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Helicobacter pylori infection in childhoodNURUL AIN ZAKARIAANAMNESISA 7 year-old girl, 21kg, 118cmREASON OF ADMISSIONIntensive spastic abdominal pain lasts long for 1 hour and 30 minutesPresent symptoms : 3 days with constipationFailure to thriveAbominal pain around umbilical, usually after eatingNo apetite

ANAMNESISPERSONAL HISTORY1st pregnancy, 1st deliveryGiven birth at 37weeks, with Caesarean section for obstructed labour. Birth weight : 3.05kg, Birth length : 46cmNormal adaptation & psychomotoric developmentNegative perinatal examination (US of hip, screening )Normal vaccination without complicationBreastfed until 3 months old, continue with complementary food

ANAMNESISPAST HISTORYHas chicken-pox on 2008Second admission to the hospitalPrevious symptoms on January 2009Abdominal painDiarrheaPrevious examinationsUltrasoundGastroscopy with biopsyBiochemistry test

Histological analysis total villus atrophy, increase number of intraepithelial lymphocytes, hyperplastic cryptDiagnosed with classical Celiac Disease, 3rd degree

ANAMNESISFailure to thrive118 cm (25th percentile) not optimal21 kg (25th percentile) not optimal

Has allergy to milk

ANAMNESISFAMILY HISTORYFather : healthyMom : has Irritable Bowel Syndrome (IBS)Has 1 sister (different father and mother) and 1 brother (same father, different mom). Both are healthySOCIAL HISTORYLives with father and his girlfriend, and siblingsHas contact with cats and dogsStay with grandparents during weekend

ANAMNESISPHARMACOLOGICAL HISTORYFenistil drops against allergyCream for skin against eczema

Physical examinationCooperates well during examinationInspection :Has skin rashes, exanthema on extremitiesGood hydration with normal skin turgorNormal peripheral blood circulation no cyanosisNormal eyes, with no secretionPalpitationNo enlarged lymph nodesNo pain on abdomenAuscultation Breathing is normal during auscultationHeart rate is normal; 70bpm

EXAMINATION RESULTSIMAGING7/12/2014 : xray of abdomen while standing shows no free gas, mixed intestinal contents from colon to sigmoid8/12/2014 : Presence of gas at left loop of small intetine

*source:Lab resultsUrinanalysis result

7.12.20148.12.2014Leukocyte (leu/ul) (normal = 0 10)341Erythrocyte--Bacterial cells--Yeast--Epithelial cells--Crystal--pH (normal = 4.6 8.0)7.06.5Blood test result7.12.2014Leukocyte (leu/ul) (normal = 4.5 10.0 x 109/l)5.69 x 109/lErythrocyte (normal = 3.8 5.5 102/l)4.53 x 102/lHaemoglobin (normal = 12.5 g/l - 135 g/l mean)126 g/lHematocrit (normal = 0.36 4.0)0.37Mean corpuscular volume (normal = 80100 fL)82.1 fLMean corpuscular haemoglobin (normal = 25 to 33 picograms/cell27.8 pg/cMean corpuscular haemoglobin concentration (normal = 3137 g/dL)33.9 g/dlThrombocytes (normal 150 400 109/l)237 x 109/lBiochemistry serumNormal value7.12.2014Natrium (mmol/l)135 147142Kalium (mmol/l) ( 3.5 5.1 4.06Chloride (mmol/l)95 110 109Urea (mmol/l)3.0 7.0 3.1Creatinine (umol/l)M : 60 118F : 50 98 63Bilirubin (umol/l)3ALT (ukat/l)M : 0.5 1.1F : 0.15 0.750.33AST (ukat/l)M : 0.25 0.75F : 0.25 0.60 0.44ALP (ukat/l)0.6 2.0 2.30GGT (ukat/l)0.630.12Alpha-amylase (ukat/l)0.5 1.1 0.69Lipase (ukat/l)0.30C-reactive protein (mg/l)UL = 6< 0.60Glucose (mmol/l)4.0 6.0 4.60Coagulation screen testQuick test : 76%Quick test INR : 1.12aPTT : 31.7s

Endocrinology testTSH : 0.767 mlU/lT4 : 14.7 pmol/lGrowth percentile graphConclusionCaeliac disease was excluded for present problem. The patient was infected with Helicobacter Pylori, proven by presence of H. pylori antigen in stool.Patient also had skin urticaria and being given Forlax for treatmentThe patient was recommended to have another check up 3 days after released from hospital

Helicobacter pylori infection> 50% of the worlds population infectedRisk factorContaminated water supply with fecal matter (fecal-oral)Genetic factorLive in developing countriesHygenic factorPathogenesiscauses changes to the stomach and duodenuminfect the protective tissue that lines the stomachrelease of certain enzymes and toxins and activation of the immune systemcauses chronic inflammation in the walls of the stomach (gastritis) or duodenum (duodenitis)

SymptomsPain or discomfort (usually in the upper abdomen)BloatingFeeling full after eating a small amount of foodLack of appetiteNausea or vomitingDark or tar-colored stools

ComplicationsDuodenal ulcerInflammation of stomach lining (gastritis)Peptic ulcer

Differential DiagnosisDuodenal UlcerGastric ulcerGastrinomaGastritisGastroesophageal reflux diseaseCeliac diseaseNSAID-induced cancerPancreatic cancerMucosa-associated lymphoid tissue (MALT) lymphoma

DiagnosisBlood tests detect specific antibodies (IgG, IgM, IgA) that the body's immune system develops in response to the H. pylori bacterium.Breath tests drink a specialized solution containing a substance that is broken down by the H. pylori bacterium. The breakdown products can be detected in your breath.Stool tests to detect H. pylori proteins in stoolScope tests to view the condition of the mucosal lining of the stomach and duodenum and to obtain biopsy specimens from the gastric antrum.

TreatmentAntibiotics (10-14d of amoxicilin @ tetracycline @ metronidazole)Protein pump inhibitorHistamine H2 blockersBismuth subsalicylate

Long-term expectations

*source from kibion.com - HeliprobeSystem

ReferencesPatients anamnesisIllustrated textbook of paediatrics abdominal pain in childhoodUptodate.com h. pylori infectionCeliac.org celiac disease foundationHpylorilearningcenter.comCDC centers for disease control and prevention