Helicobacter pylori infection in children

Abstract

Helicobacter pylori infection in children differs from that in adults, from the point of view of epidemiology, host response, clinical features, related diseases, and diagnosis, as well as treatment strategies. The prevalence of H. pylori infection, in both children and adults, is decreasing in the Western World as well as in some developing countries, which contrasts with the increase in childhood asthma and allergic diseases. Recurrent abdominal pain is not specific during H. pylori infection in children. The role of H. pylori infection and failure to thrive, children's growth, type I diabetes mellitus (T1DM) and celiac disease remains controversial. The main initial diagnosis is based on upper digestive endoscopy with biopsy-based methods. Nodular gastritis may be a pathognomonic endoscopic finding of childhood H. pylori infection. The infection eradication control is based on validated noninvasive tests. The main cause of treatment failure of H. pylori infection is its clarithromycin resistance. We recommend standard antibiotic susceptibility testing of H. pylori in pediatric patients prior to the initiation of eradication therapy. H. pylori treatment in children should be based on an evaluation of the rate of eradication in the local population, a systematic use of a treatment adapted to the susceptibility profile and a treatment compliance greater than 90%. The last meta-analysis in children did not show an advantage for sequential therapy when compared to a 14-day triple therapy. Finally, the high rate of antibiotic resistance responsible for therapy failure in recent years justifies the necessity of a novel vaccine to prevent H. pylori infection in children.

Eradication rate of Helicobacter Pylori infection is directly influenced by adherence to therapy in children

“…The eradication rate was assessed by a negative 13 C-urea breath test performed at least 8 weeks after the end of the treatment and adherence evaluated using a diary. As a routine clinical practice, children infected with a strain susceptible to clarithromycin and to metronidazole received either a sequential regimen or a 10-day triple therapy while children infected with a strain resistant to clarithromycin or metronidazole received a 10-day triple regimen tailored to antimicrobial susceptibility.…”

“…13 C-UBT was performed as previously described, and the test was considered negative when the delta over baseline was less than 3.8‰. Children Conclusion: Adherence to therapy is a very important factor for the outcome and has to be assessed when evaluating the outcome of an H. pylori eradication regimen in order to understand the reasons of treatment failure.…”

“…However, most parents (and children when old enough to understand) are willing to have a treatment, although there is no conclusive evidence, that eradication of the infection will improve their symptoms of dyspepsia. [11][12][13] It has been shown that the sequential treatment performs slightly better than a standard (not tailored to antimicrobial susceptibility) triple therapy given for only 7 days. 9,10 However, this goal is seldom obtained in most currently published trials in children.…”

Metronidazole for Helicobacter pylori eradication therapy among children and adolescents in Japan: Overcoming controversies and concerns

“…Metronidazole is well tolerated in most cases. Common adverse effects include the following: vomiting; nausea; diarrhea; constipation; upset stomach; stomach cramps; loss of appetite; headache; dry mouth; sharp, unpleasant metallic taste; furry tongue and mouth; and tongue irritation (Table ) . These adverse effects, however, are not metronidazole‐specific; they also appear due to the use of other antibiotics, such as clarithromycin.…”

Future of Helicobacter pylori and its feasibility

“…However, we believe this strong decrease may come to a halt as higher numbers of small children go to creches, daycare, and preschools [10]. Exposure to less hygienic child conditions results in more and more youngsters are infected with difficult to treat (multi) drug resistant H. pylori [11]. While the treatment guidelines in themselves are effective on a per patient basis, we are still far from an ideal form of management of this infection on a national/global scale.…”