While the prevalence of H. pylori colonizing the human stomach varies between 1.8-65% in developed countries, it is generally higher in developing countries and reaches up to 90% in some countries. The pathophysiology of H. pylori infection depends on complex bacterial virulence mechanisms and their interaction with the host immune system and environmental factors. Unlike adults, the rate of serious disease associated with H. pylori is low in children and gastric malignancies are almost absent, the infection is usually asymptomatic. Both invasive and non-invasive methods can be used in diagnosis in pediatrics. To detect H. pylori infection in children, especially in the first decade of life, initial diagnosis is made including endoscopy and histological evaluation. Identification of histological samples is accomplished by the widely used updated Sydney classification
11-13.
A meta-analysis covering 60 countries showed that the overall prevalence of H. pylori infection in children worldwide was 32.3%, and this rate varied according to the diagnostic tests applied. In particular, the prevalence of H. pylori infection in children in low- and middle-income countries (43.2%) is almost twice that in high-income countries (21.7%). Studies have shown a significant decrease in the prevalence of H. pylori infection in children in recent years, especially in western industrialized countries. However, prevalence has remained stable at a high level in developing and newly industrialized countries. The infection rate in China decreased from 58.3% to 40.0% in the last decade, and in Taiwan from 63.8% to 28.2%12. In a study conducted in Jordan in 2020 with 98 children with an average age of 11.7±4.7 years who underwent endoscopy, H. pylori was detected in the stomach biopsy of 53 (54%) patients11. In a study conducted in Morocco with 213 patients aged 1-17 years who underwent upper GI endoscopy in a two-year period between January 2019 and January 2021, they determined that 95 (45%) children were infected with H. pylori14. In Romania, the presence of H. pylori was detected in 82 (33.06%) of 248 pediatric patients aged 0-18 who underwent upper gastrointestinal endoscopy4.
In the study conducted by Yıldırım15 in Antalya, 195 (47.8%) of the cases were boys and 213 (52.2%) were girls, and H. pylori was observed at various severities in 158 cases (38.7%). In the distribution of cases by age, it was determined that the frequency of H. pylori increased with age in the 0-6 year old, 7-12 year old, 13-18 year old groups (20.7%, 28.9% and 47% respectively). In their study, they found a significant relationship between the presence of H. pylori and chronic inflammation and activity. Similarly, in our study, as H. pylori severity increases, activity and inflammation severity increase significantly.
Deveci and Acar9 in their study conducted in Şanlıurfa by evaluating the endoscopy and pathology reports of 428 patients aged 1-18 years, reported the presence of H. pylori in 67.1% of the cases, with the average age of the patients being 9.8±4.6. According to the study, it was observed that the frequency of H. pylori increased with age. In our study, the presence of H. pylori at various severities was detected in 50.8% of our patients. In this study, no difference was found between genders in terms of H. pylori positivity, consistent with studies conducted in the world and in our country.
Kara et al.16, in their study between 2004 and 2008 in Istanbul with 358 pediatric patients with an average age of 10.8±3.26, detected H. pylori in 214 patients (59.8%). Özbey et al.17, in their study conducted with 101 child patients aged between 4 and 18 in Elazığ between March 2011 and September 2012, found that the prevalence of H. pylori infection was high (75.8%) in children between the ages of 13 and 18, and in children between the ages of 4 and 6. (40%) showed that the prevalence was lower. In this study, the prevalence of H. pylori was found to be higher in the 11-15 age groups (53.1%) compared to other age groups.
In their study, which included 1612 patients whose stomach biopsies were taken after upper GI endoscopy was performed in Konya between 2010 and 2018, Bayramoğlu and colleagues18 recorded the frequency of mononuclear cell infiltration as 79.9%, the frequency of neutrophil infiltration as 50.2%, and the frequency of H. pylori as 25%. They observed that the presence and severity of H. pylori increased with age. In our study, no statistically significant relationship was found between the presence and severity of H. pylori and age.
Erdoğan Durmuş et al.19, in their study conducted in the province of Erzurum between July 2014 and May 2015 with 59 cases between the ages of 1-18, found that 35.6% of the cases were boys, 64.4% were girls, the average age was 11.84±4.88, and 61.01% of the patients had various severities. H. pylori has been detected. They determined the frequency of H. pylori in the 1-5 year old, 6-10 year old, 11-18 year old groups as 57.14%, 56.25%, 63.88%, respectively. In our study, the frequency of H. pylori in the 3-10, 11-15, 16-18 age ranges was determined as 55.0%, 46.9%, 48.0%, respectively. Among 187 patients, the number of H. pylori positive patients was found to be 95 (50.8%).
There are some limitations in our research. The limitation of the study is that it is single-centered and there are no clinical findings from the pediatric patients included in the study.
The gold standard in the diagnosis of H. pylori continues to be upper GI endoscopy and histopathological examination. Histopathological evaluation of the biopsy taken by endoscopy is very important as it provides information about other accompanying pathologies and shows the presence and severity of H. pylori. When the data obtained in this study were compared with previous studies, we determined that the presence of H. pylori was generally lower in our study. Despite a recent decline in the overall prevalence of infection, morbidity and mortality rates due to gastric cancer remain high20. The results we recorded in our study are an indication that the prevalence of H. pylori is on a downward trend in our country, as well as all over the world. It is known that the presence and severity of H. pylori is directly related to factors such as socioeconomic level and hygiene habits. Although the results are promising, the rates are still quite high compared to studies conducted in Western countries and the western part of our country.
In conclusion, early diagnosis of H. pylori, which causes many problems in the GI tract and can lead to serious diseases such as stomach cancer, is very important. Indications for endoscopy in children are limited. Although invasive diagnostic methods are more risky, they are more reliable than noninvasive methods. There are few studies conducted with children on this subject in our country. More comprehensive, multicenter studies are needed to fill the gap in this area.