Prevalence, Management, and Outcomes of Non-Invasive Helicobacter pylori Testing in Children at a Tertiary Paediatric...

Area of Science:

• Pediatric Gastroenterology
• Infectious Diseases
• Clinical Practice Guidelines

Background:

• Helicobacter pylori infections present differently in pediatric versus adult populations.
• Current pediatric practice guidelines advise against a test-and-treat strategy for H. pylori diagnosis.
• Clinical practice often deviates from established guidelines, necessitating an examination of current approaches.

Purpose of the Study:

• To investigate the utilization of non-invasive H. pylori testing (stool antigen, urea breath test) in children.
• To analyze management decisions and patient outcomes following H. pylori diagnosis in a pediatric tertiary hospital.
• To assess adherence to clinical guidelines regarding H. pylori management in pediatric patients.

Main Methods:

• A retrospective review of pediatric patients (0-18 years) tested for H. pylori via stool antigen or urea breath test (UBT) from January 2018 to June 2020.
• Analysis of diagnostic test results, symptoms, treatment regimens, and symptom resolution.
• Comparison of testing and treatment strategies against existing pediatric practice guidelines.

Main Results:

• 1,397 children were tested; 8.4% had positive stool antigen tests and 5.9% had positive UBTs.
• Abdominal pain was the most common symptom (80.3%). Only 7 treatment-naïve children had biopsy-proven disease.
• 91.0% of children received treatment, with a common regimen of PPI, amoxicillin, and clarithromycin; 50.8% experienced symptom resolution.

Conclusions:

• A test-and-treat strategy was frequently employed, indicating low compliance with pediatric H. pylori management guidelines.
• Non-invasive testing in children revealed a notable rate of false positives.
• The study highlights discrepancies between recommended guidelines and actual clinical practice in diagnosing and treating H. pylori in pediatric populations.