Nathalie Wizla-Derambure

Natural outcome of Helicobacter pylori infection in asymptomatic children: a two-year follow-up study.

Background and Objectives. It is known that Helicobacter pylori can be acquired in early childhood. There is not enough data to know whether or not infected children should be treated. A better knowledge of the natural outcome and implications of H pylori infection may provide evidence that eradication therapy is beneficial in childhood. This prospective study looks at clinical symptoms, endoscopic, microbial, and histologic changes during a 2-year period in infected asymptomatic children. It is hoped that some prognostic indicators will be found that select out the children that later need therapy. Patients and Methods. During epidemiologic study of the prevalence of H pylori infection, 18 children aged 7 ± 4 years (mean ± 1 SD) were discovered to have H pylori infection and enrolled in the 2-year follow-up study. These patients had received no eradication therapy because they were asymptomatic. The follow-up for each patient consisted of an initial assessment, a clinical examination every 6 months, and an endoscopic reevaluation at the end of the first and second years. Gastric mucosal samples were analyzed for bacteriologic and histologic changes. Various factors were initially recorded: individual factors included sex, age, and housing conditions; microbial factors included bacterial load and the presence of the CagA gene. Inflammatory changes were also noted, such as the presence of active gastritis and nodular formation, and these were correlated with the histology which was described using the Sydney classification. Typing polymerase chain reaction-restriction fragment length polymorphism was performed to check the persistence of the same strain of H pyloriin each patient. Results. All of the children were still infected after 2 years with the same strain as in the initial assessment with the exception of 1 child whose infection cleared spontaneously. The density of antral and fundal mucosal colonization with H pylorialso remained stable. There were progressive inflammatory changes in this cohort, particularly between the first and second year (histologic score, 3.5 ± 1.3 vs 5 ± 1). Active antral gastritis occurred in 3 out of 14 and 1 out of 8 children during the first and second year, respectively. Gastritis became active in the fundus in 2 out of 14 and 2 out of 8 children during the same period. Increases in the histologic score were found particularly in male children, and children colonized by cagA− strains of H pylori during the follow-up. The frequency of nodular gastritis significantly rose from 11% (2 out of 18 children) to 64% (9 out of 14 children) after 1 year, and to 80% (8 out of 10 children) after 2 years. Conclusion. These findings demonstrate a deterioration in the histologic features of the gastric mucosa of infected children despite stable H pylori colonization and the absence of symptoms.

Familial and community environmental risk factors for Helicobacter pylori infection in children and adolescents.

Background The aim of the study was to identify familial and community environmental risk factors associated with Helicobacter pylori infection in a pediatric population. Methods Children requiring diagnostic upper endoscopy were included in the study during a 2-year period. During endoscopy, five gastric biopsies were performed for the histologic or bacteriologic diagnosis, or both, of H. pylori infection. Epidemiologic data collected by a questionnaire were analyzed using the chi-square test or Fisher test and stepwise logistic regression. Results The authors included 436 patients (242 boys), aged 2 days to 17.9 years (median, 2.7 years). H. pylori prevalence was 7.3%. Univariate analysis found H. pylori was more common in older patients (P < 0.00001), in children who had at least one parent born in a developing country (P < 0.02) or with a low socioeconomic status (P < 0.02), and in those living in crowded conditions (P < 0.02). Children whose mother worked at home were more frequently infected than children whose mother worked outside the home (P < 0.02). Attendance at nursery or school before the age of 6 years was not associated with infection. Logistic regression showed a strong association with H. pylori only for age and number of persons at home. Conclusions The source of H. pylori is intrafamilial rather than from a community, such as nursery and school attended at a young age. The number of persons in the home influences the infection status of children but not by the presence of the mother in home. These data suggest that H. pylori infection transmission occurs from siblings or the father rather than from mother.

Application of quantitative PCR to the diagnosis and monitoring of Pseudomonas aeruginosa colonization in 5-18-year-old cystic fibrosis patients.

Early detection of Pseudomonas aeruginosa and early aggressive treatment are recommended to delay chronic infection in cystic fibrosis (CF) patients. The aim of this study was to assess a quantitative PCR (q-PCR) assay for the diagnosis of early P. aeruginosa colonization in 23 young CF patients (group A, age range 7-18 years) and to survey the eradication of P. aeruginosa in 10 young CF patients (group B, age range 5-18 years) after an initial antibiotic treatment. q-PCR results for consecutive sputum samples from each patient during a period of 18 months were compared with bacterial cultures during the same period plus an additional period of 12 months, and with concomitant clinical signs of pulmonary exacerbation. The q-PCR and bacterial cultures were negative for 17 of the 23 patients in group A and six of the 10 patients in group B during the study period. However, consecutive positive q-PCR results were observed for one patient in group A and three patients in group B, while the bacterial cultures for the same sputum sample remained negative. They preceded positive P. aeruginosa bacterial cultures at 7 and 8 months for two patients in group B. These positive results were associated with a worsening of the clinical status of patients, but pulmonary exacerbation appeared non-specific for the diagnosis of early P. aeruginosa colonization since pulmonary exacerbations were observed in patients in whom q-PCR or bacterial culture remained negative. In conclusion, q-PCR may be a useful additional tool to provide information on the P. aeruginosa status of CF patients.

Impact of intravenous antibiotic therapy on total daily energy expenditure and physical activity in cystic fibrosis children with Pseudomonas aeruginosa pulmonary exacerbation

Resting energy expenditure (REE) increases during pulmonary exacerbation by Pseudomonas aeruginosa in cystic fibrosis (CF) patients, and decreases after i.v. anti-Pseudomonas aeruginosa antibiotic therapy (IVAT). However, the impact of IVAT on total energy expenditure (TEE) is unknown. The aim of this study was to assess the changes in TEE and its main components after IVAT administered at home. Body composition measured by skinfold thickness and bio-impedance analysis, energy intake (EI) assessed by a weekly diary, REE measured by indirect calorimetry (IC), TEE assessed by a technique using 24-h heart-rate monitoring method and physical activity (PA) monitored using an activity diary (AD) were assessed in 16 patients (9 boys and 7 girls) aged 12.1 ± 2.3 y (range, 7.1–14.6 y), before and after 28 ± 4 d including a 14-d IVAT course. After IVAT, weight increased significantly by 1.9% (32.1 ± 7.5 versus 32.7 ± 7.6 kg; p < 0.05), while fat mass and fat free mass increased non significantly. EI increased by 4.6% (10,797 ± 3,039 versus 11,320 ± 3,074 kJ/d; p < 0.05). TEE was not affected by IVAT (7,014 ± 1,929 versus 7,081 ± 1,478 kJ/d) whereas REE decreased by 4.1% (5,295 ± 909 versus 5,093 ± 837 kJ/d; p < 0.05), resulting in 9.3% increase in PA assessed by AD converted to metabolic equivalent tasks (MET) (37.0 ± 3.1 versus 40.7 ± 4.5 MET; p < 0.05). The improvement in nutritional status after IVAT is not related to a decrease in TEE, but probably to an increase in EI and a decrease of REE after IVAT. After IVAT, the reduction in REE is probably compensated by an increase in PA in CF patients.

Changes in lung function in young cystic fibrosis patients between two courses of intravenous antibiotics against Pseudomonas aeruginosa.

Repeated intravenous antibiotic therapy (IVAT) against chronic pulmonary infection with Pseudomonas aeruginosa is often necessary in cystic fibrosis patients (CF). The aim of this study was to monitor kinetics of degradation of pulmonary and nutritional status after IVAT in CF patients.

Effets de la rhdnase sur la fonction respiratoire et le statut nutritionnel de l'enfant et de l'adolescent atteints de mucoviscidose

Resume Des 1994, nous avons debute la rhDNase chez tous les patients atteints de mucoviscidose âges de plus de 5 ans et ayant une CVF ≥ 40 % de la valeur theorique. Population et methodes Nous avons analyse retrospectivement les effets de la rhDNase au cours de 2 ans de traitement chez 69 enfants et adolescents. Les patients ( 35 garcons, 34 filles) ont recu une dose unique journaliere de 2,5 mg de rhDNase. Ils etaient âges initialement de 8,5 ans (5 a 16,4 ans). Les valeurs spirometriques (pourcentage de la valeur theorique) et le statut nutritionnel de base etaient les suivants: CVF = 84,8 ± 21,7, VEMS = 80,8 ± 22,2, DEP = 89,7 ± 34,2, DEM 25-75 = 71, 8 ± 32,8, Z score poids/taille = -0,41 ± 1,14, Z-score poids/âge = −0,48 ± 1,25, index de Quetelet = 15,4 ± 1,8, ration calorique = 107 ± 25 % des apports journaliers recommandes. Les donnees spirometriques et nutritionnelles ont ete analysees apres 1, 3, 6, 12, 18 et 24 mois de traitement et comparees aux valeurs de base (resultats spirometriques exprimes en pourcentage des valeurs de base moyennes). Le score de Shwachman-Kulczycki etait de 87 ± 9 avant le traitement et a ete releve 24 mois plus tard. Resultats Une amelioration de la CVF (+ 10,7 %, p p p ≤ 0,01 ). Ceci a ete note en particulier chez les enfants âges de 5 a 10 ans, chez les garcons et chez les patients dont la CVF de base etait e ( p e mois ( p ≤ 0,02), essentiellement chez les filles. Les Z scores poids/âge et poids/taille se sont ameliores respectivement pendant les 3 premiers mois et apres 2 ans de traitement. Le score de Shwachman-Kulczycki est reste stable. Conclusion La rhDNase ameliore donc la fonction respiratoire et le statut nutritionnel des jeunes patients atteints de mucoviscidose et la reponse au traitement peut etre evaluee des les 3 premiers mois.