# _Helicobacter pylori_--The Bridge between Local and Systemic Inflammation in Children
## 4 Discussions  
Although over 50% of the population worldwide is infected with \(H\). _pylori_, its prevalence is closely related to the geographic area suggesting that other factors aside from the host and bacterium itself might be implicated in the development of \(H\). _pylori_-induced gastritis [25]. Moreover, several environmental factors were related with the presence of \(H\). _pylori_ infection such as rural area, male gender, poor socio-economic status, poverty, educational level, poor parental education and unemployment, house crowding, birth order, bed sharing with adults, farmer profession, using a traditional pit or having no toilet, the lack of in-home water service, source of drinking water, using tanks as water supplies, active smoking, alcohol drinking, eating raw uncooked vegetables or spicy food, eating unwashed vegetables or fruits, improper hand washing after school, as well as difficult access and poor adherence to treatment [25]. Nevertheless, the majority of the studies worldwide indicated a descending prevalence trend of \(H\). _pylori_ infection revealing a decrease by one-third during the first decade of this century most likely due to the worldwide improvements of environmental and living conditions, as well as socio-economic status leading to better sanitation and lowering the transmission over time [26]. Unfortunately, our study revealed that in our country rural area remains a considerable risk for the presence of \(H\). _pylori_  
Figure 4: The difference of median values of eosinophils between the three groups. \begin{table}
\begin{tabular}{l c c c} \hline \hline  & **Presence of TNF \(\alpha\) (n/\%)** & **Absence of TNF \(\alpha\) (n/\%)** & \(p\) **Value** \\ \hline \(H\). _pylori_-induced & 10 (50.00\%) & 4 (8.33\%) & \\ gastritis group & & & \\ \hline Non-\(H\). _pylori_ & 7 (35.00\%) & 19 (39.58\%) & 0.0002 \\ gastritis group & & & \\ \hline Control group & 3 (15.00\%) & 25 (52.08\%) & \\ \hline \hline \end{tabular}
\end{table} 
Table 8: Correlation between the presence of TNF \(\alpha\) in the three groups. infection in children raising important concerns regarding the socio-economic level and living conditions of Romanian people from rural areas. The diagnosis of _H. pylori_ infection in children is burdened by multiple challenges related to the specificity and sensitivity of the diagnostic method, invasiveness, interobserver-associated variability, the location and size of the biopsy sample, prior treatments, etc. Although choosing the method for diagnosing _H. pylori_ infection in children might seem simple, we must also take into account that the parents/care-givers should also be involved in this process and most often their reluctance regarding invasive diagnostic methods will not allow the use of these methods in spite of their increased specificity and sensitivity. Therefore, the clinician should focus on identifying the most effective non-invasive method for diagnosing this infection. Serology tests represent an optimal choice due to their lack of invasiveness, wide availability, low cost, as well as relatively good specificity and sensitivity (up to 90% and 80%, respectively) [27; 28]. Moreover, their accuracy is not impaired by prior administration of proton pump inhibitors, antibiotics or bismuth compounds, history of atrophic gastritis, or recent gastrointestinal hemorrhage [29]. A study involving children concluded that both IgA and IgG tests are highly accurate in diagnosing _H. pylori_ infection, especially in younger children, under the age of 12 years [30]. Similarly, our findings also underlined that IgA test might be considered a reliable test for detecting _H. pylori_ infection in children. Following the same trend of non-invasiveness, recent studies focused on identifying minimally invasive tests for diagnosing the subclinical inflammatory status related to _H. pylori_ infection which was proved to begin during early childhood [7]. Thus, complete cellular blood parameters proved to be useful in suggesting the presence of subclinical inflammation.