Should an Internationally adopted child be screened for H. Pylori even if he/she seem 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 increase incidence of H. Pylori gastritis in children with the following exposure factors:
1) children where a parent already has H. Pylori 2) Low socioeconomic class 3) Children of third world countries, where the water supply is contaminated 4) Institutionalized children 5) Certain ethnic populations, African-American, Chinese, East Indians, Mexicans.
Clinical manifestations of H. Pylori infection: Many children can be asymptotic, 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:
a) Recurrent abdominal pain
b) Night time abdominal pain
c) GI bleeding
d) Meal related stomach ache or fullness
e) Family history of peptic ulcer disease
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.
1) Invasive testing: (Endoscopy) direct visualization of the stomach lining. One would identify inflammation and gastritis. A tissue biopsy would also be taken and sent to the pathology lab in order to identify microscopic evidence of gastritis and inflammation.
2) Stomach wall tissue obtained at biopsy can also be cultured in a special media. (similar to a throat culture in a pediatric office)
3) Rapid ureases test (clo test). A piece of stomach tissue is placed in a media and a chemical reaction occurs. If it changes colors it is considered positive. (similar to the rapid strep test in a pediatric office)
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.
* Note: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it -- only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made.
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