Tuesday, February 23, 2010

Review Found No Link Between Pediatric Abdominal Pain and H pylori Infection

From Medscape Medical News
Laurie Barclay, MD

February 19, 2010 — A systematic review found no link between pediatric abdominal pain and Helicobacter pylori infection, as reported online in the February 15 issue of Pediatrics.

"Recurrent abdominal pain (RAP) and other gastrointestinal (GI) symptoms are common complaints among children," write Leo A. A. Spee, MD, from Erasmus Medical Center–University Medical Center in Rotterdam, the Netherlands, and colleagues. "The role of [H pylori] in the cause of these complaints remains controversial. Nevertheless, there is an increasing pressure on primary care clinicians to screen for H pylori infection in symptomatic children. "

The reviewers searched Medline and Embase databases up to July 2009 for studies examining the association between H pylori and GI symptoms in children through 18 years of age. Studies reporting on abdominal pain without any further definition, and therefore not fulfilling Apley's criteria, were grouped as unspecified abdominal pain (UAP). Using a standardized list of criteria, the reviewers scored methodologic quality, and they also calculated and pooled crude odds ratios (ORs).

Of 38 studies meeting inclusion criteria, 23 were case-control studies, 14 were cross-sectional studies, and there was 1 prospective cohort study, with low methodologic quality overall.

For the association between RAP and H pylori infection in children, pooled ORs were 1.21 (95% confidence interval [CI], 0.82 - 1.78) in 12 case-control studies and 1.00 (95% CI, 0.76 - 1.31) in 7 cross-sectional studies. Meta-analysis of the association between UAP and H pylori infection yielded a pooled OR of 2.87 (95% CI, 1.62 - 5.09) in 6 hospital-based studies vs 0.99 (95% CI, 0.46 - 2.11) in 5 population-based studies. There was a statistically significant positive association of epigastric pain with H pylori infection in 2 of 3 studies reporting this outcome.

"We found no association between RAP and H. pylori infection in children and conflicting evidence for an association between epigastric pain and H. pylori infection," the study authors write. "We found evidence for an association between UAP but could not confirm this finding in children seen in primary care."

Limitations of this study include the possibility that some published and unpublished studies may have been missed, and that some information collected by the reviewers may not have been provided in the journal article. Overall methodologic quality was poor, and there was a large statistical and clinical heterogeneity between studies.

"There is no association between RAP and H. pylori infection in children; therefore, screening children with this classical symptom is not warranted, regardless of setting and geographic location," the study authors conclude. "Furthermore, all other GI symptoms investigated in primary care–based or population-based studies, except for epigastric pain, were not associated with H. pylori infection in children; therefore, we postulate that as long as no typical clinical picture of a child with H. pylori infection has been established and treatment effectiveness is not known, referral to a subspecialist for this matter is not recommended."

The study authors have disclosed no relevant financial relationships.

Pediatrics. Published online February 15, 2010.

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