소화기내과 R1. 임형석 / Pf. 김정욱

BACKGROUND Recent data showed that H. pylori infection is less common in patients with IBD The prevalence of IBD has been increasing in areas with lower rates of H. pylori colonization(etc. US) H. pylori infection could play a protective role against IBD development Data in pediatric populations are scarce, and the few published reports about H. pylori gastritis and IBD In this study, we aimed at assessing the relation between H. pylori infection and pediatric IBD In a large number of newly diagnosed, treatment naive children with IBD and in non-IBD undergoing upper GI endoscopy

MATERIALS AND METHODS Study design Retrospective Gastroenterology Unit of the 1st Department of Pediatrics in the University of Athens, in “Aghia Sophia” Children’s Hospital. all endoscopic and pathology reports during a 2002–2011 were retrieved 2 groups: IBD group, Non-IBD group IBD was further classified into three subgroups: Crohn’s Disease (CD), ulcerative colitis (UC), and IBD unclassified (IBDU) Exclusion criteria Pre-endoscopy: steroids, PPI, or H2 antagonists

MATERIALS AND METHODS biopsies were taken in all cases 2nd part of duodenum (2–4), duodenal bulb (1), antrum (1), body (1), and esophagus (3–6) Helicobacter pylori infection was defined according to published guidelines Culture(+) or histology(+) + CLO(+) Culture(-) or only one positive test(histology or CLO) Further evaluated by a noninvasive test(urea breath test, UBT, INFAI 13C-UBT, GmbH, Bochum, Germany) and the positives were also included in the infected group.

MATERIALS AND METHODS Including all non-IBD patients in the control group would probably generate significant bias toward increasing the prevalence of H. pylori positivity significant number of non-IBD patients underwent endoscopy for symptoms and signs related to probable H. pylori infection unrestricted analysis: overall data restricted analysis: UBT(+), IDA of unknown origin excluded

RESULTS 1602 records were retrieved and reviewed non-IBD group: 1443 (age range 0.5–18.2 years) IBD group: 159 (age range 1.0–18.0 years) 66 CD, 34 UC, 59 IBDU

RESULTS -Distribution of age in the control group -H. pylori (+) = 9.7 ± 3.6 years -H. pylori (-) = 7.1 ± 4.4 years (p <.001)

RESULTS

H. pylori(-) patients were 4.8 times more likely to belong in the IBD group (p <.001) H. pylori (+) IBD6/159 (3.8%) Non-IBD190/1443 (13.2%)

CONCLUSION H. pylori positivity was inversely related to the probability of having IBD particularly after adjusting for age and gender Also in restricted analysis strongly supports that it is a true relation rather than a methodological artifact Etiological relations are difficult to be established in cross- sectional analyses such as ours Prospective studies are needed to determine whether these findings are produced by a true protective effect of H. pylori.