الفهرس 
DYSPEPSIAOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Helicobacter pylori infect more than half of the world’s population, and it has been linked to several diseases, whether gastric or extragastric.
The effect of H pylori eradication on functional dyspepsia, had been a matter of debate for a long time, and recently, some authors recommended categorizing functional dyspepsia associated with H pylori as a different disease entity. Few studies were conducted upon children and none of these studies linked the different outcomes to genotypes of H pylori.
Iron deficiency anemia was linked to H pylori infection, but whether eradication therapy alone without iron supplementation can correct the anemia is still also controversial.
This prospective cohort study aimed at assessing the role of H pylori in childhood dyspepsia, and the effect of its eradication on the disease outcome. A subsidiary aim is to find out a correlation between both the virulence factors of H pylori together with host susceptible phenotypes as regarding the blood group antigens, the clinical presentation of the disease and response to eradication therapy.
The study included 154 children or adolescents presenting to the gastroenterology department paediatrics Hospitals Ain Shams University, complaining of dyspepsia. They were 72 males (46.7%) and 82 females (53.3%). Their ages ranged from 5-17 years, with mean age of 9.09 years (+/- 2.01).
Patients in the study were subjected to thorough medical history and examination, CBC, iron profile, blood grouping and upper GI endoscopy, 3 antral biopsies, one for histopathology, another for rapid urease test and the third one for genotyping of H pylori( in Hp positive samples) and a single corporal biopsy also for histopathology.
Patients were classified into one of four groups: 1-Functional dyspepsia, H pylori positive (14 patients), 2-Functional dyspepsia, H pylori negative (72 patients), 3-Organic dyspepsia, H pylori positive (47 patients) and 4-Organic dyspepsia, H pylori negative (21 patients).
H pylori positive group received eradication therapy, and the success of eradication was confirmed by the fecal antigen testing.
Organic dyspepsia were treated according to causes, while FD was managed by prokinetics, antacid therapy, dietary management and psychotherapy if needed
All patients were followed up at 6 weeks, 3 months, 6 months and 12 months. The outcome at 12 months was classified into total cure, control with minimal relapses, control with stormy bouts and the uncontrolled group.
Also follow up CBC and iron profile were done at 3 months.
The results of our study showed that significantly different outcomes were found between the 4 groups, indicating that each group should be dealt with separately.
There were nearly no predictors for good outcome, even different H pylori genotypes, except for lower dyspepsia symptom score on presentation and being organic in nature, and a certain rate of DROP of dyspepsia symptom score at follow up periods is also required.
Genotyping of H pylori for 26 patients with dyspepsia (42.6%) showed: CagA (53.8%), VacAs1m1 (42.3%), BabA2 (57.7%) and iceA1(30.8%). There was no statistically significant difference between genotypes among organic and functional dyspepsia, indicating that functional dyspepsia patients too might be infected by even the most virulent genotypes.
Iron deficiency anemia was significantly higher in the H pylori positive group, versus H pylori negative group, Although TIBC and transferrin saturation improved after 3 months, but this happened simultaneously in both groups indicating that treatment of dyspepsia per se, improves iron indices regardless of H pylori status.
Blood group AB was significantly higher, and blood group B was significantly lower in the H pylori positive patients, than H pylori negative patients. Proportion of Lewis a,b positive (weak secretors) was high in our study population(45%) of dyspeptic patients, and Lewis negative (a-b-) was significantly higher in H pylori negative patients, which might indicate a protective role.
We concluded from this study that Eradication of H pylori, totally or partially improves the symptoms of dyspepsia in most of the patients, whether it was causing organic changes on endoscopy or not, yet a significant proportion of patients remained symptomatic after H pylori eradication indicating either the presence of co-existing FD from the start or that H pylori infection induces post infectious FD.