Gastric Emptying in Children with Non-ulcerative Dyspepsia H. pylori Positive and H. pyloriNegative. The Effect of H. pylori Infection

Overview

H. pylori has been established as a cause of various gastroduodenal disorders. The role of H. pylori in thedevelopment of functional dyspepsia (NUD) and recurrent abdominal pain (RAP) in children is unclear. Gastricmotility disturbances are considered to be associated with dyspeptic symptoms. The objectives of the study wereto elucidate whether gastric emptying was altered in children with and without H. pylori infection with NUD.A total of 36 consecutive children with NUD (n = 36, female 19, male 17, range 7 - 18 years) were enrolled inthe study. All children underwent extensive check-up to exclude organic lesions, ultrasonography, gastroscopy,histologic examination, and standardized scintigraphic examination using a technetium-99m (99mTc) radiolabelledsolid meal, and gastric emptying was measured as t1/2 (time taken for half the labelled meal to be emptied fromthe stomach). The updated Sydney system was used to score the grade of chronic gastritis (0 - 3). H. pylori infectionwas determined by two biopsy - based methods.Results: 19 (52.7 %) patients (13.74 ± 3.41 years) were identified as having H. pylori, 17 (47.3 %) patients (13.54± 3.12 years) were negative for H. pylori. The difference between the mean ages of two groups with and withoutH. pylori was statistically insignificant as well as for sex. There was no difference in clinical symptoms between thetwo groups. Nodular gastritis was found in 10/19 (52.6 %) in H. pylori positive patients, and in 1/17 (5.8 %) H.pylori negative (p < 0.0001). The gastritis score was significantly more severe in the H. pylori positive groupcompared to H. pylori negative (p < 0.001). There was no difference in intragastric distribution of the solid contentbetween H. pylori positive and H. pylori negative children. The mean half-time gastric emptying for H. pylori positive NUD patients was (44.9 ± 16.8 min), H. pylori negative patients (57.6 ± 12.9 min). Gastric emptying ofa solid meal was found to be significantly accelerated in patients with NUD H. pylori positive (p < 0.05). Nocorrelation was found between gastric emptying rate and age, and sex of the subjects in both groups.Conclusion: Gastric emptying of a solid meal was significantly accelerated in H. pylori positive children withNUD. Alteration in gastric motility may play a role in the development of clinical symptoms in a sub-group ofpatients with NUD in childhood. The scintigraphic method is easy to perform and accurate for the evaluation ofgastric emptying in the pediatric population.

Key words:
H. pylori, non-ulcerative dyspepsia, gastric emptying, scintigraphy