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Pediatric Gastroenterologists' Practice Styles and Compliance With European/North American Helicobacter pylori
Ashwin Agrawal1,2, Anupama Chawla3, Héctor E Alcalá4
1Pediatric Gastroenterology, RWJBarnabas Health, Long Branch, USA.
Insights
Pediatric gastroenterologists show mixed adherence to 2016 Helicobacter pylori (H. pylori) guidelines, with notable gaps in non-invasive testing and treatment strategies. Further education is needed, especially with updated 2024 guidelines available.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Adherence to established guidelines is crucial for effective pediatric Helicobacter pylori (H. pylori) management.
- Previous guidelines, such as the 2016 ESPGHAN/NASPGHAN update, provide a framework for diagnosis and treatment.
- Variations in clinical practice may impact patient outcomes and antimicrobial resistance.
Purpose of the Study:
- To assess pediatric gastroenterologists' adherence to the 2016 European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)/North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines for H. pylori in children.
- To identify areas of consistent application and areas needing improvement in H. pylori diagnosis and treatment protocols.
- To inform future educational initiatives and guideline updates.
Main Methods:
- A survey was distributed to pediatric gastroenterologists via a professional listserv.
- The survey assessed knowledge and practices regarding H. pylori diagnosis, workup, and treatment.
- Data were collected from April 13, 2022, to May 12, 2022, with 302 respondents from 25 countries.
Main Results:
- The stool antigen test and upper endoscopy were the most common diagnostic methods.
- A significant proportion of providers (40.72%) rarely or never treated H. pylori based on positive non-invasive tests.
- Adherence was noted in waiting periods before testing and in eradication testing, but less so in non-invasive diagnosis, treatment based on non-invasive results, endoscopy use, susceptibility testing, and antibiotic choices.
Conclusions:
- Pediatric gastroenterologists demonstrate adherence to specific aspects of the 2016 H. pylori guidelines, particularly regarding pre-testing intervals.
- Significant deviations were observed in diagnostic approaches (favoring non-invasive tests over endoscopy), treatment decisions based on non-invasive results, and the utilization of culture and susceptibility testing.
- There is a clear need for enhanced education on H. pylori management for pediatric gastroenterologists, particularly in light of the recently released 2024 guidelines.
Abstract:
Objective This study aims to determine pediatric gastroenterologists' adherence to the management, diagnosis, and treatment of Helicobacter pylori (H. pylori) per the joint European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)/North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines for H. pylori in children (update 2016). Methods A survey was sent to the pediatric gastroenterology listserv to assess the knowledge of guidelines, workup, and treatment of H. pylori infection. The survey was open to respondents between 4/13/2022 and 5/12/2022. Results A total of 302 individuals completed the survey, representing 25 countries. The most ordered test for H. pylori was the stool antigen test (n = 151, 56.62%), followed by upper endoscopy (n = 97, 32.12%). Based on positive non-invasive test, 123 (40.72%) providers would never or not often treat H. pylori. Most providers treat H. pylori on histopathology in the absence of peptic ulcer disease. The majority of providers did not send H. pylori susceptibility testing. Most waited for the appropriate time after discontinuing antibiotics/anti-acid medication prior to testing for H. pylori. In the absence of susceptibility testing, 121 (40.5%) providers utilized proton pump inhibitors, amoxicillin, and clarithromycin to treat H. pylori compared to 79 (26.4%) providers who utilized proton pump inhibitors, high-dose amoxicillin, and metronidazole. Conclusion Areas where gastroenterologists adhere to the 2016 guidelines include waiting time after stopping antibiotics/anti-acid therapy and testing for eradication. Pediatric gastroenterologists had less adherence with the use of non-invasive testing for the diagnosis of H. pylori, treatment based on non-invasive test, diagnosis of H. pylori by endoscopy, utilizing culture and susceptibility testing, and antibiotic regimen used to treat H. pylori. Our survey results indicate that pediatric gastroenterologists require further education, especially now that the updated 2024 guidelines have been released.
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