Children Adopted from Orphanage, Testing for Resistant Hp

[elizabeth bradley]

I have a four year old child that was born and lived in a Vladivostok orphanage for one and 1/2 years. He suffered from a very antibiotic resistant strain of hp. He was treated several times over a two 1/2 year period and we thought we had finally cured this. He did have the endoscopy and this time it appeared to be clear. It has been almost a year since we had the endoscopy however, he still seems to suffer from some of the same symptoms. We have put him back on prevacid to help with stomach pains and he is on a gluten free diet. Should we test him again? I would think we should. I do not think there is a breath test for children. Am I correct in this? I would really love to get to the bottom of this. This poor little guy has been suffering from this -pretty much his whole life. Thank you very much for your help in this matter. Elizabeth Bradley

[admin]

You need proof of cure with a urea breath test (c13 or c14 are both quite safe) - it depends on whether he can swallow a small C14 capsule or drink the sour c13 test liquid. If not then have a stool antigen test done. Make sure he is not on interfering treatment for 1 week beforehand. After that, an acid blocker (nexium, etc) would be OK to use for a trial. Or Zantac perhaps.
To eradicate Hp on a second try is a little harder, but use high dose PPI (maybe rabeprazole 20 mg bid) with amoxicillin 500 mg tid all for 10 days and add a third drug after about 5 days until day 10; consider norfloxacin 250 mg bid or a dose advised by your doctor (adult dose is 500 mg bid). Discuss the short term usage of norfloxacin with your pediatrician, there are side effects in children but not usually with just 5 days of treatment. If treatment fails then maybe try to settle him with acid blockers and then try again some time in the future when he understands wha is going on.

[elizabeth bradley]

Dr. Marshall,

The stool antigen came back positive. What is the percentage of false positives in stool antigen tests for children that have had previous treatments? My son Christopher's History: He has had several treatments for H Pylori. The last treatment was over a year ago and resulted in an endoscopy with no indication of H Pylori. However, he has continued to have gastric symptoms similar to those prior to treatment. This is the reason we wished to verify the cure.
Should we treat? Or test again? If we test again should we do another stool antigen, endoscopy or urea breath test. He is four years old.

Thank you so much for your assistance and life time study of this amazingly resilient bacterium.

Elizabeth Bradley

[barjammar]

I suggest you repeat the tests. Have a urea breath test and only accept a stron positive reading rather than a "weak" or or borderline result which might be false positive. The stool test is 90% accurate. A negative biopsy test for histology is a good indicator of cure if the patient has not been taking medications which inhibit H.pylori. This means 28 days for antibiotics, 7 days for acid proton pump blockers.

[elizabeth bradley]

Thank you. My youngest child has also tested positive. He has been treated before but has not had the problems his brother has experienced. My third child did not test positive. Thank goodness. I will retest the younger two and then if they are positive we will treat. Do you have any treatment recommendations? The last treatment we followed was the quadruple and that was over a year ago. The children are four and five years old. I am determined to get rid of this even though I have been thwarted for several years! Thank you very much for all your assistance.

[Jenn BB]

Thank you Dr, Marshall & Elizabeth for posting this. We have been struggling for 5 years to treat our daughter adopted from China.
She has been treated three times (unsuccessfully as evidenced by endoscopic biopsy/breath test). For the last 18 months she has been asymptomatic, yet in the last 8 weeks has developed upper stomach pain.

She came into our family with multiple health issues: severe giardia and TB (which have both been successfully treated) and the H. Pylori. She is also lactose intolerant (as evidenced by endoscopic biopsy).

Dr. Marshall do you have any recommendation or advice on which combination prove most effective at the point we are at?

many thanks for your willingness to help those of us in the adoptive community.

Jenn