K Thame, T James, N Williams, M Smikle, M Lee
K Thame, T James, N Williams, M Smikle, M Lee. Helicobacter pylori infection in children undergoing upper endoscopy in Jamaica. The Internet Journal of Gastroenterology. 2009 Volume 9 Number 2.
H. pylori infection is usually acquired in childhood in developing countries but the prevalence differs among socioeconomic status of the family during childhood. This study determined the prevalence of
In Jamaica, a previous endoscopic study found a prevalence of 55%
The route of transmission is thought to be mainly fecal-oral, but oral-oral and gastric-oral transmission may also occur. Children born within four years of an older sibling were four times more likely to be infected with
In developing countries, infection seems to occur primarily in the paediatric age group with most occurring before age 5-10 years (11). If untreated, infection is life-long with most individuals being asymptomatic. Amongst infected persons, there is a 15% risk of developing peptic ulcer disease, 0.01% of developing gastric carcinoma and 0.001% for gastric lymphoma (12).
Although infection with
Patients and Methods
All patients aged 0-18 years referred for upper gastrointestinal endoscopy to the University Hospital of the West Indies (UHWI) between January and December 2006 were eligible for the study.
Patients were assessed by a consultant gastroenterologist, and if endoscopy was deemed necessary, were invited to participate in the study. Informed consent was obtained from a parent or guardian for endoscopy as well as for participation in the study. The consent for having endoscopy was obtained by the endoscopist, however, consent for participation in the study was obtained by a separate physician who also completed the questionnaire. Exclusion criteria were; a)previous diagnosis of
Endoscopy was performed by a single consultant gastroenterologist using a thin flexible endoscope. Local anaesthetic was administered and conscious sedation was given to all patients. Evaluation of the oesophagus, stomach and proximal duodenum was performed and any abnormalities noted. Four pinch biopsy specimens were taken, two each from the antral and body mucosa of the stomach. The antral specimens were taken within two to three centimeters of the pylorus. Two specimens, one from
the antrum and one from the body, were immediately tested for
The rapid urease test (CLO Test, Trimed Laboratories, Draper,Utah) was performed on specimens collected from all patients. The results were read by a gastroenterology nurse blinded to the patients diagnosis or endoscopic findings and confirmed by a gastroenterology resident or consultant.
All histological specimens were routinely stained with hematoxylin & eosin stain (H/E). Cresyl violet staining was also done to improve visibility of the organism if these were not evident on H/E staining in the presence of inflammation. Histological evaluation was performed by a single histopathologist who was blinded to the
At the time of endoscopy, five milliliters of venous blood was drawn for
Endoscopic findings were discussed with the patient and parents and further management recommended by the consultant gastroenterologist. On subsequent follow-up, the result of the
Approval for the study was obtained by the Ethics committee of the UWI/UHWI. Data analysis was done using the Statistical Package for the Social Sciences (SPSS). Calculation of socio-economic status (SES) score was performed by the following parameters; parental occupation, possessions, toilet facilities, water supply and travel.
Calculation of crowding index was performed using the following parameters: total number of rooms divided by total number of household members
Twenty four (24) patients were enrolled in the study. Thirteen (56%) were males and 11 (46%) were females. The age ranged from 3-13 years with a mean age of 8.2 years ± 2.6 years. There was no significant difference between the mean age of males (7.9 years ±3 years) and females (8.7 years ± 2.2 years) (p = 0.4).
Most patients (63%) resided in the Kingston and St Andrew metropolitan area. Twenty patients (83%) had water piped inside the house. Nineteen (79%) patients had toilet facilities located inside the house. The households had between 2-7 members. The mean number of rooms was 5 ± 2 (range 1-11). The maximum crowding index was 3. Of the 24 patients, 7 (29%) parents were unemployed inclusive of 1 housewife. The remaining 17 parents held jobs ranging from higher professional to unskilled laborer. No child was from a low socio-economic group. They were evenly distributed between middle to upper socio-economic classes.
Abdominal pain was the most common presenting symptom. Other symptoms included nausea, vomiting and reflux. Of the 24 patients, 4 (17%) had all symptoms.
All patients had CLO Test and histology done and 7(29%) patients had serologic testing for
The prevalence of
Children from households with four or more household members had a higher seropositivity rate for
A similarly lower than expected prevalence (34%) of
The main limitation in this study is the small number of patients studied. Several potential patients were on anti-microbial drugs or proton pump inhibitors which rendered them ineligible for participation in the study.
In conclusion, in this study, the majority of Jamaican children in the middle to upper socio-economic groups with upper gastro-intestinal complaints are negative for