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Persistent presence of H. pylori slows growth rate

Mera RM. Pediatr Infect Dis J. 2012;doi:10.1097/INF.0b013e31824434fec.

Children whose Helicobacter pylori infection was eradicated quickly grew faster than those who were not treated early, according to a study from Vanderbilt University Medical Center in Nashville, Tenn.

Robertino M. Mera, MD, PhD, and colleagues in the division of gastroenterology, hepatology and nutrition examined data from 295 school-age children from rural communities in Nariño, Colombia, who were separated into two groups: 150 who were treated for H. pylori and 145 who were not.

Children in the treatment group who tested positive for H. pylori were treated with lansoprazole, amoxicillin, metronidazole and bismuth for 14 days, and they were re-treated if they remained positive 3 months after baseline. Six months after baseline, height and weight measurements were taken, and presence of H. pylori was evaluated; children were measured every 3 months and checked for H. pylori every 6 months using a urea breath test. Children were followed for an average of 3.7 years. 

Researchers concluded that children from the treatment group were 2.98 cm taller on average, even after adjusting for other fixed variables such as sex, father’s education and number of siblings. Similarly, children in the treatment group were 1.1 kg heavier on average, even with fixed variable adjustment.

“This study showed a significant and durable effect of clearing H. pylori infection on increased height and weight,” the researchers said. “Although treatment is only recommended for certain indications, this study suggests that in terms of growth, school-age children may benefit from being treated for H. pylori infection.”

This is the third study in this group of children, according to Mera. The first study showed the growth gap in a prospective cohort study in infants, and that there was no “catch up” of growth after being infected by H. pylori for a long time. 

“We have been following this particular group of school-age children for several years now, and we have shown that the treatment, when effective, produces a startling growth difference when compared to infected children or those that do not clear the infection,” Mera told Infectious Diseases in Children. “In this latest study, we also have shown a weight difference, which is difficult due the large variability of weight in children.”

Disclosure: The researchers report no relevant financial disclosures.

The factors that impact growth of children in developing countries remain largely unknown. This understanding is critical because as we get better at saving children's lives, particularly from infectious diseases, we see large numbers of children surviving early childhood with stunted growth and cognitive delay. We do know that caloric deprivation is only part of the equation, and possibly only a minor part in many areas. So what else contributes to childhood stunting?

Working in Colombia, Mera and colleagues suggest that children infected with Helicobacter pylori exhibit slower growth than children who are not infected or who have their infections treated. The association is plausible, largely because it has been observed by other groups. But a likely mechanistic hypothesis remains elusive. Moreover, there are some problems with the study. Foremost, if H. pylori makes one grow slower, why is it that at study entry, those with Helicobacter and those without are not significantly different with regard to size and weight? Could it be that there are unintended positive effects of the treatment? There are emerging data to suggest that the intestinal microbiome may contribute to childhood growth in developing countries, and the microbiota are obviously affected by antibiotics.

Antibiotics could also have prevented other infections occurring during the treatment period (these infectious agents would have been not-so-innocent bystanders); studies going back to the 1970s suggest that infectious insults of nearly any variety can lead to growth retardation. In the end, of course, H. pylori could simply be one of these infections, or the infection could be linked to growth delay via mechanisms not yet understood. In any case, the study of Mera and colleagues provides important food for thought in a still hungry world.

James P. Nataro, MD, PhD, MBA
Benjamin Armistead Shepherd Professor and Chair,
Department of Pediatrics University of Virginia School of Medicine
Pediatrician-in-Chief, University of Virginia Children's Hospital
Charlottesville, Va.

Disclosure: Dr. Nataro reports no relevant financial disclosures.

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