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Helicobacter pylori infection and eradication in paediatric patients
1Department of Medicine, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas 77030, USA. hmalaty@bcm.tmc.edu
Insights
Childhood Helicobacter pylori (H. pylori) infection causes gastritis and ulcers. Eradication therapy is recommended for infected children with ulcers, with post-therapy testing crucial for confirming cure and preventing resistance.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Helicobacter pylori (H. pylori) infection is typically acquired in childhood and is linked to chronic gastritis and peptic ulcer disease.
- While H. pylori can be lost during childhood, the reasons (antibacterials, natural history, or both) remain unclear.
- Eradication of H. pylori in children with peptic ulcers leads to ulcer healing and reduced relapse rates.
Purpose of the Study:
- To review the current understanding of H. pylori infection in children, focusing on diagnosis, treatment, and associated conditions.
- To emphasize the importance of confirming H. pylori infection before initiating therapy and the need for post-therapy testing.
- To discuss the evidence regarding H. pylori and recurrent abdominal pain (RAP) in children.
Main Methods:
- Review of existing literature on H. pylori infection in pediatric populations.
- Discussion of diagnostic methods, including the [13C]urea breath test as the preferred noninvasive option.
- Analysis of treatment strategies, advocating for regimens similar to adult triple therapy (PPI plus two antibiotics for 14 days).
Main Results:
- H. pylori eradication is effective in healing duodenal ulcers and lowering relapse rates in children.
- The [13C]urea breath test is recommended for diagnosing H. pylori infection and confirming successful eradication post-therapy.
- Evidence linking H. pylori to recurrent abdominal pain in children is weak and inconsistent, necessitating careful diagnosis.
Conclusions:
- H. pylori treatment should be initiated in children diagnosed with peptic ulcers and confirmed infection.
- Accurate diagnosis and post-therapy testing are essential to ensure treatment efficacy and prevent antibiotic resistance.
- The role of H. pylori in pediatric recurrent abdominal pain remains controversial and requires further investigation.
Abstract:
Helicobacter pylori is now recognised to be typically acquired during childhood. Studies also indicate that the infection is frequently lost in childhood; however, it is still unclear whether this is related to the use of antibacterials, the natural history of the infection, or both. H. pylori colonises gastric mucosa and is causally related to chronic gastritis and peptic ulcer disease in both children and adults. Successful eradication of H. pylori has resulted in the healing of duodenal ulcers and the lowering of the ulcer relapse rate in children. Therapy to cure the infection should be started in all children with peptic (duodenal or gastric) ulcer who are still infected. The ideal anti-H. pylori regimen should be safe, cheap, easy to comply with, well tolerated by children and able to achieve a high cure rate. Although US data are lacking, it is anticipated that the treatment regimen for children should be similar to that in adults (a triple therapy regimen that combines a proton pump inhibitor with 2 antimicrobial agents for 14 days). It is inappropriate to prescribe anti-H. pylori therapy without a firm diagnosis. The use of multiple antibacterials in a paediatric patient with an ulcer but without H. pylori infection cannot provide any benefit to the patient or the community. Such an approach only provides the possibility for adverse effects, for example development of antibacterial resistance among bystander bacteria. It is very important to confirm the diagnosis of H. pylori infection. The [13C]urea breath test is the noninvasive method of choice to determine H. pylori status in children and the ideal test for post-therapy testing. There is a need for post-therapy confirmation because of the likelihood of poor outcome for some treatment regimens, which is why post-therapy testing should be the standard of care. There is weak and inconsistent evidence of an association between H. pylori infection and recurrent abdominal pain (RAP) in children, in part because of the unclear definition of RAP in the literature. Therefore, there is still considerable debate regarding the treatment of infected children with RAP.