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PEDIATRICS Vol. 113 No. 1 January 2004, pp. 54-58

Influence of Helicobacter pylori Eradication on Gastroesophageal Reflux Symptoms and Epigastric Pain in Children and Adolescents

Arie Levine, MD^*, Tamir Milo, MD, Efrat Broide, MD^¶, Eitan Wine, MD, Ilan Dalal, MD, Mona Boaz, PhD^||, Yona Avni, MD and Haim Shirin, MD

^* Pediatric Gastroenterology Unit
Department of Pediatrics
Gastroenterology Division
^|| Epidemiology Unit, Edith Wolfson Medical Center, Holon, Israel
^¶ Pediatric Gastroenterology Unit, Assaf Harofe Medical Center, Holon, Israel

Objective. Conflicting reports have noted a possible association linking eradication of Helicobacter pylori with aggravation of gastroesophageal reflux (GER) disease. We prospectively evaluated the effect of eradication of H pylori on GER symptoms and epigastric pain and the association among these 3 parameters in a pediatric cohort.

Methods. Patients who were referred for gastroscopy were evaluated for frequency, severity, and nocturnal presence of symptoms related to GER as well as epigastric pain. Patients who were positive for H pylori received triple antibiotic therapy. The patients were followed for at least 6 months after therapy. Patients with successful eradication had symptoms compared with their pre-eradication state and were compared with a cohort of patients without H pylori or those with persistent H pylori.

Results. Of 119 children and adolescents who were recruited, 95 patients completed the study, with a mean follow-up of 11.2 months. The distribution of outcomes for each GER symptom (better, worse, unchanged) was similar before and after eradication and did not depend on prior H pylori status. Among patients with GER and epigastric pain, improvement in epigastric pain was significantly correlated with the improvement in GER symptoms but not with eradication of H pylori.

Conclusions. Eradication of H pylori is not associated with increased symptoms of GER in children and adolescents. Improvement in epigastric pain in children is significantly correlated with the improvement in GER symptoms but not with eradication of H pylori.

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Key Words: gastroesophageal reflux • Helicobacter pylori • child • esophagitis • abdominal pain • dyspepsia

Abbreviations: GER, gastroesophageal reflux

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Received for publication Feb 18, 2003; Accepted May 15, 2003.

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