Helicobacter pylori Gastritis in Children – Assessment of Resistance to Treatment on the Casuistry of the Ist Pediatric Clinic Tîrgu Mureș

Background: It is generally recognized the role of Helicobacter pylori in the pathogenesis of peptic ulcer disease in adults and children. Some cases raise serious concern regarding the therapeutic approach because they do not heal with normal treatment schemes or have frequent relapses due to the fact that the microorganism has virulence factors that determine resistance to therapy.
The purpose of this work was to analyze the cases of gastritis due to H. pylori in children from our casuistry, which have not healed despite a properly conducted treatment to eradicate the bacteria.
Material and methods: This was a prospective study carried out on 1,041 children aged between 2 and 18 years, diagnosed with different types of gastritis in Ist Pediatric Clinic from Tîrgu Mureș, admitted between January 2001 and March 2010. We have had 539 cases of gastritis due to H. pylori; for these patients a specific treatment was prescribed in order to eradicate the infection and to cure gastritis (accor-ding to the current internationally accepted recommendations).
Results: The average age of patients in the study group was 12.9 years, with a higher incidence in the 7–12 (33.02%) and 13-18 years (62.89%) age group, predominantly among female patients (63.45%) and those from rural areas (55.84%). From the patients diagnosed with Helicobacter pylori gastritis, 478 cases presented for review; after proper treatment with anti-infectives in combination with proton pump inhibitors, clinical-histological healing of the disease after a month was found in 426 cases (89.12%); a number of 52 patients remained positive (10.87%). Two months after treatment the endoscopical and histopatological modifications persisted in 26 cases (5.43%); a total of six cases (1.25%) remained positive for Helicobacter pylori infection after therapy.
Conclusions: The resistance of Helicobacter pylori infection to therapy is caused by the continued action of favoring factors, the virulence of the microorganisms in association with a genetic predisposition present in some individuals.