Diagnosis and management of Helicobacter pylori infection in children

Abstract

The prevalence of infections with Helicobacter pylori is declining in industrialized countries, yet a significant percentage of children still appear to test positive for this bacterium. Although infection usually occurs in childhood, H. Pylori infection in children differs significantly from infection in adults with respect to clinical presentation, treatment strategy and antibiotic resistance. Because of all these differences, guidelines also differ substantially between children and adults. Based on the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN/ NASPGHAN) guidelines, this article aims to guide the pediatrician when and how to test for H. pylori infection and discusses treatment options

Given the lack of symptomatic improvement after treating Helicobacter pylori in the absence of gastric erosions and ulcers and the rising rate of antibiotic resistance worldwide, the joint European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines were updated in 2017. The society states that the primary goal of testing for H. pylori in children is to find the underlying cause of abdominal symptoms and that eradication therapy is only recommended in patients with confirmed peptic ulcer disease. Furthermore, anti-H. pylori therapy should be tailored accordingly after antimicrobial susceptibility testing and the outcome of the treatment should be assessed at least 4 weeks after completion, using non-invasive tests such as the ¹³C-breath test or the fecal antigen test.