HELICOBACTER-PYLORI, GASTRODUODENAL DISEASE, AND RECURRENT ABDOMINAL-PAIN IN CHILDREN

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.