Diagnosis and treatment of gastric ulcers in children caused by Helicobacter Pylori

The article was professionally consulted by a Gastroenterologist, Department of Examination & Internal Medicine - Vinmec Hai Phong International General Hospital.

Helicobacter Pylori (H. Pylori or HP) is a bacteria found in the mucous layer of the stomach lining, known as the main cause of inflammation, stomach ulcers. In Vietnam, up to 80% of children under 10 years of age have signs of H.Pylori infection when tested. Therefore, understanding about gastric ulcers in children caused by H. pylori plays an important role in early detection and treatment to avoid dangerous complications.

Gastric ulcers are lesions of the gastric mucosa, duodenum through the muscularis mucosa into the deeper layers of the stomach wall, caused by diverse pathogens, including:
Helicobacter pylori bacteria; Due to stressors in life; Drug measurement: Aspirin, NSAIDs, corticosteroids, chemotherapy for cancer treatment; More rarely in autoimmune disease, Crohn's or tuberculosis.

In addition to abdominal pain which is the most common manifestation, the disease also has other clinical manifestations as follows:
Poor appetite, fussiness in young children; Older children often present with epigastric pain with vomiting or heartburn; Symptoms of stomach ulcers will be gnawing and burning in the upper abdomen, between the ribs and above the navel, pain that increases when fasting and decreases after eating or drinking milk, reducing secretions or neutralizing acids. If the stomach ulcer causes bleeding, there will be symptoms of vomiting blood or passing black stools. Severe gastrointestinal bleeding can cause severe anemia, shock. The anemia is subtle or has a gradual to severe course. Children eat quickly, full stomach and indigestion.

Diagnostic criteria for peptic ulcer disease caused by H.Pylori will be based on endoscopy with ulcerative lesions.
Diagnosis of H pylori infection should be based on and histopathological presence of H pylori bacteria, with at least 1 positive result of the following tests:
Urease rapid test positive; Culture of gastric biopsies containing Helicobacter Pylori; If only 1 of 2 histological tests or urease test is positive, a breath test or stool test can be done, if positive, HP infection is confirmed; In case the family refuses to endoscopy for the child, it is necessary to appoint a breathing test (if the child is over 4 years old) or a stool test first, if positive, then the endoscopy is required to find the cause.

The treatment regimen to kill HP bacteria lasts for 14 days, combining 2-3 antibiotics to achieve effectiveness with the following priority order:
Amoxicillin + Clarithromycin + PPI; Amoxicillin + Metronidazole + PPIs; Tetracylin or Doxycylin + Metronidazole + PPI (in children over 8 years old). Evaluation of the effectiveness of killing H.Pylori will be conducted after stopping antibiotics for 4 weeks or PPI for 2 weeks, the method is C13 breathing test or stool test. A negative test result means that HP has been eradicated.
In case the regimen fails, the evaluation test still exists H.Pylori, it is necessary to continue to monitor and make an antibiotic map. The next treatment will be a combination of 2 sensitive antibiotics and PPIs according to the antibiogram for 2 weeks.
It can be seen that the diagnosis and treatment of gastritis caused by Helicobacter pylori requires specialized equipment and highly specialized doctors, because endoscopy on children is very difficult and can only be done once. . Currently, Vinmec International General Hospital is a modern and prestigious medical system in the diagnosis and treatment of acute gastritis caused by HP bacteria.
Vinmec gathers a team of specialized gastroenterologists with rich expertise and experience in general examination and treatment of diseases related to the digestive tract and digestive auxiliary organs, including acute gastritis in children with HP. In addition, Vinmec owns a system of modern medical equipment, meeting international standards and professional service quality, bringing high efficiency in diagnosis and treatment.