Helicobacter pylori infection was identified in 5 children with severe neurologic impairment who underwent upper gi endoscopy at the Alfred I duPont Institute, Wilmington, De, and Jefferson Medical College, Philadelphia. Subsequently, patients with severe neurologic impairments, such as cerebral palsy and head trauma, who had endoscopies because of gastrointestinal symptoms were examined for H. pylori infection in gastric antral mucosa biopsies. Of 61 examined, 7 (11%) were positive for infection and had gastritis. Institutionalized patients were at much greater risk of infection than those seen as outpatients (75% cf 7%). Resolution of gi symptoms (emesis, guiac-positive stools, refusal to eat, and irritability during feedings) was complete in 6 of the 12 infected patients and partial in 4 after antibiotic treatment. 
COMMENT. All neurologically impaired, and especially institutionalized, children with persistent gastrointestinal symptoms should be examined and treated when positive for H. pylori infection.
A possible H. pylori infection should be considered in children with epilepsy who develop gastritis and feeding difficulties after long-term treatment with valproic acid, divalproex sodium, and other antiepileptic drugs. (see Progress in Pediatric Neurology I, PNB Publishers, 1991). Gastritis and gastric ulceration attributed to the antiepileptic drugs may be due primarily to infection in the gastric mucosa.