儿童幽门螺杆菌感染的诊断和治疗

Diagnosis and Treatment of Helicobacter pylori Infection in Children

幽门螺杆菌(H.pylori)感染主要发生在儿童期,儿童期许多消化系统疾病,如慢性胃炎、消化性溃疡等与H.pylori感染密切相关,并可能与成年后胃癌的发生相关。H.pylori感染还可导致儿童缺铁性贫血。H.pylori感染主要经"口-口"或"粪-口"以及"胃-口"途径从人到人传播,社会经济因素对H.pylori感染的影响是主要的。胃镜活检胃黏膜细菌学检查是诊断H.pylori现症感染的"金标准",粪抗原的测定和^(13)C-尿素呼气试验可用于诊断和评价疗效。质子泵抑制剂(PPI)加两种抗生素的三联疗法是目前最佳治疗方案,抗生素耐药的不断增加给治疗带来了困难,儿童H.pylori感染对大环内酯类药物的耐药高于成人。

Helicobacter pylori （H. pylori） infection occurs mainly in childhood and is closely related to the development of various gastrointestinal diseases, such as chronic gastritis and peptic ulcer, and also may be related to the later development of gastric cancer in adults. In addition, H. pylori infection can also cause iron deficiency anemia in childhood. The route of transmission appears to be from human to human via fecal-oral, oral-oral and gastro-oral routes, and social-economic status has great impact on the spread of H. pylori infection. Bacteriological examination of endoscopic gastric mucosal biopsy specimen remains the gold standard for the diagnosis of current H. pylori infection, while the fecal antigen test and ^13C-urea breath test are usually used in the diagnosis and evaluation of treatment efficacy in patients with H. pylori infection. Proton pump inhibitor-based （plus 2 antibiotics） triple therapy remains currently the mainstay for eradication of H. pylori. Increase of antibiotic resistance has brought difficulty to its treatment, and the resistance to macrolide antibiotics is higher in children than in adults.