Helicobacter pylori (H. pylori) is one of the most prevalent bacteria that can infect humans globally. The World Health Organization estimates that around 70% of people residing in developing countries and 30% from industrialized nations are infected with H. pylori. It is classified as a gram-negative bacterium and inhabits the gastric mucosa, which can result in digestive disturbances and decline in health irrespective of age. This issue also pertains to children, as the infection with the bacterium typically occurs during childhood.
Helicobacter pylori infection in pediatric populations: Epidemiological distribution, pathogenic mechanisms, and clinical implications
The likelihood of *Helicobacter pylori* infection in pediatric populations exhibits substantial geographic and socioeconomic variability. In low-resource settings—particularly within African nations such as South Africa and Ethiopia—prevalence rates among children under five years of age may reach 50–60%, whereas in European countries, the corresponding figure often remains below 1%. Polish epidemiological data suggest an estimated 32% infection rate among children and adolescents up to 18 years old. Transmission pathways differ by developmental context: in high-income societies, oral-oral or fecal-oral routes predominate, while in underdeveloped regions, fecal-oral transmission is the primary mode. During the first six months of life, maternal antibodies present in breast milk confer partial protection against colonization; thereafter, salivary contact and fomite exposure become the most common vectors. The bacterium’s pathogenicity stems from its capacity to colonize gastric mucosa, survive in acidic environments, and induce structural tissue alterations. A pivotal adaptive mechanism is urease production—an enzyme that hydrolyzes urea into ammonia and carbon dioxide, thereby neutralizing gastric acid and facilitating epithelial adherence. Infection triggers progressive mucosal inflammation, potentially culminating in atrophic gastritis. Notably, 80–90% of cases remain asymptomatic; however, symptomatic presentations frequently involve peptic ulcer disease affecting the stomach and duodenum, with long-term implications including an elevated risk of gastric carcinoma. Common gastrointestinal manifestations in children comprise epigastric pain with a burning quality, nausea, vomiting, heartburn, premature satiety post-meal, and recurrent eructation. Additionally, *H. pylori* infection has been linked to iron-deficiency anemia. Emerging evidence further suggests potential associations with extra-gastrointestinal conditions, such as myocardial infarction, circulatory disorders, migraine episodes, and cutaneous lesions.
Cutaneous manifestations associated with *Helicobacter pylori* infection: Clinical correlations, emerging evidence, and diagnostic controversies
Epidemiological research indicates that individuals with confirmed *Helicobacter pylori* infection within the gastrointestinal tract may exhibit an elevated susceptibility to dermatological manifestations, including **rosacea**, a condition whose pathogenesis has been linked to chronic inflammatory responses triggered by the bacterium. Furthermore, a substantial body of scientific literature has established correlations between *H. pylori* colonization and the development of **prurigo nodularis**, a dermatological disorder characterized by severe, persistent itching and nodular skin lesions that, in numerous documented cases, resolve following successful pathogen eradication through targeted antibacterial therapy. Additionally, medical case reports have described instances of **atopic dermatitis** in children infected with this gram-negative bacterium, suggesting a potential role in modulating skin immune responses. There are also accounts of an association between *H. pylori* infection and **chronic urticaria**, wherein a subset of patients experienced remission of cutaneous symptoms after the initiation of antimicrobial treatment. However, it is critical to emphasize that the majority of these observations stem from isolated case studies or investigations with limited sample sizes, precluding the establishment of definitive diagnostic guidelines. Moreover, some researchers challenge the causative nature of these relationships, positing that they may instead reflect the coexistence of alternative inflammatory mediators or dysbiosis within the microbiome. Consequently, further well-designed clinical trials are essential to elucidate the precise role of *H. pylori* in the pathogenesis of skin disorders and to determine whether bacterial eradication could serve as a viable therapeutic intervention in affected individuals.
Diagnostic assessment for Helicobacter pylori infection: methodologies and clinical implications
The diagnosis of Helicobacter pylori infection relies on two primary categories of diagnostic assessments: invasive procedures, which necessitate upper gastrointestinal endoscopy (gastroscopy), and non-invasive methods. Invasive techniques include the rapid urease test (detecting the bacterial enzyme urease), histopathological examination (microscopic analysis of gastric mucosal biopsies), and microbial culture (cultivating the bacterium to identify strain-specific characteristics and antibiotic susceptibility profiles).
Among non-invasive approaches, the urea breath test (UBT) using isotopically labeled urea (^13C or ^14C) is widely regarded as the "gold standard" for confirming active infection. The procedure involves administering a solution containing labeled urea, which—upon exposure to bacterial urease—decomposes into ammonia and labeled carbon dioxide (CO₂). After 30 minutes, an exhaled breath sample is collected, and the concentration of labeled CO₂ correlates with the presence of H. pylori. This test demonstrates exceptional sensitivity (probability of detecting infection when present) and specificity (probability of excluding infection when absent), rendering it more reliable than alternative diagnostic tools. The average cost in diagnostic facilities ranges from 250 to 300 USD (or equivalent in local currency).
Another non-invasive option is the stool antigen test (HpSA), which detects bacterial antigens in fecal samples. The procedure entails collecting a small stool specimen, suspending it in a buffer solution, and applying three drops onto a test cassette. Results are interpreted after 10 minutes according to the manufacturer’s instructions. This test confirms active infection or evaluates the success of eradication therapy (elimination of the bacterium). Its availability in pharmacies and drugstores (price: 25–35 USD) makes it a convenient choice for patients. However, false-negative results may occur in cases of low bacterial load or shortly after treatment completion.
Serological tests measure IgG-class antibodies against H. pylori in the patient’s blood serum. A positive result indicates prior exposure to the bacterium but does not confirm active infection, as antibodies may persist for 12 months or longer post-successful eradication. While useful for epidemiological surveys or preliminary screening, this method is unsuitable for monitoring treatment outcomes.
A clinically concerning trend is the rising antibiotic resistance of H. pylori to conventionally used agents (e.g., clarithromycin, metronidazole), significantly reducing the efficacy of standard therapeutic regimens. This infection also affects pediatric populations, potentially leading to gastric and/or duodenal ulcer disease as well as chronic gastrointestinal symptoms such as abdominal pain, nausea, vomiting, or weight loss. Early diagnosis and tailored treatment selection are therefore critical to preventing complications.
