Helicobacter Pylori Infection and Peptic Ulcer Disease in Children and Adolescents from the Age Range of 6 to 18 Years Old in Yaounde (Cameroon)

F Ankouane Andoulo, G Ngatcha, M Tagni-Sartre, M Biwolé Sida, EC Ndjitoyap Ndam

Abstract


ABSTRACT
BACKGROUND: A high prevalence of Helicobacter pylori (H pylori) infection is observed in the pediatric age in developing countries. Thus, in these countries with a high prevalence of H pylori infection, peptic ulcer disease (PUD) is still common in the pediatric age. This study aimed to describe the prevalence, clinical manifestations and complications of PUD in the pediatric age in Cameroon.
MATERIAL AND METHODS: This was a 9-year retrospective study. Data of children and adolescents admitted to the “Centre Médical la Cathédrale” of Yaounde, for upper GI tract endoscopy between January 2006 and December 2014 were reviewed. A group of 115 patients with PUD (84 boys [73.0%], 31 girls [27.0%]; 24 children [20.9%], 91 adolescents [79.1%]; mean age 14.7 ± 3.0 years) were compared with a control group of 99 patients without ulcer (49 boys [49.5%], 50 girls [50.5%]; 35 children [35.4%], 64 Adolescents [64.6%]; mean age 14.1 ± 3.4 years). H pylori was diagnosed when the rapid urease test and histology were both positive.
RESULTS: PUD was found in 33.1% (115/347) of patients. The overall prevalence of H pylori was 68.3%. Peptic ulcers were mostly duodenal ulcers (75.7%) and Helicobacter pylori-positive ulcers (77.4%). The prevalence of Helicobacter pylori in gastric ulcer and in duodenal ulcer was 61.9% and 79.3%, respectively. H pylori was more frequent in patients with PUD than in control patients (77.4% vs. 52.4%; p=0.0001). H pylori was more frequently detected in girls than in boys (90.3% vs. 72.6%; p= 0.07), in adolescents than in children (78.0% vs. 75.0%, p= 0.75). Most of patients were admitted due to abdominal pain (80.9%). There was no significant association between abdominal pain and Helicobacter pylori infection (p= 0.99). Peptic ulcer hemorrhage accounted for 20% of PUD and was mostly duodenal ulcer in children. Stenosis complicated 13% of PUD and this was more frequent in male adolescents.
CONCLUSION: PUD is common in the pediatric age in Cameroon. H pylori-related PUD is the most frequent variety and is more common among boys and in the duodenum. Measures to improve the hygienic and the social conditions are necessary to protect children against H pylori infection.

RÉSUMÉ
OBJECTIF : Évaluer la prévalence de l’infection à H pylori, déterminer les manifestations cliniques et les complications dans la maladie ulcéreuse peptique chez l’enfant et l’adolescent camerounais.
MATÉRIELS ET MÉTHODES: Il s’agit d’une étude rétrospective sur 9 ans chez des patients issus de la cohorte du Centre Médical la Cathédrale de Yaoundé, qui effectue des endoscopies digestives. Un groupe de 115 patients avec un ulcère peptique (84 garçons [73,0%], 31 filles [27,0%] ; 24 enfants [20,9%], 91 adolescents [79,1%] ; moyenne d’âge 14,7±3,0 ans) a été comparé à un groupe contrôle de 99 sujets sans ulcère (49 garçons [49,5%], 50 filles [50,5%] ; 35 enfants [35,4%], 64 adolescents [64,6%] ; moyenne d’âge 14,1±3,4 ans). Tous ont bénéficié d’une endoscopie digestive haute à la même période pour des symptômes digestifs. L’infection à H pylori était diagnostiquée quand le test rapide à l’uréase et l’histologie étaient tous les deux positifs.
RÉSULTATS: L’ulcère peptique a été retrouvé chez 33,1% (115/347) des patients ayant bénéficiés d’une endoscopie. La prévalence globale de H. pylori était de 68,3%. La majorité des ulcères étaient duodénaux (75,7%) et H pylori positif (77,4%). La prévalence de H pylori dans l’ulcère gastrique et dans l’ulcère duodénale était de 61,9% et 79,3%, respectivement. H pylori était plus fréquent chez les patients avec un ulcère que chez les sujets contrôles (77, 4% vs. 52,4% ; p=0,0001). H pylori était détecté plus fréquemment chez les filles que chez les garçons (90, 3% vs. 72,6% ; p=0,07), chez les adolescents que chez les enfants (78,0% vs. 75,0% ; p=0,75). La majorité des patients étaient admis pour les douleurs abdominales (80,9%) et les hématémèses (23,5%). Il n’y avait pas d’association significative entre la douleur abdominale et l’infection à H pylori (p=0,99). L’ulcère peptique hémorragique représentait 20% des ulcères et était plus fréquent dans le duodénum et chez l’enfant. La sténose compliquait 13% des ulcères et plus fréquemment chez les adolescents de sexe masculin.
CONCLUSION: La maladie ulcéreuse est très fréquente parmi les enfants et adolescents camerounais, il s’agit souvent des ulcères compliqués duodénaux et H pylori positif.


Keywords


Helicobacter pylori, Peptic ulcer disease, Children, Adolescent, Cameroon

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