PERINATOLOGY AND PEDIATRIC. UKRAINE. 2017.3(71):108-114; doi 10.15574/PP.2017.71.108

Ali Sameh Ali
Bohomolets National Medical University, Kyiv, Ukraine

Objective. To analyze the indications for bismuth-based anti-H. pylori therapy and to study its efficacy in children with functional dyspepsia (FD) taking into account H. pylori CagA-status and serum vitamin D levels.
Material and methods. Sixty children (main group) aged 6-17 years diagnosed with H. pylori-associated functional dyspepsia underwent different modified bismuth-based anti-H. pylori treatment regimens comparing to children in the control group (n=62), where 32 patients received no treatment and 30 children received standard 7-day lansoprazole-based triple anti-H. pylori therapy. The common diagnostic algorithm was used. Children with FD who had H. pylori infection confirmed in subsequent non-invasive tests were included in the study. At the pre-treatment stage, we analyzed the disease course to establish its main factors, not considering the presence of H. pylori infection, and weighed the risks and benefits of anti-H. pylori therapy. To verify H. pylori infection in children with FD, from 4 to 6 biopsy samples from gasrtric mucosa were taken during duodenoscopy for further microscopic examination and rapid urease analysis: once H. pylori infection was detected, the final decision concerning anti-H. pylori therapy in each particular case was made. In all children tests for total serum anti-H. pylori CagA antibodies as well as serum 25-hydroxycholecalciferol (vitamin D) were performed.
Results. In the main group H. pylori CagA antibodies were detected in 40 patients and were not detected in 20: 40 children had H. pylori CagA_positive (CagA+) status and 20 children had H. pylori CagA-negative (CagA-) status. In the main group, 22 children had serum vitamin D levels within the normal range and 38 children had vitamin D deficiency. In the main group the rate of successful eradication was 78.3%. A comparison of the efficacy of 10-day bismuth-based sequential eradication therapy with vitamin D as an adjuvant and 7-day bismuth-based triple therapy showed the rates of eradication 73.3% and 83.3%, respectively. In the main group, the rates of successful eradication depending on H. pylori CagA+ and H. pylori CagA-status were 92.5% and 50%, respectively; depending on vitamin D supply: in children who had vitamin D deficiency – 76.3%, in those who had serum vitamin D levels within the normal range – 81.8%. The rate of successful eradication of standard 7-day triple therapy was 70%: depending on H. pylori CagA+ or H. pylori CagA-status: 95.2% and 11.1%, respectively; depending on vitamin D supply: 66.7% in children who had vitamin D deficiency, in those who had serum vitamin D levels within the normal range – 80%.
Conclusions. The indications for anti-H. pylori therapy in children with FD should be individualized taking into consideration its risks and benefits: simultaneous eradication in family members who have first- or second-degree relatives with H. pylori–dependent conditions; detection of H. pylori in gastric samples; self-contamination with H. pylori CagA+. In children with FD both bismuth-based therapies, 7-day triple and 10-day sequential, provide a high rate of eradication. H. pylori CagA-status and serum vitamin D level can serve as predictors of effective H. pylori eradication. The rate of successful eradication does not depend on clinical forms of functional dyspepsia. Children with H. pylori CagA-status who have insufficient supply of vitamin D or vitamin D deficiency should obtain vitamin D exogenously as an adjuvantto 10-day bismuth_based sequential eradication therapy. The above-mentioned combined scheme may increase the efficacy of H. pylori eradication.
Key words: functional dyspepsia, H. pylori CagA-status, sequential anti-H. pylori therapy, bismuth subcitrate, 25-hydroxycholecalciferol, children.

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