Tanju Başarır ÖZKAN, Taner ÖZGÜR, Gülin ERDEMİR, Sevim ÇAKAR, Hanife Ayşegül ARSOY

Çocuklarda Helicobacter pylori Enfeksiyonunda Risk Faktörleri ve Klinik Bulgular

Giriş ve Amaç: Helicobacter pylori(H.pylori) enfeksiyonu tüm dünyada en yaygın kronik enfeksiyonlardan biridir. Gelişmekte olan ülkelerde bulaş genellikle çocukluk döneminde olmaktadır. Düşük sosyoekonomik seviyede yaşayanlarda daha sık görülmektedir. Tamamen asemptomatik olabileceği gibi, gastrointestinal ve ekstraintestinal semptomlarla karşımıza çıkabileceği de bilinmektedir. Bu çalışmada çocuklarda H.pylori seroprevalansının saptanması, risk faktörleri ve semptomların değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya Bursa ilinde beş farklı ilköğretim okulundan randomizasyonla 6-16 yaş arası 489 öğrenci alındı. Kabul eden ailelerden sosyoekonomik bilgileri ve çocuklarındaki semptomları sorgulayan anketleri doldurmaları istendi. Okullara gidilerek çocukların antropometrik ölçümleri yapıldı. H.pylori İmmunglobulin G (IgG) çalışılmak üzere çocuklardan 5 ml kan örneği alındı. Çocuklar H.pylori IgG pozitifliğine göre 2 gruba ayrılarak sosyoekonomik özellikler ve semptomlar karşılaştırıldı. Bulgular: Çalışmaya 489 öğrenci alındı, %48,7 kız ve %51,3 erkekti. Yaş ortalaması 9,9±2,3 yıldı. H. pylori seropozitifliği %44 çocukta saptandı. Kızların %52,1’i, erkeklerin %36,3’ü seropozitif bulundu (p=0,0001). Sosyoekonomik faktörlerden babanın eğitim düzeyi azaldıkça çocukta H. pylori sıklığının arttığı saptandı (p=0,005). H. pylori seropozitif olanlarda boy ve vücut ağırlığı Z skorları negatif olanlara göre anlamlı olarak düşüktü (p=0,012 ve p=0,03;sırasıyla). Yaş gruplarına göre bakıldığında H.pylori seropozitiflerde 6-10 yaşta vücut ağırlığının ( p=0,03), 10 yaşından büyüklerde ise boy uzunluğunun (p=0,04) daha geri olduğu saptandı. Sonuç: Bursa ilinde ilköğretim çağında saptanan H.pylori seropozitivite sıklığı Türkiye verileri ile uyumludur. Vücut ağırlığı ve boy uzunluğunun seropozitiflerde daha geri olduğu görülmüştür. Seropozitivitenin 10 yaştan küçük çocuklarda vücut ağırlığını, 10 yaştan büyük olanlarda ise boy uzunluğunu ön planda etkilediği görülmüştür. Sonuç olarak çocuklarda H.pylori, bulaş sonrası asemptomatik kalabilen ancak çocuklarda büyümeyi olumsuz etkilediği unutulmaması gereken önemli bir faktördür.

Anahtar Kelimeler:

çocuk, helicobacter pylori, büyüme, epidemiyoloji

The risk factors and clinical findings in pediatric helicobacter pylori Infection

Objective: Helicobacter pylori (H.pylori) infection is one of the most common chronic infections in the world. In developing countries, new infections more commonly occur in childhood and lasts for life unless treated. H pylori infection is more prevalent in low socioeconomic conditions. The infection may remain asymptomatic or it may cause gastrointestinal and extra intestinal symptoms. The aim of this study is to determine the prevalence, associated risk factors and symptoms of H.pylori infection in healthy school children. Materials and Methods: The study included randomly selected 489 students aged 6-16 years, from five colleges in Bursa city. Informed consent was taken from the parents and they were asked to fill out the questionnaire forms about their socioeconomical conditions and child’s symptoms. School visits were organized for anthropometric measurements of each student and to collect blood samples for testing H.pylori Immunoglobulin G (IgG). The children were grouped according to H pylori seropositivity and groups were compared according to socioeconomical and clinical characteristics. Results: This study group included 251 girls (48.7%) and 248 boys (51.3%), the mean age was 9.9±2.3 years. Forty-four percent of the children were H.pylori seropositive, of whom 52.1% were girls and 36.3% were boys (p=0.0001). Paternal education was an independent risk factor for H.pylori infection and was inversely correlated with seropositivity (p=0.005). The body weight and height were significantly lower in seropositives in comparison to negative ones (p=0.012 and p=0.03, respectively). The analysis according to age groups revealed that seropositivity was associated with low weight in children younger than the age of 10 years (p=0.03), and with short stature in the older group (p=0.04). Conclusion: The H.pylori seropositivity of school children in Bursa city was consistent with Turkey data. Our results showed that both body weight and height of school children were negatively affected by H.pylori infection. While weight is affected primarily in younger ages, height was impaired in older ones. In conclusion, H.pylori infection is generally asymptomatic in childhood but it should be kept on mind that it has unfavorable consequences on child’s growth.

Keywords:

child, helicobacter pylori, growth, epidemiology,

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