0
March 1, 1995, Vol 273, No. 9 >
ARTICLE | March 1, 1995

Helicobacter pylori, Gastroduodenal Disease, and Recurrent Abdominal Pain in Children FREE

Colin Macarthur, MBChB, MSc; Norman Saunders, MD, FRCPC; William Feldman, MD, FRCPC
[+] Author Affiliations

Reprint requests to the Paediatric Outcomes Research Team, Division of General Paediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1×8 (Dr Macarthur).


JAMA. 1995;273(9):729-734. doi:10.1001/jama.1995.03520330059038
Text Size: A A A
Published online
Article
References

Objective.  —To assess the evidence for a cause-and-effect relationship between Helicobacter pylori infection and antral gastritis, peptic ulcer disease, and recurrent abdominal pain in children.

Data Sources.  —A MEDLINE search from January 1983 through July 1994 was used to identify pertinent English-language publications. Current Contents and selected specialty journals were searched manually. Editorials, reviews, case reports, abstracts, and letters to the editor were excluded.

Study Selection.  —All studies in children (ie, 0 to 18 years) were included.

Data Extraction.  —Hill's criteria for causal inference were used to determine the strength of the evidence for a causal relationship.

Data Synthesis.  —In total, 45 studies (case series, cross-sectional surveys, and treatment trials) were retrieved. The rate ratio of antral gastritis in children with H pylori infection (compared with uninfected children) ranged from 1.9 to 71.0 (median, 4.6). The prevalence of H pylori infection in children with duodenal ulcer was high (range, 33% to 100%; median, 92%) compared with children with gastric ulcer (range, 11% to 75%; median, 25%). Prevalence rates of infection in children with recurrent abdominal pain were inconsistent (range, 0% to 81%; median, 22%), with lower rates in children meeting Apley's criteria (range, 0% to 9%; median, 6%).

Conclusions.  —There is strong evidence for an association between H pylori infection and antral gastritis and duodenal ulcer disease in children; however, data from randomized, double-blind, placebo-controlled treatment trials are required. There is weak evidence for an association with gastric ulcer and weak or no evidence for an association with recurrent abdominal pain.(JAMA. 1995;273:729-734)

REFERENCES

1 +
Blaser M.  Helicobacter pylori and the pathogenesis of gastroduodenal inflammation. J Infect Dis . 1990;;161:626-633.
2 +
Dooley C, Cohen H.  The clinical significance of Campylobacter. Ann Intern Med . 1988;;108:70-79.
3 +
Taylor D, Blaser M.  The epidemiology of Helicobacter pylori infection. Epidemiol Rev . 1991;;13: 42-59.
4 +
Peterson W.  Helicobacter pylori and peptic ulcer disease. N Engl J Med . 1991;;324:1043-1048.
5 +
Veldhuyzen van Zanten S, Sherman P.  Helicobacter pylori infection as a cause of gastritis, duodenal ulcer, gastric cancer, and non-ulcer dyspepsia: a systematic overview. Can Med Assoc J . 1994;; 150:177-185.
6 +
The Eurogast Study Group.  An international association between Helicobacter pylori infection and gastric cancer. Lancet . 1993;;341:1359-1362.
7 +
Parsonnet J, Friedman G, Vandersteen D, et al.  Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med . 1991;;325:1127-1131.
8 +
Nomura A, Stemmerman G, Chyou P, Perez-Perez G, Blaser M.  Helicobacter pylori infection and gastric carcinoma among Japanese Americans in Hawaii. N Engl J Med . 1991;;325:1132-1136.
9 +
Farrell MK.  Dr Apley meets Helicobacter pylori. J Pediatr Gastroenterol Nutr . 1993;;16:118-119.
10 +
Judd RH.  Helicobacter pylori, gastritis, and ulcers in pediatrics. Adv Pediatr . 1992;;39:283-306.
11 +
Sullivan PB, Thomas JE.  Helicobacter pylori in children. Postgrad Med J . 1991;;67:330-333.
12 +
Glassman MS.  Helicobacter pylori infection in children: a clinical overview. Clin Pediatr . 1992;;31: 481-487.
13 +
Drumm B.  Helicobacter pylori. Arch Dis Child . 1990;;65:1278-1282.
14 +
Kramer MS. Clinical Epidemiology and Biostatistics: A Primer for Clinical Investigators and Decision-Makers . Berlin, Germany: Springer-Verlag; 1988;:58-77.
15 +
Miettinen O.  Estimability and estimation in case-referent studies. Am J Epidemiol . 1976;;103:226-235.
16 +
Armitage P, Berry G. Statistical Methods in Medical Research . 2nd ed. Oxford, England: Black-well Scientific Publications Inc; 1987;:115-120.
17 +
Hill A.  The environment and disease: association or causation? Proc R Soc Med . 1965;;58:295-300.
18 +
Czinn S, Dahms B, Jacobs G, Kaplan B, Rothstein F.  Campylobacter-like organisms in association with symptomatic gastritis in children. J Pediatr . 1986;;109:80-83.
19 +
Czinn S, Carr H.  Rapid diagnosis of Campylobacter pyloridis—associated gastritis. J Pediatr . 1987;;110:569-570.
20 +
Glassman M, Schwarz S, Medow M, et al.  Campylobacter pylori—related gastrointestinal disease in children: incidence and clinical findings. Dig Dis Sci . 1989;;34:1501-1504.
21 +
Glasssman M, Dallal S, Berezin S, et al.  Helicobacter pylori-related gastroduodenal disease in children: diagnostic utility of enzyme-linked immunosorbent assay. Dig Dis Sci . 1990;;35:993-997.
22 +
Kilbridge PM, Dahms BB, Czinn SJ.  Campylobacter pylori—associated gastritis and peptic ulcer disease in children. Am J Dis Child . 1988;;142: 1149-1152.
23 +
Veereman-Wauters G, Ferrell L, Heyman M.  Trends in Campylobacter pylori in pediatric and adult antral biopsies: a 5-year retrospective analysis. West J Med . 1989;;151:406-409.
24 +
Drumm B, O'Brien A, Cutz E, Sherman P.  Campylobacter pyloridis—associated primary gastritis in children. Pediatrics . 1987;;80:192-195.
25 +
Drumm B, Sherman P, Cutz E, Karmali M.  Association of Campylobacter pylori on the gastric mucosa with antral gastritis in children. N Engl J Med . 1987;;316:1557-1561.
26 +
Drumm B, Guillermo I, Perez-Perez D, Blaser M, Sherman P.  Intrafamilial clustering of Helicobacter pylori infection. N Engl J Med . 1990;;322: 359-363.
27 +
Mahony M, Wyatt J, Littlewood J.  Campylobacter pylori gastritis. Arch Dis Child . 1988;;63: 654-655.
28 +
Mahony MJ, Wyatt JI, Littlewood JM.  Management and response to treatment of Helicobacter pylori gastritis. Arch Dis Child . 1992;;67:940-943.
29 +
Thomas JE, Whatmore AM, Barer MR, Eastham EJ, Kehoe MA.  Serodiagnosis of Helicobacter pylori infection in childhood. J Clin Microbiol . 1990;; 28:2641-2646.
30 +
Oderda G, Vaira D, Holton J, Dowsett JF, Ansaldi N.  Serum pepsinogen I and IgG antibody to Campylobacter pylori in nonspecific abdominal pain in childhood. Gut . 1989;;30:912-916.
31 +
Oderda G, Vaira D, Dell'Olio D, et al.  Serum pepsinogen I and gastrin concentrations in children positive for Helicobacter pylori. J Clin Pathol . 1990;; 43:762-765.
32 +
De Giacomo C, Lisato L, Negrini R, Licardi G, Maggiore G.  Serum immune response to Helicobacter pylori in children: epidemiologic and clinical applications. J Pediatr . 1991;;119:205-210.
33 +
Vandenplas Y, Blecker U, Devreker T, et al.  Contribution of the 13C-urea breath test to the detection of Helicobacter pylori gastritis in children. Pediatrics . 1992;;90:608-11.
34 +
Prieto G, Polanco I, Larrauri J, Rota L, Lama R, Carrasco S.  Helicobacter pylori infection in children: clinical, endoscopic, and histologic correlations. J Pediatr Gastroenterol Nutr . 1992;;14:420-425.
35 +
Maaroos I, Rago T, Sipponen P, Siurala M.  Helicobacter pylori and gastritis in children with abdominal complaints. Scand J Gastroenterol . 1991;; 26( (suppl 186) ):95-99.
36 +
Hardikar W, Davidson PM, Cameron DJ, Gilbert GL, Campbell PE, Smith AL.  Helicobacter pylori infection in children. J Gastroenterol Hepatol . 1991;;6:450-454.
37 +
Mitchell HM, Bohane TD, Tobias V, et al.  Helicobacter pylori infection in children: potential clues to pathogenesis. J Pediatr Gastroenterol Nutr . 1993;; 16:120-125.
38 +
Yeung C, Yuen K, Fu K, Tsang T, Seto W, Saing H.  Rapid endoscopy room diagnosis of Campylobacter pylori—associated gastritis in children. J Pediatr Gastroenterol Nutr . 1990;;10:357-360.
39 +
Yahav J, Oderda G, Diver HA, Keller N, Jonas A.  Mucosal peptic activity during Helicobacter pylori infection in pediatric patients. Gut . 1992;;33: 1162-1165.
40 +
Celinska-Cedro D, Socha J, Teisseyre M.  Campylobacter pylori in upper digestive tract diseases in children. Materia Medica Polona . 1989;;21:259-262.
41 +
Queiroz DM, Mendes EN, Rocha GA, Barbosa AJ, Carvalho AS, Cunha MJ.  Histamine concentration of gastric mucosa in Helicobacter pylori positive and negative children. Gut . 1991;;32:464-466.
42 +
Carvalho AS, Queiroz DM, Mendes EN, Rocha GA, Penna FJ.  Diagnosis and distribution of Helicobacter pylori in the gastric mucosa of symptomatic children. Braz J Med Biol Res . 1991;;24:163-166.
43 +
Rocha GA, Queiroz DM, Mendes EN, de Carvalho AS, de Oliveiri AM, de Moura SB.  Serodiagnosis of Helicobacter pylori infection in children by an indirect immunofluorescence test. J Pediatr Gastroenterol Nutr . 1993;;16:247-251.
44 +
Radhakrishnan S, al Nakib B, Kalaoui M, Patric J.  Helicobacter pylori-associated gastritis in Kuwait: endoscopy-based study in symptomatic and asymptomatic children. J Pediatr Gastroenterol Nutr . 1993;;16:126-129.
45 +
Veldhuyzen van Zanten SJO, Sherman PM.  Indications for treatment of Helicobacter pylori infection: a systematic overview. Can Med Assoc J . 1994;;150:189-198.
46 +
Oderda G, Dell'Olio D, Morra I, Ansaldi N.  Campylobacter pylori gastritis: long-term results of treatment with amoxycillin. Arch Dis Child . 1989;; 64:326-329.
47 +
Oderda G, Vaira D, Holton J, Ainley C, Altare F, Ansaldi N.  Amoxycillin plus tinidazole for Campylobacter pylori gastritis in children: assessment by serum IgG antibody, pepsinogen I, and gastrin levels. Lancet . 1989;;1:690-692.
48 +
Oderda G, Vaira D, Ainley C, et al.  Eighteen-month follow up of Helicobacter pylori positive children treated with amoxycillin and tinidazole. Gut . 1992;;33:1328-1330.
49 +
De Giacomo C, Fiocca R, Villani L, et al.  Helicobacter pylori infection and chronic gastritis: clinical, serological, and histologic correlations in children treated with amoxicillin and colloidal bismuth subcitrate. J Pediatr Gastroenterol Nutr . 1990;;11: 310-316.
50 +
Yeung CK, Fu KH, Yuen KY, et al.  Helicobacter pylori and associated duodenal ulcer. Arch Dis Child . 1990;;65:1212-1216.
51 +
Israel DM, Hassall E.  Treatment and long-term follow-up of Helicobacter pylori—associated duodenal ulcer disease in children. J Pediatr . 1993;;123: 53-58.
52 +
Drumm B, Sherman P, Chiasson D, Karmali M, Cutz E.  Treatment of Campylobacter pylori—associated antral gastritis in children with bismuth subsalicylate and ampicillin. J Pediatr . 1988;;113:908-912.
53 +
Hassall E, Dimmick JE.  Unique features of Helicobacter pylori disease in children. Dig Dis Sci . 1991;;36:417-423.
54 +
Queiroz DM, Rocha GA, Mendes EN, et al.  Differences in distribution and severity of Helicobacter pylori gastritis in children and adults with duodenal ulcer disease. J Pediatr Gastroenterol Nutr . 1991;;12:178-181.
55 +
Oderda G, Vaira D, Holton J, et al.  Helicobacter pylori in children with peptic ulcer and their families. Dig Dis Sci . 1991;;36:572-576.
56 +
Fiedorek SC, Casteel HB, Pumphrey CL, et al.  The role of Helicobacter pylori in recurrent, functional abdominal pain in children. Am J Gastroenterol . 1992;;87:347-349.
57 +
van der Meer S, Forget PP, Loffeld RJ, Stobberingh E, Kuijten RH, Arends JW.  The prevalence of Helicobacter pylori serum antibodies in children with recurrent abdominal pain. Eur J Pediatr . 1992;;151:799-801.
58 +
Mavromichalis I, Zaramboukas T, Richman P, Slavin G.  Recurrent abdominal pain of gastrointestinal origin. Eur J Pediatr . 1992;;151:560-563.
59 +
Conti-Nibali S, Sferlazzas C, Fera MT, Saitta G, Tedeschi A, Magazzu G.  Helicobacter pylori infection: a simplified diagnostic approach. Am J Gastroenterol . 1990;;85:1573-1575.
60 +
Bujanover Y, Konikoff F, Baratz M.  Nodular gastritis and Helicobacter pylori. J Pediatr Gastroenterol Nutr . 1990;;11:41-44.
61 +
Ashorn M, Maki M, Ruuska T, et al.  Upper gastrointestinal endoscopy in recurrent abdominal pain of childhood. J Pediatr Gastroenterol Nutr . 1993;;16:273-277.
62 +
Crabtree JE, Mahony MJ, Taylor JD, Heatley RV, Littlewood JM, Thompkins DS.  Immune responses to Helicobacter pylori in children with recurrent abdominal pain. J Clin Pathol . 1991;;44:768-771.
63 +
Falchetti D, Villanacci V, Bisicchia R, et al.  Campylobacter pylori in children: endoscopic and histopathologic investigations. Zeitschrift Fur Kinderchirurgie . 1988;;1:50-51.
64 +
Apley J, Naish N.  Recurrent abdominal pains: a field survey of 1000 school children. Arch Dis Child . 1957;;33:165-170.
65 +
Marshall B, Armstrong J, McGechie D, Glancy R.  Attempt to fulfil Koch's postulates for pyloric Campylobacter. Med J Aust . 1985;;142:436-439.
66 +
Morris A, Nicholson G.  Ingestion of Campylobacter pyloridis causes gastric and raised fasting gastric pH. Am J Gastroenterol . 1987;;82:192-199.
67 +
Ormand JE, Talley NJ, Shorter RG, et al.  Prevalence of Helicobacter pylori in specific forms of gastritis: further evidence supporting a pathogenic role for H. pylori in chronic nonspecific gastritis. Dig Dis Sci . 1991;;36:142-145.
68 +
Koop H, Stumpf M, Eissele R, et al.  Antral Helicobacter pylori—like organisms in different states of gastric acid secretion. Digestion . 1991;;48: 230-236.
69 +
Fich A, Talley NJ, Shorter RG, Phillips SF.  Zollinger-Ellison syndrome: relation to Helicobacter pylori—associated chronic gastritis and gastric acid secretion. Dig Dis Sci . 1991;;36:10-14.
70 +
Lee A, Fox J, Hazell S.  Pathogenicity of Helicobacter pylori: a perspective. Infect Immun . 1993;; 61:1601-1610.
71 +
Goodwin C.  Duodenal ulcer, Campylobacter pylori, and the 'leaking roof' concept. Lancet . 1988;;2: 1467-1469.
72 +
Wyatt JI, Rathbone BJ, Sobala GM, et al.  Gastric epithelium in the duodenum: its association with Helicobacter pylori and inflammation. J Clin Pathol . 1990;;43:981-986.
73 +
Sipponen P, Varis K, Fraki O, et al.  Cumulative 10-year risk of symptomatic duodenal and gastric ulcer in patients with or without gastritis. Scand J Gastroenterol . 1990;;25:966-973.
74 +
Trout K.  How to read clinical journals, IV: to determine etiology or causation. Can Med Assoc J . 1981;;124:985-990.
75 +
Drumm B.  Helicobacter pylori in the pediatric patient. Gastroenterol Clin North Am . 1993;;22:169-182.
76 +
Dooley CP, Cohen H, Fitzgibbons PL, et al.  Prevalence of Helicobacter pylori infection and histologic gastritis in asymptomatic persons. N Engl J Med . 1989;;321:1562-1566.
77 +
Graham DY, Malaty HM, Evans DG, Evans DJ, Klein PD, Adam E.  Epidemiology of Helicobacter pylori in an asymptomatic population in the United States: effect of age, race, and socioeconomic status. Gastroenterology . 1991;;100:1495-1501.
78 +
Gormally S, Drumm B.  Helicobacter pylori and gastrointestinal symptoms. Arch Dis Child . 1994;; 70:165-166.
79 +
Chamberlain C, Peura D.  Campylobacter (Helicobacter) pylori: is peptic disease a bacterial infection? Arch Intern Med . 1990;;150:951-955.
80 +
NIH Consensus Development Panel on Helicobacter pylori in Peptic Ulcer Disease.  Helicobacter pylori in peptic ulcer disease. JAMA . 1994;;272: 65-69.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Blaser M.  Helicobacter pylori and the pathogenesis of gastroduodenal inflammation. J Infect Dis . 1990;;161:626-633.
2 +
Dooley C, Cohen H.  The clinical significance of Campylobacter. Ann Intern Med . 1988;;108:70-79.
3 +
Taylor D, Blaser M.  The epidemiology of Helicobacter pylori infection. Epidemiol Rev . 1991;;13: 42-59.
4 +
Peterson W.  Helicobacter pylori and peptic ulcer disease. N Engl J Med . 1991;;324:1043-1048.
5 +
Veldhuyzen van Zanten S, Sherman P.  Helicobacter pylori infection as a cause of gastritis, duodenal ulcer, gastric cancer, and non-ulcer dyspepsia: a systematic overview. Can Med Assoc J . 1994;; 150:177-185.
6 +
The Eurogast Study Group.  An international association between Helicobacter pylori infection and gastric cancer. Lancet . 1993;;341:1359-1362.
7 +
Parsonnet J, Friedman G, Vandersteen D, et al.  Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med . 1991;;325:1127-1131.
8 +
Nomura A, Stemmerman G, Chyou P, Perez-Perez G, Blaser M.  Helicobacter pylori infection and gastric carcinoma among Japanese Americans in Hawaii. N Engl J Med . 1991;;325:1132-1136.
9 +
Farrell MK.  Dr Apley meets Helicobacter pylori. J Pediatr Gastroenterol Nutr . 1993;;16:118-119.
10 +
Judd RH.  Helicobacter pylori, gastritis, and ulcers in pediatrics. Adv Pediatr . 1992;;39:283-306.
11 +
Sullivan PB, Thomas JE.  Helicobacter pylori in children. Postgrad Med J . 1991;;67:330-333.
12 +
Glassman MS.  Helicobacter pylori infection in children: a clinical overview. Clin Pediatr . 1992;;31: 481-487.
13 +
Drumm B.  Helicobacter pylori. Arch Dis Child . 1990;;65:1278-1282.
14 +
Kramer MS. Clinical Epidemiology and Biostatistics: A Primer for Clinical Investigators and Decision-Makers . Berlin, Germany: Springer-Verlag; 1988;:58-77.
15 +
Miettinen O.  Estimability and estimation in case-referent studies. Am J Epidemiol . 1976;;103:226-235.
16 +
Armitage P, Berry G. Statistical Methods in Medical Research . 2nd ed. Oxford, England: Black-well Scientific Publications Inc; 1987;:115-120.
17 +
Hill A.  The environment and disease: association or causation? Proc R Soc Med . 1965;;58:295-300.
18 +
Czinn S, Dahms B, Jacobs G, Kaplan B, Rothstein F.  Campylobacter-like organisms in association with symptomatic gastritis in children. J Pediatr . 1986;;109:80-83.
19 +
Czinn S, Carr H.  Rapid diagnosis of Campylobacter pyloridis—associated gastritis. J Pediatr . 1987;;110:569-570.
20 +
Glassman M, Schwarz S, Medow M, et al.  Campylobacter pylori—related gastrointestinal disease in children: incidence and clinical findings. Dig Dis Sci . 1989;;34:1501-1504.
21 +
Glasssman M, Dallal S, Berezin S, et al.  Helicobacter pylori-related gastroduodenal disease in children: diagnostic utility of enzyme-linked immunosorbent assay. Dig Dis Sci . 1990;;35:993-997.
22 +
Kilbridge PM, Dahms BB, Czinn SJ.  Campylobacter pylori—associated gastritis and peptic ulcer disease in children. Am J Dis Child . 1988;;142: 1149-1152.
23 +
Veereman-Wauters G, Ferrell L, Heyman M.  Trends in Campylobacter pylori in pediatric and adult antral biopsies: a 5-year retrospective analysis. West J Med . 1989;;151:406-409.
24 +
Drumm B, O'Brien A, Cutz E, Sherman P.  Campylobacter pyloridis—associated primary gastritis in children. Pediatrics . 1987;;80:192-195.
25 +
Drumm B, Sherman P, Cutz E, Karmali M.  Association of Campylobacter pylori on the gastric mucosa with antral gastritis in children. N Engl J Med . 1987;;316:1557-1561.
26 +
Drumm B, Guillermo I, Perez-Perez D, Blaser M, Sherman P.  Intrafamilial clustering of Helicobacter pylori infection. N Engl J Med . 1990;;322: 359-363.
27 +
Mahony M, Wyatt J, Littlewood J.  Campylobacter pylori gastritis. Arch Dis Child . 1988;;63: 654-655.
28 +
Mahony MJ, Wyatt JI, Littlewood JM.  Management and response to treatment of Helicobacter pylori gastritis. Arch Dis Child . 1992;;67:940-943.
29 +
Thomas JE, Whatmore AM, Barer MR, Eastham EJ, Kehoe MA.  Serodiagnosis of Helicobacter pylori infection in childhood. J Clin Microbiol . 1990;; 28:2641-2646.
30 +
Oderda G, Vaira D, Holton J, Dowsett JF, Ansaldi N.  Serum pepsinogen I and IgG antibody to Campylobacter pylori in nonspecific abdominal pain in childhood. Gut . 1989;;30:912-916.
31 +
Oderda G, Vaira D, Dell'Olio D, et al.  Serum pepsinogen I and gastrin concentrations in children positive for Helicobacter pylori. J Clin Pathol . 1990;; 43:762-765.
32 +
De Giacomo C, Lisato L, Negrini R, Licardi G, Maggiore G.  Serum immune response to Helicobacter pylori in children: epidemiologic and clinical applications. J Pediatr . 1991;;119:205-210.
33 +
Vandenplas Y, Blecker U, Devreker T, et al.  Contribution of the 13C-urea breath test to the detection of Helicobacter pylori gastritis in children. Pediatrics . 1992;;90:608-11.
34 +
Prieto G, Polanco I, Larrauri J, Rota L, Lama R, Carrasco S.  Helicobacter pylori infection in children: clinical, endoscopic, and histologic correlations. J Pediatr Gastroenterol Nutr . 1992;;14:420-425.
35 +
Maaroos I, Rago T, Sipponen P, Siurala M.  Helicobacter pylori and gastritis in children with abdominal complaints. Scand J Gastroenterol . 1991;; 26( (suppl 186) ):95-99.
36 +
Hardikar W, Davidson PM, Cameron DJ, Gilbert GL, Campbell PE, Smith AL.  Helicobacter pylori infection in children. J Gastroenterol Hepatol . 1991;;6:450-454.
37 +
Mitchell HM, Bohane TD, Tobias V, et al.  Helicobacter pylori infection in children: potential clues to pathogenesis. J Pediatr Gastroenterol Nutr . 1993;; 16:120-125.
38 +
Yeung C, Yuen K, Fu K, Tsang T, Seto W, Saing H.  Rapid endoscopy room diagnosis of Campylobacter pylori—associated gastritis in children. J Pediatr Gastroenterol Nutr . 1990;;10:357-360.
39 +
Yahav J, Oderda G, Diver HA, Keller N, Jonas A.  Mucosal peptic activity during Helicobacter pylori infection in pediatric patients. Gut . 1992;;33: 1162-1165.
40 +
Celinska-Cedro D, Socha J, Teisseyre M.  Campylobacter pylori in upper digestive tract diseases in children. Materia Medica Polona . 1989;;21:259-262.
41 +
Queiroz DM, Mendes EN, Rocha GA, Barbosa AJ, Carvalho AS, Cunha MJ.  Histamine concentration of gastric mucosa in Helicobacter pylori positive and negative children. Gut . 1991;;32:464-466.
42 +
Carvalho AS, Queiroz DM, Mendes EN, Rocha GA, Penna FJ.  Diagnosis and distribution of Helicobacter pylori in the gastric mucosa of symptomatic children. Braz J Med Biol Res . 1991;;24:163-166.
43 +
Rocha GA, Queiroz DM, Mendes EN, de Carvalho AS, de Oliveiri AM, de Moura SB.  Serodiagnosis of Helicobacter pylori infection in children by an indirect immunofluorescence test. J Pediatr Gastroenterol Nutr . 1993;;16:247-251.
44 +
Radhakrishnan S, al Nakib B, Kalaoui M, Patric J.  Helicobacter pylori-associated gastritis in Kuwait: endoscopy-based study in symptomatic and asymptomatic children. J Pediatr Gastroenterol Nutr . 1993;;16:126-129.
45 +
Veldhuyzen van Zanten SJO, Sherman PM.  Indications for treatment of Helicobacter pylori infection: a systematic overview. Can Med Assoc J . 1994;;150:189-198.
46 +
Oderda G, Dell'Olio D, Morra I, Ansaldi N.  Campylobacter pylori gastritis: long-term results of treatment with amoxycillin. Arch Dis Child . 1989;; 64:326-329.
47 +
Oderda G, Vaira D, Holton J, Ainley C, Altare F, Ansaldi N.  Amoxycillin plus tinidazole for Campylobacter pylori gastritis in children: assessment by serum IgG antibody, pepsinogen I, and gastrin levels. Lancet . 1989;;1:690-692.
48 +
Oderda G, Vaira D, Ainley C, et al.  Eighteen-month follow up of Helicobacter pylori positive children treated with amoxycillin and tinidazole. Gut . 1992;;33:1328-1330.
49 +
De Giacomo C, Fiocca R, Villani L, et al.  Helicobacter pylori infection and chronic gastritis: clinical, serological, and histologic correlations in children treated with amoxicillin and colloidal bismuth subcitrate. J Pediatr Gastroenterol Nutr . 1990;;11: 310-316.
50 +
Yeung CK, Fu KH, Yuen KY, et al.  Helicobacter pylori and associated duodenal ulcer. Arch Dis Child . 1990;;65:1212-1216.
51 +
Israel DM, Hassall E.  Treatment and long-term follow-up of Helicobacter pylori—associated duodenal ulcer disease in children. J Pediatr . 1993;;123: 53-58.
52 +
Drumm B, Sherman P, Chiasson D, Karmali M, Cutz E.  Treatment of Campylobacter pylori—associated antral gastritis in children with bismuth subsalicylate and ampicillin. J Pediatr . 1988;;113:908-912.
53 +
Hassall E, Dimmick JE.  Unique features of Helicobacter pylori disease in children. Dig Dis Sci . 1991;;36:417-423.
54 +
Queiroz DM, Rocha GA, Mendes EN, et al.  Differences in distribution and severity of Helicobacter pylori gastritis in children and adults with duodenal ulcer disease. J Pediatr Gastroenterol Nutr . 1991;;12:178-181.
55 +
Oderda G, Vaira D, Holton J, et al.  Helicobacter pylori in children with peptic ulcer and their families. Dig Dis Sci . 1991;;36:572-576.
56 +
Fiedorek SC, Casteel HB, Pumphrey CL, et al.  The role of Helicobacter pylori in recurrent, functional abdominal pain in children. Am J Gastroenterol . 1992;;87:347-349.
57 +
van der Meer S, Forget PP, Loffeld RJ, Stobberingh E, Kuijten RH, Arends JW.  The prevalence of Helicobacter pylori serum antibodies in children with recurrent abdominal pain. Eur J Pediatr . 1992;;151:799-801.
58 +
Mavromichalis I, Zaramboukas T, Richman P, Slavin G.  Recurrent abdominal pain of gastrointestinal origin. Eur J Pediatr . 1992;;151:560-563.
59 +
Conti-Nibali S, Sferlazzas C, Fera MT, Saitta G, Tedeschi A, Magazzu G.  Helicobacter pylori infection: a simplified diagnostic approach. Am J Gastroenterol . 1990;;85:1573-1575.
60 +
Bujanover Y, Konikoff F, Baratz M.  Nodular gastritis and Helicobacter pylori. J Pediatr Gastroenterol Nutr . 1990;;11:41-44.
61 +
Ashorn M, Maki M, Ruuska T, et al.  Upper gastrointestinal endoscopy in recurrent abdominal pain of childhood. J Pediatr Gastroenterol Nutr . 1993;;16:273-277.
62 +
Crabtree JE, Mahony MJ, Taylor JD, Heatley RV, Littlewood JM, Thompkins DS.  Immune responses to Helicobacter pylori in children with recurrent abdominal pain. J Clin Pathol . 1991;;44:768-771.
63 +
Falchetti D, Villanacci V, Bisicchia R, et al.  Campylobacter pylori in children: endoscopic and histopathologic investigations. Zeitschrift Fur Kinderchirurgie . 1988;;1:50-51.
64 +
Apley J, Naish N.  Recurrent abdominal pains: a field survey of 1000 school children. Arch Dis Child . 1957;;33:165-170.
65 +
Marshall B, Armstrong J, McGechie D, Glancy R.  Attempt to fulfil Koch's postulates for pyloric Campylobacter. Med J Aust . 1985;;142:436-439.
66 +
Morris A, Nicholson G.  Ingestion of Campylobacter pyloridis causes gastric and raised fasting gastric pH. Am J Gastroenterol . 1987;;82:192-199.
67 +
Ormand JE, Talley NJ, Shorter RG, et al.  Prevalence of Helicobacter pylori in specific forms of gastritis: further evidence supporting a pathogenic role for H. pylori in chronic nonspecific gastritis. Dig Dis Sci . 1991;;36:142-145.
68 +
Koop H, Stumpf M, Eissele R, et al.  Antral Helicobacter pylori—like organisms in different states of gastric acid secretion. Digestion . 1991;;48: 230-236.
69 +
Fich A, Talley NJ, Shorter RG, Phillips SF.  Zollinger-Ellison syndrome: relation to Helicobacter pylori—associated chronic gastritis and gastric acid secretion. Dig Dis Sci . 1991;;36:10-14.
70 +
Lee A, Fox J, Hazell S.  Pathogenicity of Helicobacter pylori: a perspective. Infect Immun . 1993;; 61:1601-1610.
71 +
Goodwin C.  Duodenal ulcer, Campylobacter pylori, and the 'leaking roof' concept. Lancet . 1988;;2: 1467-1469.
72 +
Wyatt JI, Rathbone BJ, Sobala GM, et al.  Gastric epithelium in the duodenum: its association with Helicobacter pylori and inflammation. J Clin Pathol . 1990;;43:981-986.
73 +
Sipponen P, Varis K, Fraki O, et al.  Cumulative 10-year risk of symptomatic duodenal and gastric ulcer in patients with or without gastritis. Scand J Gastroenterol . 1990;;25:966-973.
74 +
Trout K.  How to read clinical journals, IV: to determine etiology or causation. Can Med Assoc J . 1981;;124:985-990.
75 +
Drumm B.  Helicobacter pylori in the pediatric patient. Gastroenterol Clin North Am . 1993;;22:169-182.
76 +
Dooley CP, Cohen H, Fitzgibbons PL, et al.  Prevalence of Helicobacter pylori infection and histologic gastritis in asymptomatic persons. N Engl J Med . 1989;;321:1562-1566.
77 +
Graham DY, Malaty HM, Evans DG, Evans DJ, Klein PD, Adam E.  Epidemiology of Helicobacter pylori in an asymptomatic population in the United States: effect of age, race, and socioeconomic status. Gastroenterology . 1991;;100:1495-1501.
78 +
Gormally S, Drumm B.  Helicobacter pylori and gastrointestinal symptoms. Arch Dis Child . 1994;; 70:165-166.
79 +
Chamberlain C, Peura D.  Campylobacter (Helicobacter) pylori: is peptic disease a bacterial infection? Arch Intern Med . 1990;;150:951-955.
80 +
NIH Consensus Development Panel on Helicobacter pylori in Peptic Ulcer Disease.  Helicobacter pylori in peptic ulcer disease. JAMA . 1994;;272: 65-69.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems