A Re-evaluation of the Association Between Helicobacter pylori Infection and Pediatric Recurrent Abdominal Pain: A Systematic Review of Organic Versus Functional Etiologies
Notice bibliographique
Résumé
Introduction: The association between Helicobacter pylori infection and Recurrent Abdominal Pain (RAP) in children is a subject of long-standing, significant controversy. While numerous studies in hospital-based settings report a significant link, major practice guidelines conclude no association exists for functional abdominal pain. This systematic review aims to resolve this conflict by synthesizing the evidence through the distinct frameworks of organic versus functional gastrointestinal disease. Methods: This review adheres to the PRISMA 2020 guidelines. A systematic search of PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library was conducted for studies published from 1995 to 2025. Observational (cross-sectional, case-control, cohort) studies, randomized controlled trials (RCTs), and meta-analyses comparing H. pylori-positive and H. pylori-negative pediatric patients (<18 years) with RAP or functional abdominal pain disorders (FAPDs) were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) for observational studies. Results: Eighteen primary studies, including four meta-analyses, met the inclusion criteria. The evidence was highly stratified by study setting. A key meta-analysis demonstrated a statistically significant and strong association between H. pylori and abdominal pain in hospital-based studies (Pooled Odds Ratio 2.87; 95% Confidence Interval [CI]: 1.62–5.09). This was supported by hospital-based cohorts reporting that 100% of H. pylori-positive RAP patients had organic gastritis and 80% experienced symptom resolution post-eradication. Conversely, the same meta-analysis found no association in population-based studies (Pooled OR 0.99; 95% CI: 0.46–2.11). This null finding was confirmed by large, population-based studies and meta-analyses specific to FAPDs like Irritable Bowel Syndrome (IBS), which found no significant link. Discussion: The "controversy" in the literature is identified as a "lumping fallacy," wherein studies fail to differentiate between two distinct clinical entities: (1) organic RAP caused by H. pylori-induced gastritis/PUD, and (2) true, Rome IV-defined FAPD, a disorder of gut-brain interaction. The significant findings (OR 2.87) represent the subset of children with organic disease, while the null findings (OR 0.99) represent the larger FAPD population where H. pylori is an incidental finding. Conclusion: The association between H. pylori and pediatric RAP is significant, but only within the specific subgroup of children whose pain is a clinical manifestation of H. pylori-driven organic gastroduodenal pathology. H. pylori infection is not associated with true functional abdominal pain. Clinical practice must, therefore, be guided by rigorous triage using "red flag" symptoms to differentiate patients who require organic workup (including H. pylori testing) from those who require FAPD management.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,173 | 0,151 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».