Helicobacter Pylori Therapy in Children: Overview and Challenges

Abstract

Helicobacter pylori is one of the most common infections found in humans. It was first identified in 1982 and by 1989 had been associated with gastric inflammation and ulcers in adults and children. During the 1990's evidence emerged of its etiologic role in stomach cancers in adults. That the infection is common and may have serious consequences, has led to an avalanche of research during the last twenty years. During this time, there have been many studies on children which have sought an effective and safe treatment to eradicate the infection, but as yet, no therapy regimen has been found which is always effective and safe. This article provides information, from a pediatric point of view, on the major developments in the therapeutics and therapy of H. pylori infection. It examines first-line treatment regimens, evaluates the efficacy of the main drugs used in the management of (primary) H. pylori infection in children, assesses the potential for the use of probiotics and sequential therapy, examines therapeutic options after failure of initial treatment, and discusses factors affecting eradication rate, including antibiotic resistance, adherence to therapy, and bacterial factors.

Seroprevalence of Antibodies to Helicobacter Pylori Six Virulent Antigens in Asymptomatic Adult Beta Thalassemic Patients

“…Epidemiological studies have demonstrated that the prevalence of H. pylori infection increases with advancing age and is higher in developing countries and among population with low socioeconomic background, probably due to conditions that favor the acquisition of infection, such as poor hygiene, crowded living conditions and absence or deficiency of sanitation [20]. It has been reported that in developing countries, H. pylori infection is usually acquired before 10 years of age and in the absence of antibiotic therapy, it generally persists for life [21].…”

Helicobacter pylori—Associated Dyspepsia in Paediatrics

“…Few randomized, placebo-controlled treatment trials are available in children for the different outcomes (gastritis or peptic ulcer), and often consist of only small numbers of cases [86,106]. Clearly in children as in adults, successful eradication of H. pylori markedly reduces the risk of ulcer recurrence [107][108][109][110]. Thus, there is general consensus worldwide to treat H. pylori infection when there is endoscopic evidence of peptic ulceration.…”

<i>Helicobacter pylori</i> Therapy in Children: A Focus on Proton Pump Inhibitors

“…Nonetheless, twice daily PPI therapy has been the rule in most pediatric efficacy studies for H. pylori eradication [19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37]. Although extending PPI dose timing may be attractive to some investigators, this PPI schedule may challenge the child’s and adolescent’s adherence to the medication [4], which may be important in determining clinical outcomes.…”

“…Over the last two decades, there have been many studies on children which have sought an effective and safe treatment to eradicate the infection, but as yet, no therapy regimen has been found which is always effective and safe [4]. Differences in drug response among pediatric patients are common [5].…”

“…Such individual variability in drug response is multifactorial, including environmental, genetic, development and disease determinants that affect the disposition of a given drug. In pediatric efficacy studies for the management of H. pylori eradication in children, the most commonly tested regimen has contained a combination of proton pump inhibitor (PPI), clarithromycin and amoxicillin, followed by triple therapies containing PPI, clarithromycin and nitroimidazoles [4]. Thus, PPIs are an integral part of triple therapy for H. pylori eradication in children with gastroduodenal disease.…”