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The impairment of gastric acid barrier caused by Helicobacter pylori (H. pylori) at the onset of infection may predispose to small bowel bacterial overgrowth, which could contribute to persistent diarrhea.Using the 13C-urea breath test, we determined the prevalence of H. pylori infection in 123 Nicaraguan children from Tipitapa, aged 1 to 65 months, from a low socioeconomic background.The overall prevalence of H. pylori infection was 77.2% (95/123). The prevalence varied with age and was significantly (p < 0.001) higher in infants ≤12 months than in children aged 13-65 months, 91% (57/63) as against 63% (38/60). H. pylori infection was present in 44 of 59 (75%) children suffering from persistent diarrhea compared with 51 of 64 (80%) age-matched asymptomatic controls. In the diarrheal group, 20 of 59 (34%) children presented with malnutrition, and 16 (80%) of them showed H. pylori infection. In the control group, 20 of 64 (31%) were malnourished, and 14 (70%) of them showed H. pylori infection.In Nicaragua, H. pylori is acquired in early infancy. The high prevalence among children in the first 12 months of life and the lower infection rate between 1 and 5 years of age suggest a loss or clearance of infection, also an occasional finding in adults. H. pylori infection appears to be not a risk factor for persistent diarrhea or malnutrition in Nicaraguan children.