Academic journal article Central European Journal of Public Health

Helicobacter Pylori Prevalence in Children Influenced by Non-Specific Antibiotic Treatments

Academic journal article Central European Journal of Public Health

Helicobacter Pylori Prevalence in Children Influenced by Non-Specific Antibiotic Treatments

Article excerpt

SUMMARY

Objective: Helicobacter pylori (H.p.) infections play a very important role in the development of ulcerations and malignancies of the gastrointestinal tract. It is assumed that the primary infection occurs during childhood, depending on numerous environmental factors among them hygiene and social status. Our aim was to determine whether treatment with antibiotics affects the persistence of H.p. infection.

Methods: In 2006, we conducted an epidemiological study among all grade 8 students in the city of Leipzig (mean age 14.6 years). To determine the prevalence of H.p. infection, a voluntary H.p. test (^sup 13^C-urea breath test) was performed in all participants.

Results: The H.p. prevalence was 6.3% (N = 1,598). A significant difference was found between those students who had been treated with an antibiotic at least once prior to the test and those who had never received any antibiotics (4.0% and 11.1%, respectively, p < 0.001). H.p. prevalence decreased with increasing numbers of antibiotic treatments.

Conclusion: In adolescence, treatment with "non-H.p. specific" antibiotics appears to significantly affect H.p. prevalence. Moreover, the actual persistence of H.p. in "chronic persistent" H.p. infections appears to fluctuate at least in younger years. Thus, any "non-H.p. specific" antibiotic treatment should be considered in the diagnosis and treatment of H.p. infections and should be taken into account as an important confounder in future epidemiological studies.

Key words: Helicobacter pylori infection, adolescents, antibiotics

INTRODUCTION

Helicobacter pylori (H.p.) infection is an important cause of ulcerations of the stomach and duodenum as well as gastric malignancies and MALT-lymphoma (1). As one of the most prevalent chronic infections with more than 50% of the world population being infected (2), H.p. is believed to be of immense epidemiological importance. Population based prevalences of over 80% have been reported from developing countries, whereas in industrialized nations substantially lower prevalences of around 40% have been found (1, 3). These differences are thought to be due to a number of environmental factors. Besides different infectious pathways and better hygienic and social conditions in industrialized nations (4), the increasing use of antibiotics in the treatment of bacterial infections is seen as an additional factor (5-7). Thus, antibiotic treatments should be considered as a confounding factor in prevalence studies. However, study results are not so clear-cut. Furthermore, comprehensive epidemiologic cohort studies of children and adolescents are still missing. To our knowledge, this is the first study that focuses on the effect of nonH.p. specific antibiotic treatment on H.p. colonization in children.

Up to now, data regarding the effect of antibiotic treatment on H.p. infection has only been available in the form of studies comparing the effectiveness of different eradication strategies. The assumption is that the infection occurs mainly during childhood (8-10) and persists throughout the life (11,12). This is why epidemiologic studies during childhood and adolescence would be of clinical interest in order to detect and comprehend the factors which determine the persistence of H.p. infection. In this study, H.p. prevalence among grade 8 students in Leipzig was investigated in relation to the number of antibiotic treatments the students had received prior to the test.

MATERIALSAND METHODS

Study Population and Clinical Procedures

The investigation was carried out among grade 8 students during the spring and summer of 2006 in several public schools in Leipzig. It was the second follow-up of the large environmental epidemiologic "LISS" study (the Leipzig Study of Respiratory Disease, Allergies and Infections in School Starters) which started in 1998 among school starters who were followed up for the first time in 2000 when they reached the second grade (13, 14). …

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