Merve USTA, Zerrin ÖNAL, Fügen Çullu ÇOKUĞRAŞ, Yaşar DOĞAN, Tülay ERKAN, Tufan KUTLU, Safa BARIŞ

Çocuklarda Helicobacter pylori enfeksiyonu: Yakınma, endoskopik bulgu, tanı yöntemleri ve tedavi sonrası eradikasyon oranlarının değerlendirilmesi

Amaç: Bu çalışmada Helicobacter pylori gastriti tanısı alan olguların yakınma, endoskopik bulgu, tanıya yönelik yapılan test sonuçları, aldıkları tedavi ve tedavi sonrası eradikasyon oranlarını değerlendirmek istedik. Gereç ve Yöntem: 1997-2005 yılları arasında çeşitli sindirim sistemi yakınmaları nedeni ile endoskopi yapılan ve biyopsi örneklerinde mikroorganizmanın histolojik olarak değerlendirilmesi ile Helicobacter pylori gastriti tanısı alan olguların dosyaları geriye dönük olarak değerlendirildi. Olguların yaş, cinsiyet, geliş yakınmaları, tanıya yönelik yapılan testleri, endoskopi bulguları, tedavi uygulamaları ve tedavi sonrası takipleri kaydedildi. Bulgular: Yaşları 3 ile 20 yaş arasında (ortalama: 10±3,2) değişen 239 olgunun 129'u (%54) erkek, 110'u (%46) kız idi. Olguların 197'sinde (%82,4) karın ağrısı, 55'inde (%23) kanlı kusma veya kanlı dışkılama, 49'unda (%20,5) kusma yakınması vardı. Endoskopi yapılan olguların 176'sında (%73,6) antral nodülarite, 24'ünde (%10) antral hiperemi, 31'inde (%13) mide ülseri, 31'inde (%13) duodenum mukozasında hiperemi ve 3 (%1,2) olguda duodenal ülser vardı. Test yaptırabilen olguların %79,3'ünde (96/121) anti Helicobacter pylori IgG, %61,1'inde (44/63) dışkıda Helicobacter pylori antijeni ve %38,5'inde (15/39) ise mide biyopsi kültürü pozitif idi. Olguların 224'ü (%93,7) tedavi almıştı. Tedavi sonrası izlemde 44 hasta kontrole gelmedi. Kontrole gelen 180 olgunun 152'sinde (%84,4) Helicobacter pylori eradikasyonu sağlanmıştı. Çıkarımlar: Helicobacter pylori tanısı alan olgularda karın ağrısı yakınması ön plandadır. Tanıya yönelik yapılan testlerden histolojik değerlendirme ve kültür altın ölçüt olmakla birlikte etkenin çoğunlukla üretilememesi önemli bir sorundur. Ayrıca olguların önemli bir kısmında üçlü tedaviye rağmen eradikasyon sağlanamamaktadır.

Helicobacter pylori infection in children: Evaluation of complaints, endoscopic findings, diagnostic methods and post-treatment eradication rates

Aim: This study aims to evaluate symptoms, endoscopic findings, diagnostic test results of cases with Helicobacter pylori gastritis, the treatment they have received and post-treatment eradication rates.Material and Method: Files of cases, who had undergone endoscopy and diagnosed as Helicobacter pylori gastritis in their biopsy samples taken between 1997-2005, were retrospectively evaluated. Age, sex, initial complaints, diagnostic tests, endoscopy findings, treatment methods and post-treatment follow-up results of cases were recorded.Results: Out of a total of 239 cases, 129 (54%) were males and 110 (46%) were females, with an average age of 10±3.2 years. There were complaints about abdominal cramps in 197 (82.4%) of cases, bloody vomiting and/or blood in stools in 55 (23%), and vomiting in 49 (20.5%). Among cases who had undergone endoscopy, 176 (73.6%) had antral nodularity, 24 (10%) had antral hyperemia, 31 (13%) had gastric ulcer, 31 (13%) had hyperemia in duodenal mucosa and 3 (1.2%) had duodenal ulcer. Anti-Helicobacter pylori IgG, Helicobacter pylori stool antigen and gastric biopsy culture were positive, respectively, in 79.3% (96/121), 61.1% (44/63) and 38.5% (15/39) of the cases. 224 cases (93.7%) had received treatment. Forty-four patients were lost to follow-up. Helicobacter pylori was eradicated in 152 (84.4%) of the 180 patients who came for follow-up.Conclusions: Abdominal pain is a common complaint in cases diagnosed as helicobacter pylori infection. While histological evaluation and culture are gold standards among the diagnostic tests, frequent failure of growth of Helicobacter pylori in culture is an important problem. Moreover, eradication cannot be achived in a considerable number of cases despite triple treatment.

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