Should an internationally adopted child be screened for H. Pylori even if he/she seems asymptomatic?
The incidence of H. Pylori is very low in children of industrialized countries. The incidence increases by a small amount every year and it dramatically increases after the age of 20 years.
Transmission is usually by person to person contact, and water supply is also incriminated as a mode of transmission.
There seems to be an increased incidence of H. Pylori gastritis in children with the following exposure factors:
Clinical manifestations of H. Pylori infection: Many children can be asymptomatic, or there may be acute or chronic pain.
Acute symptoms: Result from inflammation of the stomach lining, thus causing abdominal pain, nausea, heartburn, and other meal related symptoms. Children with H. Pylori usually do not respond to conventional treatments with ( antacids, and dietary manipulation).
Chronic abdominal pain: H. Pylori should be considered in all children with recurrent abdominal pain that do not respond to conventional antacid therapy. It should also be considered if the child has any of the following signs or symptoms:
The older the child is the more likely the diagnosis can be made because of the increase of prevalence of H. Pylori with age.
Diagnosis of H. Pylori Invasive vs. Non-Invasive
Aggressiveness of the evaluation should be determined by the age group of the child, severity of the symptoms and the presence of the high risk group.
Noninvasive methods: Serologic blood testing IgG to HP may help detect H. Pylori Infection.
This type of testing is much cheaper to perform but it is also less sensitive than the endoscopy. In the adult population, in view of the fact that colonization with HP is quite high, a positive result may be just colonization with the organism. The clinical relation to disease must be judged clinically. In other words, a positive serologic test in a asymptomatic patient is more than likely to be colonized with the HP and not cause any type of disease process, and a positive serologic test in conjunction with abdominal complaints is active disease and needs to be treated.
In children, most pediatric gatroenterologist do not recommend treating a child based on serologic testing alone, although a positive result in a child may be more specific than in an adult because of the low prevalence rate of the pathogen.
In regard to internationally adopted children and universal screening for H. Pylori, it is not a routine practice since children in general have a low incidence of H. Pylori infection. When evaluating a Internationally adopted child, it must be remembered that these children have an increased incidence of infection when compared to children from the USA. Each case should be evaluated individually, and if there is even the slightest suspicion of abdominal complaints, these kids should be tested and referred to a Pediatric Gastroenterologist.
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© George Rogu, M.D.
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