Pediatric Guidelines for H. Pylori Diagnosis and Treatment (By: Juan Gregory, MD)
The European and North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN and NASPGHAN) jointly renewed clinical guidelines using a standardized evidence-based approach to develop updated recommendations for children and adolescents in North America and Europe. These clinical practice guidelines represent updated, best-available evidence and are meant for children and adolescents living in Europe and North America.
Diagnostic testing for H. pylori in patients with functional abdominal pain is not indicated. It is recommended that the diagnosis of H. pylori infection be based on either a positive histopathology plus a rapid urease test or positive culture of tissue obtained from the corpus and antrum of the stomach. A test and treat strategy is not recommended. Test based on antibodies (IgA,IgG) for H. pylori are not reliable because of the lack of sensitivity and specificity. The cutoff value obtained in validation studies in adults results in failure to detect a large proportion of infected children. 13C-urea breath tests and ELISA test for
H pylori antigen in the stool are reliable noninvasive tests to determine H. pylori eradication.
It is recommended that diagnostic and noninvasive testing be withheld for 2 weeks after PPI’s and weeks after antibiotics have been discontinued.
First line eradication regimen: Triple therapy with a PPI + amoxicillin + clarithromycin or an imidazole or bismuth salts + amoxicillin + imidazole or a sequential therapy: 5 days of a PPI + amoxicillin, then 5 days of a PPI + clarithromycin + metronidazole. It is recommended that the duration of therapy be 7-14 days.