Helicobacter Pylori Infection in Paediatric Age Group and Recurrent Abdominal Pain

Background: The term ‘recurrent abdominal pain’ or RAP is defined in terms of duration and frequency of pain. The duration is to be defined as: minimum preceding three months, and Methodology: One hundred children with recurrent abdominal pain were selected using non probability consecutive sampling. H. Pylori serology was done and results presented. Results: The mean age was 7.28±2.6 years. H. pylori infection was seen in 27%. More patients belonged to middle socio economic status. Conclusion: Recurrent abdominal pain in paediatric age group is caused commonly by H. pylori infection and it is easily treatable if detected in early stages.


INTRODUCTION
The definition of Recurrent abdominal pain (RAP) in paediatrics is minimum3 episodes of pain that occur over at least 3 months and causing impairment in child's daily routine activities. Functional (nonorganic) abdominal pain is mostly considered in such cases, but in 5% to 10% of cases, organic cause is found [1]. All patients in paediatrics who presented with RAP along with fever, vomiting, dysentry, more than three alarm symptoms, or a history of dysuria or pyuria, should be properly evualated [2].
If on examination, there is weight loss or failure to thrive; jaundice; hepatosplenomegaly, or kidney enlargement; mass palpable in abdomen; or tenderness/ guarding in abdomen, furthur workup is required [3]. Investigations may include blood tests like complete blood picture (CBC),acute phase reactants(ESR,CRP), stool tests as fecal occult blood testing, detection of parasitic infection(ova and cystsin stool), Helicobacter pylori antigen detection in stool or urinalysis [4][5][6][7]. Obstruction or constipation is detected by abdominal ultrasonography [8].
Functional abdominal pain is a clinical diagnosis. One of the major causes in children is Helicobacter pylori infection which is less recognized but a major contributing factor. In Belgium a study carried out and showed a prevalence of 11% [9]. A study carried in Rawalpindi showed prevalence of 38% [10].
The rationale of this study is to find out current frequency of H .pylori in local population. Treating the underlying cause will result in better patient care.

MATERIALS AND METHODS
This study was cross sectional descriptive conducted at Department Of Pediatrics DHQ Teaching Hospital Sargodha from 10 th June 2018 to 9 th December 2018 and comprised 100 children. Children aged 3 to 12 years of both gender and having history of recurrent abdominal pain were included. Patients with other established cause of recurrent abdominal pain i.e. UTI, IBD, celiac disease, renal stone, appendicitis, anemia (Hb less than 10), diarrhea and using PPI were excluded. Demographic data including age, gender and family income was noted. Children having recurrent abdominal pain underwent H. pylori serology for detection of infection. Analysis of all data was done by using SPSS-20.
Biopsies from 150 patients, in which both the antrum and corpus had been sampled at endoscopy, were randomly chosen for further clinical and pathological analysis. In this group of 150 patients, it was established whether both regions were correctly sampled (by analysis of the histology of the gastric mucosatransitional mucosa was grouped with antral mucosa), and the density of H pylori within each region. The electronic patient record system was used to evaluate whether the patients were taking PPIs at the time of endoscopy.
To investigate the sampling pattern when the endoscopy report indicated that only one region was sampled, the histology pattern in 200 consecutive specimens that satisfied that criterion was reviewed.

RESULTS
The mean age was 7.28±2.6 years and mean family income was 16000±3000 rupees. There were 48 % females and 52% males. Regarding socioeconomic status 32% belonged to lower socio economic status and 68% belonged to middle class socioeconomic status (Table 1) In 27% children, cause of recurrent abdominal pain was H. pylori infection ( Table 2).

DISCLAIMER
The products used for this research are commonly and predominantly use products in our area of research and country. There is absolutely no conflict of interest between the authors and producers of the products because we do not intend to use these products as an avenue for any litigation but for the advancement of knowledge. Also, the research was not funded by the producing company rather it was funded by personal efforts of the authors.

CONSENT
As per international standard, parental written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
As per international standard or university standard written ethical approval has been collected and preserved by the author(s).