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Indian Pediatr 2013;50: 324-326 |
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Growth Parameters in Children with Dyspepsia
Symptoms and Helicobacter pylori Infection
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Seyed Mohsen Dehghani, *Hamdollah Karamifar, Tayebbeh Raeesi and Mahmood
Haghighat
From the Departments of Pediatric Gastroenterology,
and Gastroenterohepatology Research Center; and *Department of
Endocrinology, Shiraz University of Medical Sciences, Shiraz, Iran.
Correspondence to: Dr Seyed Mohsen Dehghani, Assoc.
Professor Pediatric Gastro-enterology, Gastroenterohepatology Research
Center, Shiraz University of Medical Sciences, Shiraz, 71937-11351,
Iran.
Email: [email protected]
Received: March 02, 2012;
Initial review: March 23, 2012;
Accepted; June 06, 2012;
Published online: July 05, 2012.
PII: S097475991200203-2
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Controversy exists about relationship of H. pylori infection
and somatic growth retardation of children. The aim of this study
was to evaluate the relationship between H. pylori infection
and growth parameters in children. 113 children with dyspepsia (4-18
years) were enrolled. C13 urea breath test was performed for
determination of H.pylori infection. Height, weight, body
mass index (BMI) and standard deviation score (SDS) was calculated
and growth parameters were compared between two groups of
H.pylori positive and those with negative results. The
prevalence of H.pylori infection was 52.2%. There was no
meaningful relation between calculated SDS (for height and BMI) and
H.pylori infection.
Key words: Children, Helicobacter pylori, Growth.
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It has been estimated that at least half of the
world population is infected by H.pylori [1]. Although, this
infection occurs in childhood, but still its consequences are not
identified thoroughly [2]. Some studies are claiming that H.pylori
infection has an adverse effect on children’s height [3-5]. The present
paper investigates the relationships, if any, between growth parameters
and symptomatic H.pylori infection in children.
Methods
We evaluated 113 children (age 4-18 y) with symptoms
of dyspepsia. Diagnostic criteria for dyspepsia were: persistent or
recurrent pain or discomfort centered in the upper abdomen, not relieved
by defecation or associated with the onset of a change in stool
frequency or stool form, and no evidence of an inflammatory, anatomic,
metabolic, or neoplastic process that explains the subject’s symptoms
(for at least once per week for at least 2 months). All children were
subjected to urea breath test (UBT) with BreathTek UBT kits that
contained two breath collection bags and granulated Pranactin-Citric
consisting of 75 mg of C13-urea and 2 g of citric acid. The materials
were dissolved in 100 mL of water. Patients were required to fast for at
least 6 hour prior to administration of the UBT. Each patient provided
two breath samples: a baseline breath sample and a post-dose breath
sample 15 minutes after ingestion of the C13-urea. Breath samples were
analyzed using UBiT-IR300 spectrophotometers. The results of UBT were
scored based on enrichment of C13 in the breath as delta over baseline
(DOB). H.pylori-positive and H.pylori-negative results
were determined using the cut-off DOB greater than 2.4%. After measuring
weight and height of children, body mass index (BMI) was calculated.
Standard deviation score (SDS) of height, weight, BMI, and growth
parameters were used for the comparison of H.pylori infected
subjects with those who were not infected by H.pylori. We used
WHO Child Growth Standards for calculation of SDS of height, weight, and
BMI.
Results
There were 113 children (58% girls) with mean age of
9.8±4.1 years (range 4-18 years). Among these, 59 (52%) patients
including 33 girls and 26 boys were UBT positive for H.pylori;
found differences were not significant comparing prevalence of
H.pylori in boys and girls (P=0.577). Mean age for UBT
positive children was 11.1± 4.1 years, and for the UBT negative was
8.5±3.4 years (P <0.001).
TABLE I Symptom In UBT [+] and UBT [-] Groups
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Symptoms |
UBT(-) |
UBT (+) |
P value |
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Abdominal pain |
54 (100%) |
59 (100%) |
—- |
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Anorexia |
35 (64.8%) |
48 (81.4%) |
0.041 |
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Early satiety |
35 (64.8%) |
37 (62.7%) |
0.816 |
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Nausea |
27 (50%) |
30 (50.8%) |
0.928 |
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Heartburn |
12 (22.2%) |
18 (30.5%) |
0.319 |
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Eructation |
10 (18.5%) |
12 (20.3%) |
0.807 |
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Vomiting |
6 (11.1%) |
14 (23.7%) |
0.079 |
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UBT: Urea Breath Test. |
Table I compares the gastrointestinal
symptoms between H. pylori infected and non-infected children.
Only anorexia had a significant relation with H.pylori
infection (P=0.041). Table II compares the
distribution of SDS for height and BMI for all subjects.
TABLE II Comparison of Distribution of SDS of Height and BMI for UBT [+] and UBT [-] Children
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Variables
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UBT(-) |
UBT (+) |
P value |
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SDS of Height |
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Total |
- 0.82 1.6 |
- 0.78 1.4 |
0.899 |
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Girls |
- 0.88 1.4 |
- 0.77 1.5 |
0.763 |
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Boys |
- 0.72 1.9 |
0.80 1.3 |
0.873 |
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SDS of BMI |
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Total |
- 0.92 1.7 |
0.88 1.5 |
0.213 |
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Girls |
- 0.93 1.7 |
- 0.87 1.4 |
0.112 |
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Boys |
- 0.88 1.9 |
- 0.89 1.5 |
0.620 |
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SDS: Standard Deviation Score; BMI:
Body Mass Index; UBT: Urea Breath Test. |
Discussion
This study revealed that 52% of dyspeptic children
were infected with H. pylori, but did not show any significant
correlation between symptomatic H. pylori infections and SDS for
height and BMI.
Prevalence rates of H. pylori infection in
children ranged between 1-80%. Prevalence rates are higher in developing
countries [6]. The rate of H.pylori infection as found in our
study was higher than that in Sood, et al. [7] findings, in which
the infection was prevalent in 38% of dyspeptic children in the United
States. Contrary to our results, they observed that H. pylori
infected children have significantly shorter height and lower weight in
comparison to H. pylori negative children. However, in terms of
socioeconomic and ethnic factors, these differences were not significant
as their study did not make any appropriate adjustments of socioeconomic
factors. Our results are similar to that of another study [8], which
found no correlation between H. pylori infection and growth
failure, and between its treatment and growth velocity. Another Egyptian
study reported high prevalence of H. pylori among school children
and demonstrated that the infection caused growth retardation in them
[5]. However, a similar study done by Soylu, et al. [9] did not
support this effect of the disease.
We found no significant evidence of the effects of
H. pylori on growth, but socioeconomic parameters, if not
appropriately adjusted, can limit the findings of growth related
studies, including this study. However, SDS values were calculated and
the age-group of the patients were excluded to improve the findings of
this study. As our data presents, the mean SDS, for height and BMI,
falls below zero; that means in average, height and BMI of subjects are
below the 50 th centile. It
seems that all under study children with gastrointestinal symptoms,
either those who had H. pylori infection or the others who were
not infected, had a decreased growth in comparison with average of
society. These results indicate the influence of other factors such as
malnutrition on growth failure.
Based on data collected in this study, we have found
no significant correlation between H. pylori infection and growth
parameters. Symptomatic H. pylori infection does not appear to
influence the linear growth in children.
Contributors: The first draft was written by DSM
in collaboration with the HM. Data collection was performed by RT, KH
and DSM with data analysis performed together with KH. Critical review
was performed by all.
Funding: None; Competing interests: None
stated.
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What This Study Adds?
•
Symptomatic H. pylori
infection does not appear to influence the linear growth in
children.
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