Complications

The most frequent complication of PUD is digestive bleeding, with hematemesis and melena reported in more than half the cases.6 Gastrointestinal bleeding may be present even in the absence of ulcer, if diffuse varioliform gastritis with erosions is present at endoscopy. Another complication of PUD is perforation (10%), which may result in peritonitis, if anterior, or in pancreatic penetration, if posterior. Pyloric stenosis as a consequence of a parapyloric ulcer is quite rare; a malignant ulcer is exceptional in children.

A vicious cycle between chronic diarrhea, malnutrition and H. pylori infection is evident, especially for children in developing countries.79 Some other gastrointestinal disorders based on the presence of heterotopic gastric mucosa, such as Barrett's ulcer80 and Meckel's diverticulum bleeding,81 have been anecdotally associated with H. pylori infection, but further studies suggested that H. pylori did not play a causal role in their determination.

Extraintestinal manifestations have been controversially reported in patients with H. pylori infection; iron deficiency and sideropenic refractory anemia, short stature and growth failure, and sudden infant death are the most conflicting areas in childhood.82

Iron deficiency anemia may be a consequence of H. pylori infection in children. Case reports and series of children with sideropenic refractory anemia have been reported.83 Iron deficiency without anemia has also been demonstrated in adults.84 The efficacy of eradication in raising the hemoglobin level and in restoring ferritin values has been demonstrated in adults as well as in teenagers.85 Potential mechanisms involved in producing iron deficiency are fecal occult blood loss, reduction in duodenal absorption and the iron-scavenging capability of the bacterium.

Some studies have reported the existence of an effect of the infection on the final height of the patient. H. pylori-positive children have been demonstrated to be shorter than those who are H. pylori-negative.27 Growth velocity has been demonstrated to be decreased by 1.1 cm in affected females between 7 and 11 years of age.86 However, this association has not been confirmed by other studies, which showed, instead, that reduced growth is related to genetic determinants, such as parental height, and to mixed genetic and environmental factors, such as birth weight. Low socioeconomic status was clearly relevant.87

Concerning the role of Helicobacter infection in causing infant deaths by sudden infant death syndrome (SIDS), one study detected H. pylori in lungs from 25 out of 32 SIDS cases.88 However, a further study utilizing both histology and immunohistochemistry on 25 cases of infants with SIDS failed to confirm this hypothesis.89

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