Helicobacter pylori, clinical, laboratory, and noninvasive biomarkers suggestive of gastric damage in healthy school-aged children: A case-control study. (February 2021)

• Record Type: Journal Article
• Authors: Lucero, Yalda; Lagomarcino, Anne J.; Torres, Juan P.; Roessler, Patricia; Mamani, Nora; George, Sergio; Huerta, Nicole; Gonzalez, Monica; O'Ryan, Miguel
• Is Part Of: International journal of infectious diseases. Volume 103(2021)
• Page Start: 423
• Page End: 430
• Publication Date: 2021-02
• Subjects: Helicobacter pylori -- Children -- Persistent infection -- Gastric damage -- Pepsinogen; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.11.202
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Nearly one in four apparently healthy Chilean school-aged children were persistently infected with Helicobacter pylori. Persistent infection was associated with epigastric pain after active prospective surveillance. Persistently infected children had higher levels of pepsinogen II compared with controls. Clinical and molecular findings indicate that gastric damage is detectable early on among apparently healthy children infected with H. pylori . Abstract: Background: Helicobacter pylori is acquired largely in early childhood, but its association with symptoms and indirect biomarkers of gastric damage in apparently healthy children remains controversial. We aimed to relate persistent H. pylori infection in apparently healthy school-aged children with clinical, laboratory, and noninvasive biomarkers suggestive of gastric damage using a case-control design. Materials and methods: We followed up 83 children aged 4–5 years with persistent H. pylori infection determined by stool antigen detection and/or a urea breath test and 80 noninfected matched controls from a low-income to middle-income, periurban city in Chile for at least 3 years. Monitoring included clinical visits every 4 months and annual assessment by a pediatric gastroenterologist. A blood sample was obtained to determine laboratory parameters potentially associated with gastric damage (hemogram and serum iron and ferritin levels), biomarkers of inflammation (cytokines, pepsinogens I and II, and tissue inhibitor metalloproteinase 1), and expression of cancer-related genes KLK1, BTG3, and SLC5A8 . Results: Persistently infected children had higher frequency of epigastric pain on physical examination (40% versus 16%; P = 0.001), especially from 8 to 10 years of age. No differences in anthropometric measurements or iron-deficiency parameters were found. Persistent infection was associated with higher levels of pepsinogen II (median 12.7 ng/mL versus 9.0 ng/mL; P < 0.001); no difference was observed in other biomarkers or gene expression profiles. Conclusions: H. pylori infection in apparently asymptomatic school-aged children is associated with an increase in clinical symptoms and in the level of one significant biomarker, pepsinogen II, suggesting early gastric involvement.