الفهرس 
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Abstract
Beta thalassemia syndromes are a group of hereditary
disorderscharacterized by a genetic deficiency in the synthesis of betaglobinchains.
Several gastrointestinal tract disturbances seen in B-thalassemia major
patients as hepatitis, gallbladder stones, gastritis and recurrent abdominal
pain (RAP) with a great incidence.
Recurrent abdominal pain (RAP) is one of the most common
complaints of childhood. RAP is defined as at least three episodic attacks of
abdominal pain over at least three months that are severe enough to affect
the usual activity of the child.
Helicobacter pylori (H. pylori) , a human bacterial gastric pathogen, is
highly prevalent, varying from 5–15% in developed countries to 70% in the
developing world.
However it is not proven that HP infection is one of the causes for
RAP in ß TM patients. There are very limited number of studies about this
subject.
So our study was done to determine the frequency of HP
seroprevalence and active infection in ß TM patients both symptomatic and
asymptomatic for RAP and to compare between ß TM patients and normal
controls presenting with RAP.
The study included 2 groups group I consists of forty multitransfused
β-thalassemia major patients Aged 3 – 18 years.They were subdividedinto
Group Ia ( symptomatic for RAP) and Group Ib ( asymptomatic for RAP)
each group consists of 20 β thalassemia major patients. They were collected
from hematology and oncology unit, Pediatric department, Minoufya
University Hospital. Group II(control group) consists of 20 children
complaining of recurrent abdominal pain with no chronic illness whose ages
and gender were compatible from the outpatient Pediatric clinic of the same
hospital.
Each patient and control subjected to the following:
1- Complete history includes personal history, history of the present
illness, and past history of blood transfusion, abdominal pain analysis.
2- Thorough clinical examination include general, anthropometric, and
abdominal examination.
3- Laboratory and radiological investigation: complete blood count,
Erythrocytesedimentation rate (ESR),hepatitis B and C viral
markers,ALT and AST, stool analysis,urine analysis, s. creatinine,
hemoglobin electrophoresis ,serum ferritin and abdominal Ultrasound.
All patients were examined for anti-HP antibody using HP-IgG
ELISA test. positive patients for HP-IgG were examined for helicobacter
pylori antigen in the stool.
Results of our study showed:
The overall prevalence of HP IgG in β TM patients was 45% which
was equal to that of the control group however, the overall
prevalence of stool antigen positive test was 37.5% in β TM patients
compared to 30% in controls .
The prevalence of HP Ig G (+ve) was higher in thalassemia patients
without RAP (50%) than control group (45%) and thalassemia
patients with RAP (40%) but no significant difference was found
(p>0.05).
On the other hand, our study revealed that theprevalence of stool
antigen positive patients was higher in thalassemia patients with
RAP (40%) than thalassemia patients without RAP (35%) and
control group (30%) but also no significant difference was found
(p>0.05).
No significant difference between the studied groups on comparison
of serum positive HP antibody against positive antigen in stool
(P>0.05 ).
Regarding demographic data and anthropometric measurement,no
significant difference among the studied groups regarding age, sex ,
residence and BMI (P >0.05) but significant difference between each
group of thalassemia and controls regarding height and weight
(P<0.05).
Regarding pain site, pain duration and associated symptoms,no
significant differencebetween thalassemia patients with RAP and
controls (P>0.05).
No significant difference between both groups of thalassemia
regarding chelation type, chelation course, blood transfusion units ,
blood transfusion frequency and splenectomy (P>0.05).
Regarding hematological data of the studied groups:
Regarding hemoglobin and serum ferritin, highly significant
difference between each group of thalassemia and control group
(p<0.001).
Regarding viral markers, significant difference between thalassemia
patients without RAP and controls(p<0.05).
Regarding ALT and AST, highly significant difference between
thalassemia patients without RAP and controls (p<0.001).
Results of serum positive HP antibody and positive stool antigen
regarding some parameters showed:
o Regarding age, significant difference between thalassemia
patients without RAP and controls in theresults of HPIg G
(p<0.05). While, no significant difference in theresults of HP
stool antigen (P>0.05).
o Regarding sex, residence, height, weight and body mass index
no significant difference among the studied groups for both HP
antibody and stool antigen results (P>0.05).
o Regarding pain site, no significant difference between
thalassemia patients with recurrent abdominal pain and controls
in terms of HP antibody (P>0.05). However, there was
significant difference in terms of stool antigen results (P<0.05).
o Regarding pain duration and other associated symptoms,no
significant difference betweenthalassemia patients with
recurrent abdominal pain and controls in terms of HP antibody
as well as stool antigenresults (P>0.05).
o Regarding splenectomy, no significant difference between both
groups of thalassemia for HP antibody(P>0.05). however, there
was significant difference in terms of stool antigen results
(P<0.05).
o Regarding chelation type, chelation course, blood transfusion
units and blood transfusion frequency no significant difference
between both groups of thalassemia for both HP antibody as
well asstool antigen results( P >0.05).
o Regarding hemoglobin,significant difference between each
group of thalassemia and control groupfor HP antibody
(P<0.05). However, nosignificant difference between each
group of thalassemia and control groupin terms of stool antigen
results (P>0.05).
o Regarding serum ferritin, significant difference between each
group of thalassemia and control group in terms of HP antibody
as well as stool antigen results (P<0.05).
o Regarding ALT, significant difference between thalassemia
patients without RAP and controls in terms of HP antibody
(P<0.05). However, no significant difference among the studied
groups for stool antigen results (P>0.05).
o Regarding AST, significant difference between thalassemia
patients without RAP and controls in terms of HP antibody as
well as stool antigen results (P<0.05).
o Regarding viral markers, significant difference between
thalassemia patients without RAP and controls in terms of HP
antibody (P<0.05). However, significant difference between
thalassemia patients with recurrent abdominal pain and controls
for stool antigen results (P < 0.05).
We concluded that the high prevalence of H. pylori infection suggests
that H. pylori should be remembered as a probable cause of RAP in β-
thalassemia major patients as well as healthy children. HP seroprevalence
was high (45%) in thalassemic and controls. active infection was higher in
thalassemic than controls and affected with splenectomy and high serum
ferritin.