A carregar...
Publicação
Time trend prevalence of Helicobacter pylori infection and endoscopic findings in symptomatic children in Portugal : a retrospective study of 10 years
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 1.09 MB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
Introdução: A infeção por H. pylori é maioritariamente adquirida na infância e pode ser um fator crítico para o desenvolvimento de complicações a longo prazo. Contrastando com outros países desenvolvidos, estudos prévios reportam uma prevalência de infeção elevada em Portugal na idade pediátrica ena idade adulta. No entanto, não existem dados recentes relativamente à população pediátrica.
Objetivo: Este tudo procurou estimar a tendência da prevalência da infeção por H. pylori ao longo de 10 anos e caraterizar a associação entre os achados clínicos, endoscópicos e histológicos e a infeção em crianças sintomáticas num período de 10 anos.
Métodos: Foi realizado um estudo retrospetivo relativo a um período de 10 anos (3 anos ilustrativos - 2009, 2014 e 2019) que incluiu crianças e adolescentes com idade inferior a 18 anos de idade submetidos a endoscopia digestiva alta na Unidade de Gastroenterologia pediátrica do Hospital Santa Maria. Foram obtidos dados demográficos, clínicos e anatomo-clínicos (indicação para endoscopia, status H. pylori e achados endoscópicos e histológicos).
Resultados: 461 crianças (46.2% género feminino) foram incluídas. A média das idades foi 11.2± 4.4 anos. A prevalência média global foi de 37.3%, com uma prevalência de 44.3% em 2009, 33.7% em 2014 e 32.2 % em 2019. Uma tendência decrescente na prevalência da infeção por H. pylori foi observada (p= 0.027). A indicação mais comum para realização de endoscopia foi a dor abdominal. A nodularidade antral esteve presente em 72.2% das crianças com infeção e em 31.7% das crianças sem infeção (p<0.001). O grupo etário, a presença de inflamação crónica moderada/grave, densidade bacteriana ligeira/grave e de agregados/folículos linfoides, foram indicadores preditivos da presença de nodularidade antral. A presença de dor abdominal, nodularidade antral, inflamação crónica moderada a grave, gastrite ativa no antro e no corpo e a presença de folículos/agregados linfoides no antro, foram indicadores preditivos de infeção.
Conclusões: Este estudo demonstra (pela primeira vez em Portugal e neste contexto clínico em particular), uma diminuição significativa da prevalência da infeção por H. pylori na idade pediátrica ao longo do período de estudo. No entanto, poderá considerar-se ainda elevada, tendo em consideração a evolução do nível de desenvolvimento do país, enquadrado geograficamente na Europa do Sul e a prevalência recentemente reportada noutros países do Sul da Europa. Adicionalmente, foi confirmada uma associação positiva, previamente reconhecida, entre alguns achados endoscópicos e histológicos e a infeção por H. pylori. A relevância clínica destes achados requer confirmação adicional, tendo em consideração a persistência de elevada incidência de cancro gástrico em Portugal (2950 novos casos em 2020) e a potencial relevância da consideração de estratégias de intervenção especificas quer no adulto, quer em idade pediátrica.
Background: Helicobacter pylori (H. pylori) infection acquisition occurs mainly in childhood and may be a critical factor for the development of long-term complications. In contrast to other developed countries, previous studies have reported a still high H. pylori infection prevalence in Portugal, both in children and adults. However, there are no recent data concerning the paediatric population. Aim: This study aimed to estimate the prevalence trend of H. pylori infection and characterize associated clinical, endoscopic and histologic findings in symptomatic children within ten years. Methods: We performed a retrospective observational study over ten years (2009, 2014 and 2019) that included children and adolescents under 18 years old who underwent upper gastroduodenal endoscopy in the Paediatric Gastroenterology Unit at University Hospital Santa Maria. Demographic and clinical-pathological data (indication for endoscopy, H. pylori status and endoscopy/histology findings) were collected. Results: 461 children (46.2% female) were included. The average age was 11.2± 4.4 years. In total, 37.3% had H. pylori infection, with a mean prevalence of 44.3% in 2009, 33.7% in 2014 and 32.2 % in 2019. A decreasing infection trend was observed in our study (p= 0.027). The most common indication for endoscopy was abdominal pain. Antral nodularity was present in 72.2% of the H. pylori-infected children and 31.7% of non-infected children (p<0.001). The oldest age groups, moderate/severe chronic inflammation, H. pylori density and lymphoid aggregates and follicles were positive predictors for the presence of antral nodularity. The presence of antral nodularity, neutrophilic activity in the antrum and corpus and lymphoid follicles and aggregates in the antrum were positive predictors for the presence of H. pylori infection. Conclusions: The present study reports (for the first time in our country and the endoscopy setting) a significant decrease in the prevalence of paediatric H. pylori infection during the study period, although it remains relatively high, taking into account the country’s income level and the recently reported prevalence in other South European countries. Moreover, we confirmed a previously recognized positive association of some endoscopic and histological features with H. pylori infection. The clinical relevance of these findings requires confirmation with further studies at a national level, taking into account the high incidence rate of gastric cancer in Portugal (2950 new cases in 2020) and the potential need for country-specific intervention strategies, both in adulthood and in childhood.
Background: Helicobacter pylori (H. pylori) infection acquisition occurs mainly in childhood and may be a critical factor for the development of long-term complications. In contrast to other developed countries, previous studies have reported a still high H. pylori infection prevalence in Portugal, both in children and adults. However, there are no recent data concerning the paediatric population. Aim: This study aimed to estimate the prevalence trend of H. pylori infection and characterize associated clinical, endoscopic and histologic findings in symptomatic children within ten years. Methods: We performed a retrospective observational study over ten years (2009, 2014 and 2019) that included children and adolescents under 18 years old who underwent upper gastroduodenal endoscopy in the Paediatric Gastroenterology Unit at University Hospital Santa Maria. Demographic and clinical-pathological data (indication for endoscopy, H. pylori status and endoscopy/histology findings) were collected. Results: 461 children (46.2% female) were included. The average age was 11.2± 4.4 years. In total, 37.3% had H. pylori infection, with a mean prevalence of 44.3% in 2009, 33.7% in 2014 and 32.2 % in 2019. A decreasing infection trend was observed in our study (p= 0.027). The most common indication for endoscopy was abdominal pain. Antral nodularity was present in 72.2% of the H. pylori-infected children and 31.7% of non-infected children (p<0.001). The oldest age groups, moderate/severe chronic inflammation, H. pylori density and lymphoid aggregates and follicles were positive predictors for the presence of antral nodularity. The presence of antral nodularity, neutrophilic activity in the antrum and corpus and lymphoid follicles and aggregates in the antrum were positive predictors for the presence of H. pylori infection. Conclusions: The present study reports (for the first time in our country and the endoscopy setting) a significant decrease in the prevalence of paediatric H. pylori infection during the study period, although it remains relatively high, taking into account the country’s income level and the recently reported prevalence in other South European countries. Moreover, we confirmed a previously recognized positive association of some endoscopic and histological features with H. pylori infection. The clinical relevance of these findings requires confirmation with further studies at a national level, taking into account the high incidence rate of gastric cancer in Portugal (2950 new cases in 2020) and the potential need for country-specific intervention strategies, both in adulthood and in childhood.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Helicobacter pylori Criança Prevalência Endoscopia Histologia Nodularidade antral Pediatria