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"Child`s Health" 3 (54) 2014

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Clinical and endoscopic manifestations of peptic ulcer by children depending on Helicobacter pylori infection

Authors: Sorokman T. V., Sokolnyk S. V., Gingulyak M. G., Popeluk N. O. - Bukovinian State Medical University, Chernivtsi, Ukraine

Categories: Infectious diseases, Pediatrics/Neonatology

Sections: Clinical researches

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Today Helicobacter pylori (H. pylori) has been given a great importance in the formation of inflammatory and destructive diseases of gastroduodenal region [2, 3]. This microorganism is the most widespread persistant bacterial infection (infection reaches 60% of the world population) [7]. According to various researchers, infection affects 60-70% of child’s population [1, 4, 5]. This high contamination suggests that soon there will be a further increase in H. pylori- associated diseases, primarily gastroduodenitis and peptic ulcer (PU) [4, 6, 8].

Research aim - to reveal the clinical-endoscopic peculiarities of course of H. рylori of associated  PU by children.

Material and research methods.  The detailed clinical-genealogical, molecular-genetic and laboratory-instrumental inspection was conducted by 118 children, patients with peptic ulcer (PU) of stomach and duodenum aged 8 - 18.

Identification of H. pylori was conducted with the use of diagnostic  test-systems of "Helicobest-antibody" (series of D - 3752) with the aim of reveal specific immmunoglobulines classes  M, A and G to the antigen of Cag A  H. pylori in the blood serum by the method of  IEA, backterioscopy research with biopsy from body, antrum part of stomach and bulb of duodenum and standard test-systems for determination of DNA H. pylori, CagA-positive and VacA- positive stamms of H. pylori by means of PCR.

In order to ratify about authenticity of difference the size of level of probability (р) generally accepted in medical and biological researches was taken into account - р < 0,05. Research results are presented by the amount of supervisions in a group, by percents or mean and standard deviation, exact meaning authenticity of difference between relative sizes was determined by the method of angular transformation of Fisher «Рφ».

Results of research and their discussion. The course of disease by children infected with toxic stamms of H. pylori was mild (р < 0,01) and  moderate (р < 0,001) comparatively with severe. By children infected with non-toxic stamm of H.рylori  more often there was a moderate course (р < 0,01) of disease comparatively with mild and severe, in germ-free H.pylori children prevailed moderate course (р < 0,05) comparatively with severe.

Predominance of cases of duration of disease appeared reliable 1-3 comparatively with duration 1 to (р < 0,05) and 3 over (р < 0,01) for children infected with toxic stamms of H.pylori. For germ-free children also frequency of cases of duration of PU prevailed 1-3 comparatively with 3 over (р < 0,05).

Reliable was predominance of cases with frequency of intensifying 1 time during 1 in infected toxic by the stamms of H. pylori children as in relation to germ-free and germ-free toxic by the stamm of H. pylori children, so comparatively with frequency of intensifying 1 time during 2-3 in H.pylori of positive children (р < 0,001). In H.pylori the infected toxic stamms by children are set reliable predominance of the one- week's intensifying of ulcerous process comparatively with cases two- and three week's intensifying of disease (р < 0,01). For children with the non toxic stamm of H.pylori and H. рylori of negative persons for certain differed amount of cases with duration of intensifying during 1 week and 3 weeks (р < 0,01). Majority of H.pylori of positive defeats folded Cag+VacA+ serotype to the microorganism. A reliable difference is set between the amount of defeats to data of serotype of mucous membrane of stomach and  duodenum (р < 0,001). By infecting of H.pylori in 2,17 times more often in mucous membrane of duodenum found out the toxic stamm  of CagA+VacA+ comparatively with  non-toxic of Cag-VacA- (р < 0,01). By single defeats of  mucous membrane of organs of epigastrium the toxic stamms of H.pylori, in particular the cases of presence of serotype of CagA+VacA+ prevailed comparatively with non-toxic of CagA - VacA (р < 0,01). Reliable difference between the defeat of mucous membrane of epigastrium toxic and by the non-toxic stamms of H.pylori as at single (74,6 ± 5,3 % and 25,4 ± 5,3 % accordingly) so it is not set (φ = 0,541, р > 0,05) at plural defects (79,4 ± 6,9 % and 20,6 ± 6,9 % accordingly). For persons from serotype of H.pylori of CagA+VacA- characteristical predominance of plural defeats of mucous membrane of epigastrium. For  toxic serotype H. pylori of CagA+VacA+ and CagA+VacA- and non-toxic  of CagA - VacA is more characteristic ulcer of small sizes (0,1-0,2 cm and 0,3-0,5 cm), in that time as for persons, infected with serotype of CagA - the greater amount of defects of largenesses (over 1 cm) is educed VacA+, that can testify to considerable invasiveness of this serotype microorganism.

Conclusions. 1. Predominance of H.рylori positive cases of PU regardless of localization of ulcer. 2. Toxic  stamms of H. рylori cause severe course of PU with the prolonged and frequent relapses. 3. Majority of H. pylori of positive defeats associate from Cag+VacA+ to the serotype microorganism. 4. For persons, infected serotype of CagA-VacA+, more often happen ulcer of large sizes, that can testify to considerable invasiveness of this serotype of H.рylori.


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