This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Colin Macarthur, MBChB, MSc; Norman Saunders, MD, FRCPC; William Feldman, MD, FRCPC

JAMA. 1995;273(9):729-734.

Abstract
Objective.
—To assess the evidence for a cause-and-effect relationship between Helicobacter pylori infection and antral gastritis, peptic ulcer disease, and recurrent abdominal pain in children.

Data Sources.
—A MEDLINE search from January 1983 through July 1994 was used to identify pertinent English-language publications. Current Contents and selected specialty journals were searched manually. Editorials, reviews, case reports, abstracts, and letters to the editor were excluded.

Study Selection.
—All studies in children (ie, 0 to 18 years) were included.

Data Extraction.
—Hill's criteria for causal inference were used to determine the strength of the evidence for a causal relationship.

Data Synthesis.
—In total, 45 studies (case series, cross-sectional surveys, and treatment trials) were retrieved. The rate ratio of antral gastritis in children with H pylori infection (compared with uninfected children) ranged from 1.9 to 71.0 (median, 4.6). The prevalence of H pylori infection in children with duodenal ulcer was high (range, 33% to 100%; median, 92%) compared with children with gastric ulcer (range, 11% to 75%; median, 25%). Prevalence rates of infection in children with recurrent abdominal pain were inconsistent (range, 0% to 81%; median, 22%), with lower rates in children meeting Apley's criteria (range, 0% to 9%; median, 6%).

Conclusions.
—There is strong evidence for an association between H pylori infection and antral gastritis and duodenal ulcer disease in children; however, data from randomized, double-blind, placebo-controlled treatment trials are required. There is weak evidence for an association with gastric ulcer and weak or no evidence for an association with recurrent abdominal pain.

(JAMA. 1995;273:729-734)

Author Affiliations
From the Paediatric Outcomes Research Team, Division of General Paediatrics, The Hospital for Sick Children, and the University of Toronto, Toronto, Ontario.

Footnotes
Reprint requests to the Paediatric Outcomes Research Team, Division of General Paediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1x8 (Dr Macarthur).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

What Is New Related to Helicobacter pylori Infection in Children and Teenagers?
Kato and Sherman
Arch Pediatr Adolesc Med 2005;159:415-421.
ABSTRACT | FULL TEXT  

Helicobacter pylori Infection Is Not Associated With Specific Symptoms in Nonulcer-Dyspeptic Children
Kalach et al.
Pediatrics 2005;115:17-21.
ABSTRACT | FULL TEXT  

Recurrent Abdominal Pain
Thiessen
Pediatr. Rev. 2002;23:39-46.
ABSTRACT | FULL TEXT  

Detection of Helicobacter pylori in faeces by culture, PCR and enzyme immunoassay
KABIR
J Med Microbiol 2001;50:1021-1029.
ABSTRACT | FULL TEXT  

Relevance of CagA Positivity to Clinical Course of Helicobacter pylori Infection in Children
Yahav et al.
J. Clin. Microbiol. 2000;38:3534-3537.
ABSTRACT | FULL TEXT  

Familial clustering of Helicobacter pylori infection: population based study • Commentary: Helicobacter pylori---the story so far
Dominici et al.
BMJ 1999;319:537-541.
ABSTRACT | FULL TEXT  

Natural Outcome of Helicobacter pylori Infection in Asymptomatic Children: A Two-year Follow-up Study
Ganga-Zandzou et al.
Pediatrics 1999;104:216-221.
ABSTRACT | FULL TEXT  

Abdominal Pain: What Happens in Primary Care?
Blondell
Arch Fam Med 1996;5:287-288.
ABSTRACT  

Helicobacter pylori Disease in Childhood
Wyllie
CLIN PEDIATR 1995;34:463-465.