H. pylori is a common, spiral-shaped bacterium that has adapted to live in the harsh, acidic environment of the stomach and the first part of the small intestine. It survives by producing an enzyme called urease, which neutralizes stomach acid, allowing it to burrow into the protective mucus lining. Children can become infected with H. pylori, often acquiring the bacteria early in life. While many children carry the bacterium without symptoms, the infection can cause irritation and inflammation of the stomach lining (gastritis) and lead to more serious digestive problems.
How Children Acquire the Infection
The primary way children acquire H. pylori is through person-to-person transmission, often clustering within family units. Exposure to the bacterium typically happens early in childhood, especially in households where an infected relative, most commonly the mother or a sibling, is present. This close contact facilitates the transfer of the bacteria through the oral-oral route, such as sharing utensils or through saliva contact.
Another significant pathway is the fecal-oral route, which involves ingesting the bacteria through contact with contaminated stool. This route is strongly linked to living conditions that involve poor sanitation and hygiene practices. In areas with inadequate public health infrastructure, contaminated food and water sources can also serve as vehicles for the bacteria’s spread.
The prevalence of H. pylori infection is notably higher in communities with crowded living situations and lower socioeconomic status. In high-income countries, less than 10% of children under 12 may be infected, but this rate can be significantly higher in developing regions. Once acquired, the infection almost always becomes chronic unless specific medical treatment is administered to clear the bacteria entirely.
Recognizing Symptoms in Kids
Most children who carry the H. pylori bacterium will remain asymptomatic. When symptoms do manifest, they often present as vague and non-specific gastrointestinal complaints, which can sometimes mimic other common pediatric issues. The most frequent clinical manifestation is chronic gastritis, which is the inflammation of the stomach lining caused by the bacterial presence.
Symptoms related to gastritis may include recurrent or chronic abdominal pain, often described as a dull or gnawing sensation. Children might also experience episodes of nausea, vomiting, or a persistent feeling of bloating. Unlike the classic presentation in adults, severe burning ulcer pain that wakes a child from sleep is less common, though it can occur in older children.
The infection can also lead to a poor appetite, unexplained weight loss, or a feeling of early satiety, which is feeling full after eating only a small amount of food. In rare but serious cases, the bacterium can cause a peptic ulcer, a sore in the stomach or upper small intestine. Signs of a bleeding ulcer, such as vomiting blood or having black, tarry stools, are medical emergencies that require immediate attention.
Confirming the Diagnosis
Diagnosing H. pylori in children typically begins with non-invasive testing to confirm the presence of the bacterium. One common method is the Urea Breath Test (UBT), where the child drinks a liquid containing a labeled carbon molecule. If H. pylori is present, it breaks down the liquid, releasing labeled carbon dioxide detected in the child’s breath.
Another reliable non-invasive option is the H. pylori Stool Antigen Test (HpSA), which looks for specific bacterial proteins in a stool sample. Both the UBT and HpSA tests are favored in pediatric practice because of their accuracy and ease of collection. For accurate results, children must be off certain medications, like proton pump inhibitors and antibiotics, for a specific period before the test is administered.
Invasive testing, such as an upper endoscopy, is generally reserved for children with severe or complicated symptoms, or when treatment has failed. During this procedure, a thin, flexible tube with a camera is passed down the throat to visualize the stomach lining and collect small tissue samples, called biopsies. These samples allow doctors to directly confirm the presence of the bacteria, check for antibiotic resistance, and look for complications like ulcers.
Treatment and Recovery
When H. pylori infection is confirmed and causing symptoms or complications, the standard approach is eradication therapy, which involves a combination of medications. This treatment typically consists of a proton pump inhibitor (PPI), which works to suppress the production of stomach acid, combined with two different antibiotics. The acid-reducing medication helps to heal the irritated lining and allows the antibiotics to work more effectively against the bacteria.
This triple therapy regimen is usually prescribed for a duration of 14 days. It is crucial that the full course of antibiotics be completed, even if the child feels better quickly. Failure to finish the medication increases the risk of the bacteria developing drug resistance, which complicates future treatment attempts. Common antibiotics used include amoxicillin, clarithromycin, and metronidazole.
Following the completion of the treatment course, a “test-of-cure” is required to ensure the bacteria has been completely eliminated from the stomach. This follow-up testing is usually performed using the UBT or HpSA, typically a few weeks after the medication is finished. During the recovery period, simple lifestyle adjustments, such as encouraging smaller, more frequent meals, can help reduce stomach irritation. Parents should also avoid giving their child non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin, as these can further irritate the stomach lining and impede healing.