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Abstract Beta thalassemia syndromes are a group of hereditary disorderscharacterized by a genetic deficiency in the synthesis of betaglobinchains. Several gastrointestinal tract disturbances seen in B-thalassemia major patients as hepatitis, gallbladder stones, gastritis and recurrent abdominal pain (RAP) with a great incidence. Recurrent abdominal pain (RAP) is one of the most common complaints of childhood. RAP is defined as at least three episodic attacks of abdominal pain over at least three months that are severe enough to affect the usual activity of the child. Helicobacter pylori (H. pylori) , a human bacterial gastric pathogen, is highly prevalent, varying from 5–15% in developed countries to 70% in the developing world. However it is not proven that HP infection is one of the causes for RAP in ß TM patients. There are very limited number of studies about this subject. So our study was done to determine the frequency of HP seroprevalence and active infection in ß TM patients both symptomatic and asymptomatic for RAP and to compare between ß TM patients and normal controls presenting with RAP. The study included 2 groups group I consists of forty multitransfused β-thalassemia major patients Aged 3 – 18 years.They were subdividedinto Group Ia ( symptomatic for RAP) and Group Ib ( asymptomatic for RAP) each group consists of 20 β thalassemia major patients. They were collected from hematology and oncology unit, Pediatric department, Minoufya University Hospital. Group II(control group) consists of 20 children complaining of recurrent abdominal pain with no chronic illness whose ages and gender were compatible from the outpatient Pediatric clinic of the same hospital. Each patient and control subjected to the following: 1- Complete history includes personal history, history of the present illness, and past history of blood transfusion, abdominal pain analysis. 2- Thorough clinical examination include general, anthropometric, and abdominal examination. 3- Laboratory and radiological investigation: complete blood count, Erythrocytesedimentation rate (ESR),hepatitis B and C viral markers,ALT and AST, stool analysis,urine analysis, s. creatinine, hemoglobin electrophoresis ,serum ferritin and abdominal Ultrasound. All patients were examined for anti-HP antibody using HP-IgG ELISA test. positive patients for HP-IgG were examined for helicobacter pylori antigen in the stool. Results of our study showed: The overall prevalence of HP IgG in β TM patients was 45% which was equal to that of the control group however, the overall prevalence of stool antigen positive test was 37.5% in β TM patients compared to 30% in controls . The prevalence of HP Ig G (+ve) was higher in thalassemia patients without RAP (50%) than control group (45%) and thalassemia patients with RAP (40%) but no significant difference was found (p>0.05). On the other hand, our study revealed that theprevalence of stool antigen positive patients was higher in thalassemia patients with RAP (40%) than thalassemia patients without RAP (35%) and control group (30%) but also no significant difference was found (p>0.05). No significant difference between the studied groups on comparison of serum positive HP antibody against positive antigen in stool (P>0.05 ). Regarding demographic data and anthropometric measurement,no significant difference among the studied groups regarding age, sex , residence and BMI (P >0.05) but significant difference between each group of thalassemia and controls regarding height and weight (P<0.05). Regarding pain site, pain duration and associated symptoms,no significant differencebetween thalassemia patients with RAP and controls (P>0.05). No significant difference between both groups of thalassemia regarding chelation type, chelation course, blood transfusion units , blood transfusion frequency and splenectomy (P>0.05). Regarding hematological data of the studied groups: Regarding hemoglobin and serum ferritin, highly significant difference between each group of thalassemia and control group (p<0.001). Regarding viral markers, significant difference between thalassemia patients without RAP and controls(p<0.05). Regarding ALT and AST, highly significant difference between thalassemia patients without RAP and controls (p<0.001). Results of serum positive HP antibody and positive stool antigen regarding some parameters showed: o Regarding age, significant difference between thalassemia patients without RAP and controls in theresults of HPIg G (p<0.05). While, no significant difference in theresults of HP stool antigen (P>0.05). o Regarding sex, residence, height, weight and body mass index no significant difference among the studied groups for both HP antibody and stool antigen results (P>0.05). o Regarding pain site, no significant difference between thalassemia patients with recurrent abdominal pain and controls in terms of HP antibody (P>0.05). However, there was significant difference in terms of stool antigen results (P<0.05). o Regarding pain duration and other associated symptoms,no significant difference betweenthalassemia patients with recurrent abdominal pain and controls in terms of HP antibody as well as stool antigenresults (P>0.05). o Regarding splenectomy, no significant difference between both groups of thalassemia for HP antibody(P>0.05). however, there was significant difference in terms of stool antigen results (P<0.05). o Regarding chelation type, chelation course, blood transfusion units and blood transfusion frequency no significant difference between both groups of thalassemia for both HP antibody as well asstool antigen results( P >0.05). o Regarding hemoglobin,significant difference between each group of thalassemia and control groupfor HP antibody (P<0.05). However, nosignificant difference between each group of thalassemia and control groupin terms of stool antigen results (P>0.05). o Regarding serum ferritin, significant difference between each group of thalassemia and control group in terms of HP antibody as well as stool antigen results (P<0.05). o Regarding ALT, significant difference between thalassemia patients without RAP and controls in terms of HP antibody (P<0.05). However, no significant difference among the studied groups for stool antigen results (P>0.05). o Regarding AST, significant difference between thalassemia patients without RAP and controls in terms of HP antibody as well as stool antigen results (P<0.05). o Regarding viral markers, significant difference between thalassemia patients without RAP and controls in terms of HP antibody (P<0.05). However, significant difference between thalassemia patients with recurrent abdominal pain and controls for stool antigen results (P < 0.05). We concluded that the high prevalence of H. pylori infection suggests that H. pylori should be remembered as a probable cause of RAP in β- thalassemia major patients as well as healthy children. HP seroprevalence was high (45%) in thalassemic and controls. active infection was higher in thalassemic than controls and affected with splenectomy and high serum ferritin. |