do not know what causes people to develop H. pylori. It is believed that H. pylori is transmitted orally from person to person through close contact (kissing) or through fecal-oral contact. Most people are first exposed to it during childhood.

What are the symptoms of H. pylori?

The following are the most common symptoms of H. pylori. However, each individual may experience symptoms differently.

After being infected with H. pylori, gastritis--an inflammation of the stomach lining--may develop. However, most people will never have symptoms or problems related to the infection. When symptoms are present, they may include the following:

• Abdominal discomfort, which may:
  • Cause a dull, gnawing pain
  • Occur two to three hours after a meal
  • Come and go for several days or weeks
  • Occur in the middle of the night when stomach is empty
  • Be relieved by eating or taking an antacid medication
• Loss of weight
• Loss of appetite
• Bloating
• Burping
• Nausea
• Vomiting

The symptoms of H. pylori may resemble other conditions or medical problems. Consult your child's doctor for a diagnosis.

How is H. pylori diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for H. pylori may include the following:

• Blood tests. These tests identify antibodies that indicate the presence of the bacterium.
• Stool test. This test identifies evidence of the bacterium in the stool.
• Breath tests. This test determines if carbon is present after drinking a solution that contains urea--the presence of carbon indicates the release of urease by H. pylori. 
• Tissue tests. Tissue is removed during an endoscopy. The endoscopy or EGD is a procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube called an endoscope is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary). This tissue is used to:
  • Detect the presence of the enzyme urease
  • Examine the bacteria that is present under a microscope
  • Start a culture test to grow more bacteria for examination

Treatment for H. pylori

Specific treatment will be determined by your child's doctor based on the following:

• Your child's age, overall health, and medical history

• The extent of the disease

• Your child's tolerance for specific medications, procedures, or therapies

• The expectations for the course of the disease

• Your opinion or preference

Treatment may include:

• Antibiotics to kill the bacteria

• Medications to suppress acid production, including:

  • H₂-blockers. They reduce the amount of acid the stomach produces by blocking histamine, a powerful stimulant of acid secretion.

  • Proton pump inhibitors. They more completely block stomach acid production by stopping the stomach's acid pump, which is the final step of acid secretion.

  • Stomach-lining protectors. They protect the stomach lining from acid and help kill the bacteria.