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Helicobacter pylori Infection in Children. Antimicrobial Resistance and Treatment Response
Milagrosa Montes1,2, Flor N Villalon3, Francisco J Eizaguirre4
1Servicio de Microbiología-IIS Biodonostia, Hospital Universitario Donostia, San Sebastián, Spain.
Insights
This study found that treating Helicobacter pylori infection in children, even those with only recurrent abdominal pain, led to symptom remission. Effective eradication therapy is crucial for improving pediatric H. pylori patient outcomes.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Assessing the appropriateness of current Helicobacter pylori (H. pylori) management guidelines in pediatric care.
- Investigating antimicrobial resistance patterns and eradication therapy success rates in children.
- Focusing on a university hospital setting in Southern Europe.
Purpose of the Study:
- To evaluate the efficacy of H. pylori treatment recommendations in children.
- To determine the prevalence of antimicrobial resistance in pediatric H. pylori infections.
- To assess the impact of H. pylori eradication on symptom resolution in children.
Main Methods:
- Analyzed 143 children for H. pylori using gastric biopsy culture (GBC), (13)C-urea breath test (UBT), and stool antigen immunochromatography test (SAIT).
- Determined antimicrobial susceptibility using E-test.
- Monitored disease progression and symptom evaluation 3-6 months post-diagnosis or treatment in 118 patients.
Main Results:
- H. pylori detected in 74/143 children; chronic abdominal pain was the primary symptom (n=121).
- High resistance rates observed: clarithromycin (34.7%) and metronidazole (16.7%).
- Successful eradication was 78.7% with susceptible drugs vs. 37.5% with resistant drugs (p=.024); symptom resolution in 92.9% of eradicated patients (p<.001).
Conclusions:
- Pediatric H. pylori management often deviates from guidelines, with many cases presenting with recurrent abdominal pain.
- Symptom remission in children with recurrent abdominal pain is strongly associated with successful H. pylori eradication.
- Effective eradication therapy is vital for improving clinical outcomes in pediatric H. pylori infections.
Background:
The aim of this study was to determine the appropriateness of the recent recommendations for managing Helicobacter pylori infection in children in a university hospital in Southern Europe. Antimicrobial resistance and response to eradication therapy were also determined.
Materials And Methods:
The presence of H. pylori was studied in 143 children: by gastric biopsy culture (GBC), (13)C-urea breath test (UBT) and stool antigen immunochromatography test (SAIT) in 56 children; by GBC and UBT in 20, by GBC and SAIT in 18, and by GBC alone in 49. Antimicrobial susceptibility was determined by E-test. Infection was defined as a positive culture or positivity in both UBT and SAIT. Disease progression was studied in 118 patients. First evaluation of symptoms was carried out at 3-6 months after diagnosis and/or after treatment of the infection.
Results:
H. pylori was detected in 74 from the 143 children analyzed (100% GBC positive, 98.1% UBT positive, and 58.1% SAIT positive). The main symptom was chronic abdominal pain (n = 121). Macroscopic antral nodularity was observed in 29.7% of infected patients and in 5.8% of uninfected patients, respectively. Resistance to clarithromycin and metronidazole was found in 34.7 and 16.7%, respectively. Eradication when susceptible antimicrobials were used occurred in 78.7% (48/61) versus 37.5% (3/8) when the treatment included a drug with resistance (p = .024). In patients with recurrent abdominal pain, symptoms resolved in 92.9% (39/42) patients with HP eradication versus 42.9% (6/14) without HP eradication (p < .001).
Conclusion:
Treated patients often failed to meet the criteria established in the guidelines for H. pylori diagnostic screening and treatment because most of them had only recurrent abdominal pain, but remission of their symptoms was associated with H. pylori eradication.
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