Helicobacter pylori

infection
in childhood
NURUL AIN ZAKARIA

ANAMNESIS
A 7 year-old girl, 21kg, 118cm
REASON OF ADMISSION
Intensive spastic abdominal pain
lasts long for 1 hour and 30 minutes
Present symptoms :
3 days with constipation
Failure to thrive
Abominal pain around umbilical, usually
after eating
No apetite

ANAMNESIS
PERSONAL HISTORY
1st pregnancy, 1st delivery
Given birth at 37weeks, with Caesarean section
for obstructed labour.
Birth weight : 3.05kg, Birth length : 46cm
Normal adaptation & psychomotoric
development
Negative perinatal examination (US of hip,
screening )
Normal vaccination without complication
Breastfed until 3 months old, continue with
complementary food

ANAMNESIS
PAST HISTORY
Has chicken-pox on 2008
Second admission to the hospital
Previous symptoms on January 2009
Abdominal pain
Diarrhea

Previous examinations
Ultrasound
Gastroscopy with biopsy
Biochemistry test

 Histological analysis total villus atrophy,

increase number of intraepithelial
lymphocytes, hyperplastic crypt
Diagnosed with classical Celiac Disease, 3rd
degree

ANAMNESIS
Failure to thrive
118 cm (25th percentile) not optimal
21 kg (25th percentile) not optimal

Has allergy to milk

ANAMNESIS
FAMILY HISTORY
Father : healthy
Mom : has Irritable Bowel Syndrome (IBS)
Has 1 sister (different father and mother)
and 1 brother (same father, different mom).
Both are healthy

SOCIAL HISTORY
Lives with father and his girlfriend, and
siblings
Has contact with cats and dogs
Stay with grandparents during weekend

ANAMNESIS
PHARMACOLOGICAL HISTORY
Fenistil drops against allergy
Cream for skin against eczema

Physical examination
Cooperates well during examination
Inspection :
Has skin rashes, exanthema on extremities
Good hydration with normal skin turgor
Normal peripheral blood circulation no cyanosis
Normal eyes, with no secretion

Palpitation
No enlarged lymph nodes
No pain on abdomen

Auscultation
Breathing is normal during auscultation
Heart rate is normal; 70bpm

EXAMINATION RESULTS
IMAGING
7/12/2014 : xray of abdomen while
standing shows no free gas, mixed
intestinal contents from colon to sigmoid
8/12/2014 : Presence of gas at left loop
of small intetine

*source:

Lab results
Urinanalysis result
7.12.2014

8.12.2014

Leukocyte (leu/ul) (normal = 0 10)

34

Erythrocyte

Bacterial cells

Yeast

Epithelial cells

Crystal

pH (normal = 4.6 8.0)

7.0

6.5

 Blood test result

7.12.2014
Leukocyte (leu/ul) (normal = 4.5 10.0 x 109/l)

5.69 x 109/l

Erythrocyte (normal = 3.8 5.5 102/l)

4.53 x 102/l

Haemoglobin (normal = 12.5 g/l - 135 g/l mean)

126 g/l

Hematocrit (normal = 0.36 4.0)

0.37

Mean corpuscular volume (normal = 80100 fL)

82.1 fL

Mean corpuscular haemoglobin (normal = 25 to

33 picograms/cell

27.8 pg/c

Mean corpuscular haemoglobin concentration

(normal = 3137 g/dL)

33.9 g/dl

Thrombocytes (normal 150 400 109/l)

237 x 109/l

Biochemistry serum
Normal
value

7.12.2014

Natrium (mmol/l)

135 147

142

Kalium (mmol/l) (

3.5 5.1

4.06

Chloride (mmol/l)

95 110

109

Urea (mmol/l)

3.0 7.0

3.1

Creatinine (umol/l)

M : 60 118
F : 50 98

63

Bilirubin (umol/l)

ALT (ukat/l)

M : 0.5 1.1
F : 0.15 0.75

0.33

AST (ukat/l)

M : 0.25
0.75
F : 0.25 0.60

0.44

ALP (ukat/l)

0.6 2.0

2.30

GGT (ukat/l)

0.63

0.12

Alpha-amylase (ukat/l)

0.5 1.1

0.69

Lipase (ukat/l)

0.30

 Coagulation screen test

Quick test : 76%
Quick test INR : 1.12
aPTT : 31.7s

Endocrinology test
TSH : 0.767 mlU/l
T4 : 14.7 pmol/l

Growth percentile graph

Conclusion
Caeliac disease was excluded for
present problem. The patient was
infected with Helicobacter Pylori,
proven by presence of H. pylori antigen
in stool.
Patient also had skin urticaria and
being given Forlax for treatment
The patient was recommended to have
another check up 3 days after released
from hospital

Helicobacter pylori infection

> 50% of the worlds population
infected
Risk factor
Contaminated water supply with fecal
matter (fecal-oral)
Genetic factor
Live in developing countries
Hygenic factor

 Pathogenesis
causes changes to the stomach and
duodenum
infect the protective tissue that lines the
stomach
release of certain enzymes and toxins and
activation of the immune system
causes chronic inflammation in the walls of
the stomach (gastritis) or duodenum
(duodenitis)

 Symptoms
Pain or discomfort (usually in the upper
abdomen)
Bloating
Feeling full after eating a small amount of
food
Lack of appetite
Nausea or vomiting
Dark or tar-colored stools

 Complications
Duodenal ulcer
Inflammation of stomach lining
(gastritis)
Peptic ulcer

 Differential Diagnosis
Duodenal Ulcer
Gastric ulcer
Gastrinoma
Gastritis
Gastroesophageal reflux disease
Celiac disease
NSAID-induced cancer
Pancreatic cancer
Mucosa-associated lymphoid tissue (MALT)
lymphoma

 Diagnosis
Blood tests detect specific antibodies (IgG,
IgM, IgA) that the body's immune system develops
in response to the H. pylori bacterium.
Breath tests drink a specialized solution
containing a substance that is broken down by the
H. pylori bacterium. The breakdown products can
be detected in your breath.
Stool tests to detect H. pylori proteins in stool
Scope tests to view the condition of the
mucosal lining of the stomach and duodenum and
to obtain biopsy specimens from the gastric
antrum.

 Treatment
Antibiotics (10-14d of amoxicilin @
tetracycline @ metronidazole)
Protein pump inhibitor
Histamine H2 blockers
Bismuth subsalicylate

Long-term expectations

*source from kibion.com HeliprobeSystem

References
Patients anamnesis
Illustrated textbook of paediatrics
abdominal pain in childhood
Uptodate.com h. pylori infection
Celiac.org celiac disease foundation
Hpylorilearningcenter.com
CDC centers for disease control and
prevention