Follow-up of Helicobacter pylori infection in children over two decades (1988–2007): persistence, relapse and acquisition rates

Abstract

SUMMARYHelicobacter pylori culture on gastric biopsy was performed on 4964 subjects aged <18 years from 1988 to 2007 at a central laboratory in Brussels. The total number of biopsies increased markedly from 941 in 1988–1993 to 1608 in 2004–2007. Biopsies were repeated at least once for 922 subjects (603 initially negative and 319 initially positive for H. pylori). Persistence rate of H. pylori at 1 year after initial positive biopsy was greater in the 1998–2007 cohort than in the 1988–1997 cohort (72·7% vs. 45·8%, P = 0·002), suggesting a tailored selection of candidates for biopsy with non-invasive tests (13C urea breath test). Of 68 subjects initially positive and re-examined subsequently after a documented cure, re-infection/relapse rate was 48·6% within 5 years post-elimination of H. pylori. Acquisition rate over 10 years follow-up in the initially negative cohort (603 patients) was 38·7% (re-infection/relapse vs. acquisition: P < 0·001). Multivariate analysis showed a fourfold greater risk of H. pylori acquisition in children of non-European origin vs. European origin (P < 0·001). Clarithromycin and metronidazole susceptibility were determined in 226 and 223 paired positive cultures in cases of re-infection/relapse or persistence. An initial non-susceptibility profile was highly predictive of a subsequent non-susceptibility profile, and the non-susceptible proportion increased markedly from 13·3% to 21·2% for clarithromycin (P < 0·001) and from 27·3% to 35·0% for metronidazole (P = 0·014), with no difference regarding European or non-European origin.