Diagnosis and treatment of Helicobacter pylori infection in Vietnamese children

摘要: Aim: The aim of the study was to find optimal H. pylori eradication therapy for children in Vietnam, a developing country. Therefore, we evaluated non-invasive diagnostic method and antibiotic susceptibility strains, major determinant treatment outcome, as well rate reinfection after successful eradication, rational eradication. Materials: In trial, gastric biopsy, blood faecal samples were obtained from 240 (age 3-15 years) various gastrointestinal complaints. infection status based on either positive culture or monoclonal antigen-in-stool test (Premier Platinum HpSA PLUS) at inclusion during one year follow up. For evaluation specificity test, 241 similar age with non-gastrointestinal conditions included. Methods: prospective randomized double-blind received combination lansoprazole amoxicillin clarithromycin (LAC) metronidazole (LAM). antigen-instool used determine trial study. Culture biopsies performed by standard methods. Susceptibility testing all three antibiotics Etest using microaerophilic incubation ≥72h 35 o C. Results: sensitivity Premier PLUS 96.6% (95% CI 93.3-98.5%) 94.9% 88.5-98.3%). per protocol two regimens, 62.1% LAM 54.7% LAC respectively. overall resistance clarithromycin, 50.9%, 65.3% 0.5%, regimen, linked strains being sensitive (OR 7.23, 95% 2.10-24.9, relative resistant strains). Twice-daily dosage more effective than once-daily 6.92, 1.49-32.13, dose). Factual dose kilo body weight significantly associated rates 8.13, 2.23-29.6). These differences not seen regimen. Low most prominent independent risk factor (adjusted HR among aged 3-4, 5-6, 7-8 years, those 9-15 respectively 14.3 [95% 3.8-53.7], 5.4 [1.8-16.3] 2.6 [0.7-10.4]). Female sex tended be increased girls boys 2.5, 1.1-5.9]). Conclusion: assay has good performance Vietnamese children. triple therapies methronidazole gave low rates, likely due high that unexpected clarithromycin. twice-daily medications play an important role especially clarithromycin-resistant strains. Age found main children, youngest running greatest risk. imply need investigate alternative strategies if medical condition permits, delaying treatment. LIST OF PUBLICATIONS I. Evaluation novel monoclonal-based enzyme immunoassay diagnosis Helicobacter Thi Viet Ha Nguyen, Carina Bengtsson, Gia Khanh Marta Granstrom. 2008;13: 269-273 II. regimens children: randomized, clinical trial. Thu Hoang, Dac Cam Phung, Mikael Sorberg , 2008; 13: 550-556 III. Eradication relation resistance. Li Yin, Sorberg, (Submitted) IV.