The radiation dose equivalent to 1 day background radiation may be justifiable in certain circumstances. However, a question must be raised about the ethics of any increased radiation exposure in children [16]. There are continued reports of the lack of relationship between H. pylori infection and abdominal symptoms [10,17–19]. In Nigeria, Senbanjo et al. [17] reported that while there was a high prevalence of H. pylori in both children with sickle cell disease children (SCD) (67.8%) and children without SCD (63.6%), there was no association between H. pylori infection and RAP in SCD. In refugee children of African descent, while there is a high prevalence of H. pylori

infection, digestive symptoms selleck chemicals were not predictive of H. pylori infection or of infestation with helminthes [19]. Ulcer disease in childhood is relatively rare compared with adults. There continues to be reports of the increasing prevalence of non-H. pylori-associated peptic ulcer disease in children [20–22]. A recent European multicenter study reported ulcers and/or erosions in 56 of 694 (8.5%) children. H. pylori infection was present in only 15 of 56 children (27%) with ulcers/erosions. Children with ulcers/erosions were significantly older than those without lesions (10.3 ± 5.5 vs 8.1 ± 5.7 years, p = .002). BAY 57-1293 cell line Gastrotoxic medications were less frequently implicated than expected. There were no risk factors for ulcers/erosions

identified in 24 of 56 (43%) children [20]. Similarly in a single-center retrospective study from Taiwan, Huang et al. [21] found of the 1234 children who had an upper endoscopy that only 67 (5.4%) had peptic ulcer disease of whom 32/67 (47.7%) were infected with H. pylori. Isotretinoin While 16% had a history of nonsteroidal anti-inflammatory use, 35.8% of children had no identified risk factors associated with peptic ulcer disease. The elucidation of the pathophysiology of non-H. pylori-associated peptic ulcers and erosions in children remains an interesting research question. Pacifico et al. in a comprehensive literature review on H. pylori infection in children noted

that while the development of low-grade gastric MALT lymphoma associated with chronic H. pylori gastritis has been reported in children in the past, and to date, there have been no reports of gastric adenocarcinoma in childhood [23]. Conclusions regarding possible associations between H. pylori infection and GERD are lacking. Abdollahi et al. in a study of 263 Iranian children (3–18 years), all of whom had symptoms of GERD and underwent upper digestive endoscopy showed that the prevalence of H. pylori infection in children with GERD symptoms (13/83, 15%) was significantly lower than in those without GERD symptoms (46/180, 26%) (OR 0.54, CI 0.27–0.93, and p <.05). They suggest that H. pylori infection might be protective against GERD [22]. Alternatively, GERD-like RAP could be considered a functional disorder of childhood not associated with H. pylori.