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Helicobacter pylori and some aspects of gut microbiota in children
Michal Kori1, Ilva Daugule2,3, Vaidotas Urbonas4
1Pediatric Gastroenterology, Kaplan Medical Center, Rehovot, Israel.
Insights
Helicobacter pylori (H. pylori) management in children requires distinct approaches due to differences in presentation and antibiotic resistance. Guidelines emphasize endoscopy-based diagnosis and tailored treatment for successful eradication.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Helicobacter pylori infection presents unique challenges in children compared to adults.
- Epidemiology, diagnostics, antibiotic resistance, and treatment efficacy vary significantly between pediatric and adult populations.
- Current management guidelines for H. pylori in children differ substantially from adult protocols.
Purpose of the Study:
- To highlight the distinct aspects of H. pylori infection in children.
- To emphasize the updated 2017 ESPGHAN and NASPGHAN guidelines for pediatric H. pylori management.
- To underscore the importance of tailored diagnostic and therapeutic strategies in pediatric H. pylori cases.
Main Methods:
- Review of updated European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines.
- Analysis of epidemiological trends and diagnostic applicability in children.
- Consideration of antibiotic resistance patterns and treatment success rates.
Main Results:
- H. pylori diagnosis in children should prioritize upper endoscopy to identify causes of gastrointestinal symptoms, not a "test and treat" approach.
- Increased antibiotic resistance necessitates antimicrobial susceptibility testing for H. pylori eradication.
- H. pylori infection rates have declined in Western countries, with acquisition possible outside the family and in early childhood.
- Early H. pylori exposure shows an inverse association with atopy and allergic conditions.
Conclusions:
- Pediatric H. pylori management requires specialized guidelines distinct from adult protocols.
- Diagnosis should focus on upper endoscopy, and treatment should be prescribed judiciously based on local eradication rates and susceptibility testing.
- H. pylori infection in childhood may have long-term implications, including a potential protective effect against allergies.
Abstract:
Helicobacter pylori infection in children differs from infection in adults in many aspects. The rate of infection, epidemiology, clinical presentations and complications, the applicability of diagnostic tests, antibiotic resistance, treatment options, and success rates differ significantly. Due to all these differences, management guidelines for children and adults differ also substantially. In 2017, the Updated ESPGHAN and NASPGHAN Guidelines on the management of H. pylori infection in children were published, emphasizing the differences in clinical presentation and indications for treatment, stating that the primary goal of clinical investigation in children is to identify the cause of upper gastrointestinal symptoms rather than the presence of H. pylori infection. Therefore, the diagnosis should be based on upper endoscopy, and the "test and treat strategy" should not be used in children. Due to an increasing rate of antibiotic resistance worldwide, the updated guidelines recommend broader use of antimicrobial susceptibility testing for H. pylori strains in order to tailor eradication treatment accordingly. Moreover, treatment in children should be prescribed only when indicated and should be based on the rate of eradication in local populations aiming for treatment success above 90%. During the last two decades there has been a steady decrease in the rate of H. pylori infection in both children and adults in the Western world. Two recent publications studying the incidence of H. pylori infection confirmed that early childhood is a time for acquisition of infection both in industrialized and nonindustrialized countries. In addition, they showed that H. pylori could be acquired outside the family. In respect to the inverse association between H. pylori and allergy, a longitudinal study demonstrated that early exposure to H. pylori at any age was inversely associated with atopy and allergic conditions.
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