Helicobacter pylori Infection in European Children with Gastro-duodenal Ulcers and Erosions

Background: To analyze risk factors associated with gastro-duodenal
ulcers and erosions in children. Methods: Open, prospective,
multicenter, case-control study carried out in 11 European
countries in patients with gastric or duodenal ulcers/erosions and
2 age-matched controls each. Possible risk factors were recorded.
Logistic regression models were performed with adjustment for
centers and age groups. Results: Seven-hundred thirty-two patients
(244 cases, 153 with erosions only and 91 with ulcers, and 488
controls) were recruited. Children receiving antimicrobials or acid
suppressive drugs before endoscopy were excluded (202 cases/390
controls remained for risk factor analysis). Helicobacter pylori
was detected more frequently in cases than controls but only in
32.0% versus 20.1% in controls (P = 0.001). Independent exposure
factors for gastric ulcers were male gender (P = 0.001), chronic
neurologic disease (P = 0.015), chronic renal disease (P <
0.001) and nonsteroidal anti-inflammatory drug consumption (P =
0.035). Exposure factors for duodenal ulcers were H. pylori
infection (P < 0.001) and steroid consumption (P = 0.031).
Chronic renal disease was the only independent factor associated
with gastric erosions (P = 0.026), those associated with duodenal
erosions being H. pylori infection (P = 0.023), active smoking (P =
0.006) and chronic arthritis (P = 0.008). No risk factor was
identified in 97/202 (48.0%) cases. Conclusions:H. pylori remains a
risk factor for duodenal, but not for gastric lesions in children
in countries with low prevalence of infection. No risk factor could
be identified in half of the children with gastro-duodenal
ulcers/erosions.