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Update on the Management of Helicobacter pylori Infection in Children and Adolescents
Silvana Bonilla1, Nicola L Jones2,3
1Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Insights
Antimicrobial resistance in pediatric Helicobacter pylori (H. pylori) is increasing. Novel molecular diagnostics and new therapies offer improved, tailored H. pylori eradication strategies for children.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Helicobacter pylori (H. pylori) infection is a significant global health concern.
- Rising antimicrobial resistance necessitates updated management strategies in both adults and children.
- Pediatric H. pylori management requires specific considerations distinct from adult protocols.
Purpose of the Study:
- To provide an updated review on Helicobacter pylori (H. pylori) infection management in pediatric populations.
- To highlight emerging diagnostic tools and evolving therapeutic approaches for H. pylori eradication in children and adolescents.
- To compare pediatric H. pylori management with adult guidelines and incorporate recent data.
Main Methods:
- Review of recent literature and clinical data on H. pylori diagnosis and treatment in children and adolescents.
- Analysis of emerging molecular diagnostic methods for antimicrobial susceptibility testing.
- Evaluation of novel therapeutic strategies, including optimized antibiotic regimens and new acid-suppressive agents.
Main Results:
- Pediatric antimicrobial resistance rates for H. pylori are rising, mirroring adult trends.
- Novel molecular diagnostic assays show promise for assessing H. pylori susceptibility, with potential for stool-based applications.
- New therapeutic strategies, including optimized dosing and new agents like potassium-competitive acid blockers, are emerging.
Conclusions:
- Advances in molecular diagnostics and acid-suppressive therapies can significantly improve H. pylori eradication rates in children.
- Emerging pediatric studies are investigating the link between H. pylori, premalignant lesions, and long-term gastric health.
- Innovations may reduce reliance on empiric therapies, leading to more successful, tailored H. pylori treatment in pediatric patients.
Purpose Of Review:
This review provides an update on the management of Helicobacter pylori (H. pylori) infection in children and adolescents, incorporating newly available data and highlighting how it differs from adults. It explores emerging diagnostic tools and evolving therapeutic approaches to improve eradication rates.
Recent Findings:
Pediatric data confirm that antimicrobial resistance rates are rising, mirroring trends in the adult population. Novel molecular methods to assess H. pylori antimicrobial susceptibility demonstrate good correlation with culture and are less dependent on transport conditions, timing, and laboratory expertise. These assays, already studied in adults, show promise in pediatric populations, particularly in patients with upper gastrointestinal bleeding, and may eventually extend to stool-based applications. Recent large studies in both high- and low-incidence populations confirm that H. pylori eradication reduces gastric cancer risk in adults, while emerging pediatric studies report on the prevalence and natural history of premalignant lesions. New therapeutic strategies include antibiotic and acid suppression dose optimization, and incorporation of new agents such as potassium-competitive acid blockers. Advances in molecular diagnostics and acid-suppressive therapies have the potential to significantly improve H. pylori eradication in children. While guideline endorsement is pending, these innovations may reduce reliance on repeated empiric therapies and increase the likelihood of successful, tailored treatment.
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