Canadian Helicobacter Study Group Consensus Conference: Update on the Approach to Helicobacter Pylori Infection in Children and Adolescents – an Evidence-Based Evaluation

Abstract

As an update to previously published recommendations for the management of Helicobacter pylori infection, an evidence-based appraisal of 14 topics was undertaken in a consensus conference sponsored by the Canadian Helicobacter Study Group. The goal was to update guidelines based on the best available evidence using an established and uniform methodology to address and formulate recommendations for each topic. The degree of consensus for each recommendation is also presented. The clinical issues addressed and recommendations made were: population-based screening for H pylori in asymptomatic children to prevent gastric cancer is not warranted; testing for H pylori in children should be considered if there is a family history of gastric cancer; the goal of diagnostic interventions should be to determine the cause of presenting gastrointestinal symptoms and not the presence of H pylori infection; recurrent abdominal pain of childhood is not an indication to test for H pylori infection; H pylori testing is not required in patients with newly diagnosed gastroesophageal reflux disease; H pylori testing may be considered before the use of long-term proton pump inhibitor therapy; testing for H pylori infection should be considered in children with refractory iron deficiency anemia when no other cause has been found; when investigation of pediatric patients with persistent or severe upper abdominal symptoms is indicated, upper endoscopy with biopsy is the investigation of choice; the 13C-urea breath test is currently the best noninvasive diagnostic test for H pylori infection in children; there is currently insufficient evidence to recommend stool antigen tests as acceptable diagnostic tools for H pylori infection; serological antibody tests are not recommended as diagnostic tools for H pylori infection in children; first-line therapy for H pylori infection in children is a twice-daily, triple-drug regimen comprised of a proton pump inhibitor plus two antibiotics (clarithromycin plus amoxicillin or metronidazole); the optimal treatment period for H pylori infection in children is 14 days; and H pylori culture and antibiotic sensitivity testing should be made available to monitor population antibiotic resistance and manage treatment failures.

Usefulness of a Serological Panel Test in the Assessment of Gastritis in Symptomatic Children

“…According to international guidelines [6,14,15] , in children with severe upper gastrointestinal symptoms, endoscopy with biopsies is the gold standard to diagnose organic disease and H. pylori infection. On the other side, a non-invasive test is proposed in epidemiologic studies, in efficacy monitoring of H. pylori treatment and in patients who refuse endoscopy.…”

Infection à Helicobacter pylori chez l’enfant

“…La première est l'étude de l'association entre infection à H. pylori et douleurs abdominales récurrentes ; la deuxième est l'étude de l'influence de l'éradication de l'infection sur la résolution des symptômes cliniques. Récemment, la conférence de consensus pédiatrique canadienne concernant l'infection à H. pylori de l'enfant a conclu que les douleurs abdominales récurrentes ne sont pas une indication à rechercher l'infection à H. pylori en première intention [19].…”

“…L'hypochlorhydrie induite par l'infection à H. pylori est très rare chez l'enfant et il n'est donc pas surprenant que l'éradication de la bactérie n'ait d'influence ni sur le reflux gastro-oesophagien, ni sur l'efficacité des inhibiteurs de la pompe à protons [16]. La conférence de consensus canadienne indique que la recherche de H. pylori n'est pas justifiée chez des patients ayant un reflux gastro-oesophagien nouvellement diagnostiqué [19]. Plus rarement, l'infection peut se révéler par une entéropathie exsudative [43].…”

“…L'infection par H. pylori pourrait par ailleurs augmenter la sécrétion de leptine et diminuer la sécrétion de ghréline conduisant à réduire les ingestats [44]. Une association entre infection à H. pylori et anémie ferriprive a été récemment démontrée [45,46] et selon les recommandations du consensus canadien la recherche de H. pylori pourrait être envisagée chez des enfants présentant une anémie ferriprive réfractaire, quand aucune cause n'a été trouvée [19]. Enfin, la présence de lymphome gastrique a été rapportée chez l'adolescent avec une régression spontanée après l'éradication de l'infection à H. pylori [47].…”

Extragastric diseases associated with Helicobacter pylori infection

“…Reviewers concurred that, for most extragastric diseases reportedly associated with H. pylori infection, [5], and the supporting review concludes that evidence is sufficient to consider H. pylori infection a cause of sideropenic anemia, whereas the available data do not support the inclusion of other extradigestive diseases among the conditions for which a test-and-treat strategy should be considered [2•].…”