Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Influence of Helicobacter pylori Infection on Gastric Motility in Children and Adolescents with Functional Dyspepsia

기능성 소화불량 소아청소년에서 위 운동에 대한 Helicobater pylori 감염의 영향

  • Ryoo, Eell (Department of Pediatrics, Gil Hospital, Gacheon University) ;
  • Nam, Yoo-Nee (Department of Pediatrics, Gil Hospital, Gacheon University) ;
  • Kweon, Chang-Kyu (Department of Pediatrics, Gil Hospital, Gacheon University) ;
  • Kang, Sung-Kil (Department of Pediatrics, Inha University College of Medicine) ;
  • Cho, Kang-Ho (Department of Pediatrics, Gil Hospital, Gacheon University) ;
  • Son, Dong-Woo (Department of Pediatrics, Gil Hospital, Gacheon University) ;
  • Tcha, Hann (Department of Pediatrics, Gil Hospital, Gacheon University)
  • 류일 (가천의과학대학교 길병원 소아청소년과학교실) ;
  • 남유니 (가천의과학대학교 길병원 소아청소년과학교실) ;
  • 권창규 (가천의과학대학교 길병원 소아청소년과학교실) ;
  • 강성길 (인하대학교 의과대학 소아청소년과학교실) ;
  • 조강호 (가천의과학대학교 길병원 소아청소년과학교실) ;
  • 손동우 (가천의과학대학교 길병원 소아청소년과학교실) ;
  • 차한 (가천의과학대학교 길병원 소아청소년과학교실)
  • Received : 2009.08.09
  • Accepted : 2009.08.25
  • Published : 2009.09.30
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Abstract

Purpose: In spite of many reports about Helicobacter pylori infection in children with functional gastrointestinal disorders, there are few reports about the influence of H. pylori infection to functional dyspepsia and gastric motility. Therefore, we studied the influence of H. pylori infection on gastric myoelectrical activity in children with functional dyspepsia. Methods: Between August 2006 and December 2008 upper gastrointestinal endoscopies with biopsies, the rapid urease test and/or $^{13}C$ urea breath test, and electrogastrography (EGG) were performed on 63 patients with histologic chronic gastritis; patients with chronic disorders were excluded. Comparisons about gastric myoelectrical activities were made between H. pylori-positive children (n=25) and H. pylorinegative children (n=38). Results: The percentage of pre- and post-prandial normogastria was relatively lower in H. pylori-positive children than H. pylori-negative children (80% vs. 65%, and 80% vs. 68%, respectively). Compared to H. pylori-negative children, H. pylori-positive children had lower postprandial predominant power (8.18${\pm}$22.36 dB and 32.20${\pm}$24.18 dB, respectively; p<0.01) and a lower power ratio (${\delta}P$; -1.28${\pm}$6.18 vs. +4.62${\pm}$5.93, respectively; p<0.01). Conclusion: It was suggested that the gastric myoelectrical activity in children with chronic gastritis can be influenced by H. pylori infection. Thus, this study indicates that H. pylori infection may be predictable in children with functional dyspepsia through analyzing the EGG parameters, and treatment may be considered in H. pylori-positive children with impaired gastric activity, especially in the lower prevalence area.

목 적: H. pylori는 만성 위염의 중요한 원인균으로서 이에 대한 많은 연구가 진행되었지만 이와 관련된 기능성 소화불량과의 관계나 위 운동에 미치는 영향에 대한 연구는 특히 소아에서 많지 않다. 이에 본 연구자들은 소아 및 청소년의 기능성 소화불량 환자에서 H. pylori 감염이 위전도 검사 결과에 미치는 영향을 평가하고자 하였다. 방 법: 2006년 8월부터 2008년 12월까지 복통을 주소로 가천의대 길병원과 인하대병원 소아청소년과에 소화불량을 주소로 내원한 소아 및 청소년 중 상부 위장관 내시경 검사와 함께 조직검사 혹은 요소호기 검사를 시행한 환아 중 기능성 소화불량 환자를 대상으로 위전도 검사를 시행하였다. 이 중 조직검사를 통해 만성 위염이 확인되고 만성 질환자를 제외한 63예를 대상으로 H. pylori 양성군과 음성군으로 나누어 위전도 검사 결과를 비교 분석하였다. 결 과: H. pylori 양성군은 25명(40%)이었으며 음성군은 38명(60%)이었다. H. pylori 양성군에서 음성군보다 식, 전후 정상리듬의 비율이 비교적 낮았다(80% vs. 65%, 80% vs. 68%). 또한 주 힘은 식후 검사상 H. pylori 양성군에서 유의하게 낮았으며(8.18${\pm}$22.36 dB, 32.20${\pm}$24.18 dB, p<0.01), 식후 주 힘의 변화(${\delta}P$)도 유의하게 적었다(-1.28${\pm}$6.18 vs. +4.62${\pm}$5.93, p<0.01). 그러나 다른 변수들은 유의미한 차이를 보이지 않았다. 결 론: H. pylori 감염은 위의 운동에 영향을 미치는 것으로 생각되며, 따라서 H. pylori 감염과 함께 위 운동 이상이 있을 경우 H. pylori 감염률이 낮은 지역에서는 H. pylori 제균 치료를 고려할 수도 있을 것으로 생각한다.

Keywords

References

  1. Seo JK. Helicobacter pylori infection and abdominal pain in children. Korean J Pediatr 2006;49:136-43. https://doi.org/10.3345/kjp.2006.49.2.136
  2. Ko JS, Chung JY, Bae SH, Kim EJ, Seo JK. Relation between recurrent abdominal pain and Helicobacter pylori infection and the role of CagA and VacA in Pediatric Helicobacter pylori infection. Korean J Gastroenterol 2001;37:167-72.
  3. Saslow SB, Thumshirn M, Camilleri M, Locke GR 3rd, Thomforde GM, Burton DD, et al. Influence of H. pylori infection on gastric motor and sensory function in asymptomatic volunteers. Dig Dis Sci 1998;43:258-64. https://doi.org/10.1023/A:1018833701109
  4. Testoni PA, Bagnolo F, Masci E, Colombo E, Tittobello A. Different interdigestive antroduodenal motility patterns in chronic antral gastritis with and without Helicobacter pylori infection. Dig Dis Sci 1993;38:2255-61. https://doi.org/10.1007/BF01299905
  5. Thumshirn M, Camilleri M, Saslow SB, Williams DE, Burton DD, Hanson RB. Gastric accommodation in nonulcer dyspepsia and the roles of Helicobacter pylori infection and vagal function. Gut 1999;44:55-64. https://doi.org/10.1136/gut.44.1.55
  6. Symonds EL, Tran CD, Butler RN, Omari TI. Gastric emptying is altered with the presence of gastritis. Dig Dis Sci 2008;53:636-41. https://doi.org/10.1007/s10620-007-9928-8
  7. Hyams JS, Davis P, Sylvester FA, Zeiter DK, Justinich CJ, Lerer T. Dyspepsia in children and adolescents: a prospective study. J Pediatr Gastroenterol Nutr 2000;30:413-8. https://doi.org/10.1097/00005176-200004000-00012
  8. De Giacomo C, Valdambrini V, Lizzoli F, Gissi A, Palestra M, Tinelli C, et al. A population-based survey on gastrointestinal tract symptoms and Helicobacter pylori infection in children and adolescents. Helicobacter 2002;7:356-63. https://doi.org/10.1046/j.1523-5378.2002.00109.x
  9. Barber KF, Anderson J, Puzanovova M, Walker LS. Rome II versus Rome III classification of functional gastrointestinal disorders in pediatric chronic abdominal pain. J Pediatr Gastroenterol Nutr 2008;47:299-302. https://doi.org/10.1097/MPG.0b013e31816c4372
  10. Rasruin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyam JS, Staiano A, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 2006;130:1527-37. https://doi.org/10.1053/j.gastro.2005.08.063
  11. Parkman HP, Hasler WL, Barnett JL, Eaker EY; American Motility Society Clinical GI Motility Testing Task Force. Electrogastrography: a document prepared by the gastric section of the American Motility Society Clinical GI Motility Testing Task Force. Neurogastroenterol Motil 2003;15:89-102. https://doi.org/10.1046/j.1365-2982.2003.00396.x
  12. Cucchiara S, Riezzo G, Minella R, Pezzolla F, Giorgio I, Auricchio S. Electrogastrography in non-ulcer dyspepsia. Arch Dis Child 1992;67:613-7. https://doi.org/10.1136/adc.67.5.613
  13. Chen JDZ, Lin X, Zhang M, Torres-Pinedo RB, Orr WC. Gastric myoelectrical activity in healthy children and children with functional dyspepsia. Dig Dis Sci 1998;43:2384-91. https://doi.org/10.1023/A:1026661627304
  14. Riezzo G, Chiloiro M, Guerra V, Borrelli O, Salvia G, Cucchiara S. Comparison of gastric electrical activity and gastric emptying in healthy and dyspeptic children. Dig Dis Sci 2000;45:517-24. https://doi.org/10.1023/A:1005493123557
  15. Friesen CA, Lin Z, Hyman PE, Andre L, Welchert E, Schurman JV, et al. Electrogastrography in pediatric functional dyspepsia: relationship to gastric emptying and symptom severity. J Pediatr Gastroenterol Nutr 2006;42:265-9. https://doi.org/10.1097/01.mpg.0000189367.99416.5e
  16. Leung MW, Wong BP, Chao NS, Chung KW, Kwok WK, Liu KK. Electrogastrography in the management of pediatric functional dyspepsia and motility disorder. J Pediatr Surg 2006;41:2069-72. https://doi.org/10.1016/j.jpedsurg.2006.08.008
  17. Devanarayana NM, de Silva DG, de Silva HJ. Gastric myoelectrical and motor abnormalities in children and adolescents with functional recurrent abdominal pain. J Gastroenterol Hepatol 2008;23:1672-7. https://doi.org/10.1111/j.1440-1746.2008.05529.x
  18. Friesen CA, Lin Z, Garola R, Andre L, Burchell N, Moore A, et al. Chronic gastritis is not associated with gastric dysrhythmia or delayed solid emptying in children with dyspepsia. Dig Dis Sci 2005;50:1012-8. https://doi.org/10.1007/s10620-005-2696-4
  19. Parkman HO, Harris AD, Miller MA, Fisher RS. Influence of age, gender, and menstrual cycle on the normal electrogram. Am J Gastroenterol 1996;91:127-33.
  20. Friesen CA, Lin Z, Schurman JV, Andre L, McCallum RW. An evaluation of adult electrogastrography criteria in healthy children. Dig Dis Sci 2006;51:1824-8. https://doi.org/10.1007/s10620-006-9323-x
  21. Chang FY. Electrogastrography: basic knowledge, recording, processing and its clinical applications. J Gastroenterol Hepatol 2005;20:502-16. https://doi.org/10.1111/j.1440-1746.2004.03751.x
  22. Sanders KM. A case for interstitial cells of Cajal as pacemakers and mediators of neurotransmission in the gastrointestinal tract. Gastroenterology 1996;111:492-515. https://doi.org/10.1053/gast.1996.v111.pm8690216
  23. Kock KL. Electrogastrography: physiological basis and clinical application in diabetic gastropathy. Diabet Tech Ther 2001;3:51-62. https://doi.org/10.1089/152091501750220019
  24. Koch KL, Stern RM, Stewart WR, Vasey MW, Sullivan ML. Gastric emptying and gastric myoelectrical activity in patients with symptomatic diabetic gastroparesis: effect of long-term domperidone treatment. Am J Gastroenterol 1989;84:1069-75.
  25. Walsh JW, Hasler WL, Nugent CE. Progesterone and estrogen are potential mediators of gastric slow wave dysrhythmias in nausea of pregnancy. Am J Physiol 1996;270:G506-14.
  26. Hasler WL, Kim MS, Chey WD, Stevenson V, Stein B, Owyang C. Central cholinergic and ${\alpha}-adrenergic$ mediation of gastric slow wave dysrhythmias evoked during motion sickness. Am J Physiol 1995;268:G539-47.
  27. Chong SKF. Electrogastrography in cyclic vomiting syndrome. Dig Dis Sci 1999;46:1458-65.
  28. Tack J, Bisschops R, Sarnelli G. Pathophysiology and treatment of functional dyspepsia. Gastroenterology 2004;127:1239-55. https://doi.org/10.1053/j.gastro.2004.05.030
  29. Lin W, Eaker EY, Sarosiek I, McCallum RW. Gastric myoelectrical activity and gastric emptying in patients with functional dyspepsia. Am J Gastroenterol 1999;94:2384-9. https://doi.org/10.1111/j.1572-0241.1999.01362.x
  30. van der Voort IR, Osmanoglou E, Seybold M, Heymann-Monnikes I, Tebbe J, Wiedenmann B, et al. Electrogastrography as a diagnostic tool for delayed gastric emptying in functional dyspepsia and irritable bowel syndrome. Neurogastroenterol Motil 2003;15:467-73. https://doi.org/10.1046/j.1365-2982.2003.00433.x
  31. Quigley EM, Keohane J. Dyspepsia. Curr Opin Gastroenterol 2008;24:692-7. https://doi.org/10.1097/MOG.0b013e328313b983
  32. Conchillo JM, Selimah M, Bredenoord AJ, Samsom M, Smout AJ. Air swallowing, belching, acid and non-acid reflux in patients with functional dyspepsia. Aliment Pharmacol Ther 200715;25:965-71. https://doi.org/10.1111/j.1365-2036.2007.03279.x
  33. Neumann H, Monkemuller K, Kandulski A, Malfertheiner P. Dyspepsia and IBS symptoms in patients with NERD, ERD and Barrett's esophagus. Dig Dis 2008;26:243-7. https://doi.org/10.1159/000121354
  34. Perri F, Clemente R, Festa V, Annese V, Quitadamo M, Rutgeerts P, et al. Patterns of symptoms in functional dyspepsia: role of Helicobacter pylori infection and delayed gastric emptying. Am J Gastroenterol 1998;93:2082-8. https://doi.org/10.1111/j.1572-0241.1998.00597.x
  35. Sigurdsson L, Flores A, Putnam PE, Hyman PE, Di Lorenzo C. Postviral gastroparesis: presentation, treatment, and outcome. J Pediatr 1997;131:751-4. https://doi.org/10.1016/S0022-3476(97)70106-9
  36. Mayer EA, Collins SM. Evolving pathophysiologic models of functional gastrointestinal disorders. Gastroenterology 2002;122:2032-48. https://doi.org/10.1053/gast.2002.33584
  37. Gwee KA, Leong YL, Graham C, McKendrick MW, Collins SM, Walters SJ, et al. The role of psychological and biological factors in post infective gut dysfunction. Gut 1999;44:400-6. https://doi.org/10.1136/gut.44.3.400
  38. Sobala GM, Crabtree JE, Dixon MF, Schorah CJ, Taylor JD, Rathbone BJ, et al. Acute Helicobacter pylori infection: clinical features, local and systemic immune response, gastric mucosal histology and gastric juice ascorbic acid concentrations. Gut 1991;32:1415-8. https://doi.org/10.1136/gut.32.11.1415
  39. Lin Z, Chen JD, Parolisi S, Shifflett J, Peura DA, McCallum RW. Prevalence of gastric myoelectrical abnormalities in patients with nonulcer dyspepsia and H. pylori infection: resolution after H. pylori eradication. Dig Dis Sci 2001;46:739-45. https://doi.org/10.1023/A:1010783830093
  40. Lu CL, Chen CY, Chang FY, Kang LJ, Lee SD, Wu HC et al. Impaired postprandial gastric myoelectrical activity in Chinese patients with nonulcer dyspepsia. Dig Dis Sci 2001;46:242-9. https://doi.org/10.1023/A:1005684328217