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Helicobacter pylori infection, serum pepsinogens, and pediatric abdominal pain: a pilot study

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Abstract

The significance of Helicobacter pylori (H. pylori) infection in pediatric abdominal pain remains poorly recognized. We examined associations of H. pylori infection and serum pepsinogens (PGs), as non-invasive markers of gastritis, with pediatric abdominal pain. A case-control study was conducted among 99 children aged 5–17 years admitted to one hospital for abdominal pain (cases) without an apparent organic reason. Using enzyme-linked immunosorbent assays, sera were tested and compared with 179 controls for anti-H. pylori immunoglobulin G (IgG) antibodies and PGI and PGII levels. Multivariable analysis was performed to adjust for potential confounders. H. pylori IgG sero-positivity was 34.3 and 36.3% in cases and controls, respectively, P = 0.7. H. pylori-infected children had higher median PGI and PGII levels and a lower PGI/PGII ratio than uninfected children. Cases infected with H. pylori had a higher median PGII level (P < 0.001) and lower PGI/PGII ratio (P = 0.036) than controls infected with H. pylori. The percentage of cases with PGII ≥7.5 μg/L, as indication for antral inflammation, was higher than in controls: 58.6 versus 44.7%, P = 0.027. Children with PGII levels ≥7.5 μg/L had increased risk for abdominal pain: adjusted prevalence ratio 1.73 [95% confidence intervals 1.02, 2.93], P = 0.039.

Conclusion: Children with increased serum PGII levels, as an indication of gastritis, are more likely to have abdominal pain. Serum PGs can be a useful non-invasive marker for gastritis, in evaluating children with severe abdominal pain with no apparent organic reason.

What is Known:

• The significance of Helicobacter pylori infection in pediatric abdominal pain remains debated.

• Serum pepsinogens (PGs), non-invasive markers of gastric inflammation, were rarely utilized in assessing the association between H. pylori in pediatric abdominal pain of unknown origin.

What is New:

• High serum PGII level, as an indication of gastritis, rather than H. pylori infection itself, was associated with increased risk for abdominal pain.

• Serum PGs can be a useful biomarker for gastritis in evaluating children with severe abdominal pain with no apparent organic reason.

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Abbreviations

CagA:

Cytotoxin-associated gene A

CI:

Confidence intervals

ELISA:

Enzyme-linked immunosorbent assay

IgG:

Immunoglobulin G

IQR:

Interquartile range

PG:

Pepsinogens

PR:

Prevalence ratio

SD:

Standard deviation

RAP:

Recurrent abdominal pain

VacA:

Vacuolating cytotoxin A

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Acknowledgments

This study was conducted in partial fulfillment of the master degree in Public Health of Mr. Medhat Naamna (Supervisor Dr. K. Muhsen), at the Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. We thank Mrs. Fatma Abu Rakia for her help in data collection.

Authors’ Contributions

KhM: designed the study, built the data collection tools, supervised data collection, laboratory work and data management, analyzed the data and drafted the initial manuscript.

EK: contributed to the study design, coordinated and supervised data collection, contributed to the interpretation of results, revised the manuscript and approved the final version of the manuscript.

MN: built the data collection tools, collected data and serum samples, conducted initial data analysis and approved the final version of the manuscript.

KadM: participated in data and serum samples collection, contributed to the interpretation of result and approved the final version of the manuscript.

GBD: performed the laboratory assays reviewed and approved the final version of the manuscript.

Author information

Author notes

  1. Eias Kassem and Medhat Naamna contributed equally to the study.

Authors and Affiliations

  1. Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel

    Eias Kassem & Kadri Mawassy

  2. Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel

    Medhat Naamna, Gany Beer-Davidson & Khitam Muhsen

Authors
  1. Eias Kassem
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  2. Medhat Naamna
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  3. Kadri Mawassy
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  5. Khitam Muhsen
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Corresponding author

Correspondence to Khitam Muhsen.

Ethics declarations

Parents signed written informed consent. The study protocol was approved by the institutional review board of Hillel Yaffe Medical Center, and the ethics committee of Tel Aviv University.

Funding

This study received internal funding sources from Tel Aviv University (KM, PI).

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Communicated by Mario Bianchetti

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Kassem, E., Naamna, M., Mawassy, K. et al. Helicobacter pylori infection, serum pepsinogens, and pediatric abdominal pain: a pilot study. Eur J Pediatr 176, 1099–1105 (2017). https://doi.org/10.1007/s00431-017-2955-3

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  • DOI: https://doi.org/10.1007/s00431-017-2955-3

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