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Updated: Jan 25, 2026
Detection of Helicobacter pylori Infection and Antibiotic Resistance via Stool Quantitative Polymerase Chain Reaction Analysis
Published on: May 16, 2025
Helicobacter pylori Infection in Children and Adolescents
Masumi Okuda1,2, Yingsong Lin3, Shogo Kikuchi3
1Department of Pediatrics, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. okuda@naxnet.or.jp.
Insights
Helicobacter pylori (H. pylori) infection affects one-third of children globally, primarily acquired in childhood. While linked to various diseases, treatment is strongly recommended mainly for peptic ulcer disease in children.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Public Health
Background:
- Helicobacter pylori (H. pylori) infection is prevalent in one-third of children worldwide, with higher rates in developing nations.
- Transmission typically occurs during childhood, often from mother to child, and is associated with various gastrointestinal and extra-gastrointestinal conditions.
- Current guidelines strongly recommend H. pylori testing and treatment primarily for pediatric peptic ulcer disease, with controversial indications for iron deficiency anemia and chronic immune thrombocytopenic purpura.
Purpose of the Study:
- To review the epidemiology, transmission, associated diseases, diagnostic challenges, and treatment strategies for H. pylori in children and adolescents.
- To discuss the implications of antibiotic resistance and the potential for 'screen-and-treat' strategies for gastric cancer prevention in pediatric populations.
Main Methods:
- Review of existing literature on H. pylori infection in pediatric populations.
- Discussion of diagnostic accuracy, emphasizing the need for multiple tests, with the urea breath test noted as reliable non-invasively.
- Consideration of treatment approaches, including drug susceptibility testing due to rising antibiotic resistance.
Main Results:
- H. pylori is a significant cause of gastric cancer, but 'screen-and-treat' strategies for prevention in children are controversial.
- Antibiotic resistance in H. pylori strains is increasing, necessitating susceptibility testing before treatment.
- An effective H. pylori vaccine is not yet available, and new prevention strategies are needed.
Conclusions:
- Accurate diagnosis of H. pylori in children requires multiple tests, as no single method is 100% accurate.
- Management of H. pylori in children necessitates careful consideration of antibiotic resistance and potential long-term outcomes like gastric cancer.
- Further research into effective vaccines and prevention strategies for H. pylori in pediatric populations is crucial.
Abstract:
About one-third of all children worldwide is infected with H. pylori and its prevalence is low in developed and high in developing countries. H. pylori is mainly acquired during childhood and transmission of the bacterium commonly proceeds from person to person, especially among family members. The most frequent transmission route is from the mother to children. Various gastrointestinal and extra-gastrointestinal diseases are reported to be associated with H. pylori in children and adolescents, but the strongest recommendation for testing and treating is introduced only with children and adolescents having peptic ulcer disease. Iron deficiency anemia and chronic immune thrombocytopenic purpura are also considered for testing and treating, but the effectiveness is somewhat controversial. Invasive diagnosis is recommended, whereas none of the available diagnostic tests have 100% accuracy for reliable diagnosis, and therefore at least two or more tests should be performed. Urea breath test is the most reliable among the non-invasive tests. Because the number of antibiotics-resistant H. pylori strains is increasing, it is desirable to conduct a drug susceptibility test before treatment and to select the corresponding regime. H. pylori has been proven to be a major cause of gastric cancer and 'screen-and-treat' strategies are recommended in communities at high risk of gastric cancer. However, the application to children and adolescents is controversial. An effective vaccine is desirable, but not yet available. Screen-and-treat for adolescents has started in a few areas in Japan, where conditions are well established. New prevention strategies for gastric cancer are awaited worldwide.
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