الفهرس 
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HematemesisOnly 14 pages are availabe for public view
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Abstract
This is a prospective case control study, conducted in the Gastroenterology Unit, Children’s Hospital, Assiut University during a one-year period from January to December 2016. The present study included 32 children admitted to the unit, complaining of chronic or recurrent unexplained dyspeptic symptoms and/or non variceal hematemesis. The study also included another group of 18 apparently healthy controls of matched age and sex.
The study aims to assess the effect of helicobacter pylori infection in children on the blood levels of some micronutrients including Zinc, Selenium, Ascorbic acid, and vitamin B12.
All participants were subjected to thorough medical history, thorough clinical examination, and laboratory investigations.
Medical history included personal history; presenting symptom/s and its duration, evaluation of risk factors which included father’s and mother’s education, over-crowding, Sanitary conditions, and sharing a bed; dietetic history; if there is excess intake of fats, spicy food, caffeine, or tea; history of extra gastrointestinal illness related to H pylori infection; and medication history.
Clinical examination included assessment of vital signs, anthropometric measurements, general examination, and complete systemic examination.
Laboratory investigations included complete blood picture and coagulation profile (Prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR) done for all patients and controls. Blood grouping done for all patients using indirect hemagglutination test. Serum levels of micronutrients including Zinc, Selenium, Ascorbic acid (vitamin C) and vitamin B12 were measured for all patients and controls.
Upper GI endoscopy was done for all patients and gastric mucosal biopsies were taken for histopathology, two biopsies taken from the antrum and the corpus for histopathological assessment and for confirmation of the presence of H pylori bacilli, and a third one for rapid urease test. Histopathology was assessed using updated Sydney classification.
Patients were divided according to the results histopathology into two groups, those with positive histopathology for H. pylori (helicobacter pylori positive patients) (18 patients) and those with negative histopathology for H. pylori (helicobacter pylori negative patients) (14 patients).
The present study revealed that the mean age in H. pylori-infected children was 11.6 (+ 3.8) years. Helicobacter pylori infection had no predilection for sex or residence. The most frequently reported risk factors for Helicobacter pylori infection were low parental education, poor sanitary conditions, and over-crowdness. These risk factors are usually associated with low socioeconomic conditions.
Hemoglobin level was significantly lower among cases than controls. The Platelet count was significantly higher among the cases than controls. Helicobacter pylori-infected children had a higher incidence of anemia (macrocytic 44.4%) than H. pylori negative cases. The blood group O was the most frequently reported blood group among Helicobacter pylori infected children.
Rapid urease test had a comparable accuracy to histopathological examination in diagnosis of Helicobacter pylori infection with sensitivity of 88.9% and specificity of 92.9%.
Antral nodularity was the most frequently reported endoscopic finding in Helicobacter pylori-infected children. Lymphoid follicles were more prevalent among H. pylori cases than H. pylori negative cases.
Helicobacter pylori-infected children had a higher prevalence of Vitamin C and B12 deficiency than H. pylori negative cases. The mean serum Zinc level was significantly lower in H. pylori positive cases than the control group and lower than H. pylori negative cases but not statistically significant. The mean serum selenium level was slightly higher in H. pylori positive patients than H. pylori negative patients and controls with no significant differences in the mean serum levels. The mean serum levels of vitamin C and B12 were significantly lower in H. pylori positive cases than in the negative cases and the control group.
There was a significant positive correlation between Selenium level and the H. pylori density. The serum levels of Zinc, Ascorbic acid and vitamin B12 had a significant negative correlation with the severity of inflammatory infiltrate, mucosal atrophy, and H. pylori density.
Trace element deficiency was more prevalent among H. pylori positive cases in which lymphoid follicles were present in mucosal biopsy than H. pylori negative cases with lymphoid follicles and this deficiency was statistically significant for vitamin b12 deficiency.
This study concluded that H. Pylori infection has a significant negative effect on serum levels of vitamin C and vitamin B12.
This study recommended micronutrient supplementation for all Helicobacter pylori-infected children.