The Rate of Helicobacter pylori Infection in Children With Growth Retardation

To the Editor: Patel et al. (1) have reported the results of a survey conducted in 554 school children from Edinburgh, indicating that growth was significantly reduced in girls aged 7 to 11 years with saliva serology positive for Helicobacter pylori (H. pylori). The mean height loss was 1.6 cm over 4 years, raising the possibility that H. pylori infection may diminish the pubertal growth spurt in girls. They also found that the risk of H. pylori infection was related to the type of community in which the child lived and to features of the family home. To substantiate this hypothesis, we undertook to assess the rate of H. pylori infection and of its risk factors in preadolescent schoolchildren with consistent growth retardation. A prospective survey was conducted in 48 consecutive children, 28 males (M) and 20 females (F) (mean age, 12 ± 3.5 years; range, 5-16 years) enrolled for investigation of unknown severe growth retardation (i.e., a height less than -2 SD according to French standard curves (2). H. pylori infection was sought by the measurement of serologic titers against H. pylori (enzyme-linked immunosorbent assay, IgG, second generation; Cobas Core, Roche Laboratories, France) and a 13C-urea breath test (13C-UBT), performed as has been described (3,4). Seropositivity was defined by serologic titers above cutoff values and active H. pylori infection by concomitant positivity of 13C-UBT. Data concerning demographic ethnic origins, housing tenure, domestic crowding, and socioprofessional parental classes were collected. A written consent was obtained from the parents of all. Seropositivity was detected in eight children (16.6%, four girls and four boys), among whom four had active infection (8.3%). No seronegative child exhibited a positive 13C-UBT result. The individual heights, sex, and ages of the four seropositive children were 114 cm, F, 8 years; 123 cm, M, 10 years; 140 cm, F, 13 years; 137 cm, F, 15 years; and those of the remaining four with active infection were 115 cm, M, 8.5 years;, 138 cm, F, 12.2 years; 141 cm, M, 13.7 years; 145 cm, F, 14.5 years. There was no difference between seropositive and seronegative children in mean age, ethnic origins, housing tenure, domestic crowding, and sex ratio, in contrast with the reported higher prevalence in girls in Patel et al. (1). It is of note that 80% of seropositive children belonged to the working class (p < 0.05), compared with the economic classes of the remaining parents, in good agreement with findings in previous studies (1,5,6). The seropositivity rate depicted in the present survey is relatively higher than that found for the same age range in children in the general population without growth retardation, which amounts to 6% in Italy (7), 11% in the United Kingdom (1), and 13% in Belgium (8). H. pylori infection, just as any chronic infection, has been associated with reduced growth (1), but growth retardation disappears when correlating the data with socioeconomic background (1). Therefore, because our findings do not disprove the finding by Patel et al. (1) that seropositive children have significant growth retardation, we cannot recommend the systematic search for H. pylori infection in children with growth retardation. Hélène Sauvé-Martin Nicolas Kalach Josette Raymond Lahouari Senouci Pierre Henri Benhamou Jean-Christophe Martin Françoise Briet Michèle Maurel Bernard Flourié Christophe Dupont Departments of Pediatrics and *Microbiology; Hôpital Saint Vincent de Paul; †Hôpital Fernand Widal; ‡INSERM U 290; Hôpital Saint Lazare; Paris, France