Joint ESPGHAN/NASPGHAN Guidelines for the Management of <i>Helicobacter pylori</i> in Children and Adolescents (Update 2016)

Jones, Nicola L.; Koletzko, Sibylle; Goodman, Karen J.; Bontems, Patrick; Cadranel, Samy; Casswall, Thomas; Czinn, Steve; Gold, Benjamin D.; Guarner, Jeannette; Elitsur, Yoram; Homan, Matjaž; Kalach, Nicolas; Kori, Michal; Madrazo, Armando; Mégraud, Françis; Papadopoulou, Alexandra; Rowland, Marion

doi:10.1097/mpg.0000000000001594

Cited by 403 publications

(771 citation statements)

References 87 publications

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“…On the contrary, Koletzko et al recommended the use of levofloxacin as the second‐line treatment for the children with no history of levofloxacin use . The most recent ESPGHAN/NASPGHAN guidelines, however, recommend the PPI‐amoxicillin‐metronidazole triple therapy as the first‐line treatment for H pylori infection and recommend the sole use of clarithromycin in patients with known antibiotic sensitivity . In the present study, the patients were administered empirical therapy (PPI, amoxicillin, and clarithromycin) but their treatment outcomes could not be evaluated since the antibiotic resistance of the biopsies was investigated after the treatment, which was a limitation of our study.…”

Section: Discussionmentioning

confidence: 81%

Helicobacter pylori resistance to clarithromycin and fluoroquinolones in a pediatric population in Turkey: A cross‐sectional study

2019

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Background Helicobacter pylori antimicrobial resistance is gradually increasing around the world. However, there are a limited number of studies reporting on this issue in the pediatric population. In this study, we aimed to determine H pylori resistance to clarithromycin and fluoroquinolones in the pediatric patients living in Kırıkkale province that were detected with H pylori in gastric biopsies. Moreover, we also aimed to investigate the concordance between the histopathologic and molecular methods used in the diagnosis of H pylori infection. Materials and Methods Patients aged 2‐18 years who had a history of epigastric pain and/or nausea persisting for longer than 1 month underwent upper gastrointestinal endoscopy. Biopsies were taken from the gastric antral mucosa. In the samples detected with H pylori in the histopathologic examination, the presence of H pylori and H pylori resistance to clarithromycin and fluoroquinolones was investigated using the GenoType HelicoDR test which allows the detection of wild‐type and mutant genes. The strains detected with more than one mutant gene are defined as hetero‐resistant strains. Results The 93 patients that underwent DNA extraction and amplification included 68 (73.1%) girls and 25 (26.9%) boys with a median age of 15 ± 2.62 (range 6‐17) years. The overall concordance for the diagnosis of H pylori infection between histopathology and PCR was 94%, and H pylori resistance to clarithromycin and fluoroquinolones was 27% and 15%, respectively. Conclusions The high H pylori resistance to clarithromycin and fluoroquinolones among the pediatric patients in our region implicates that the antibiotic sensitivity of strains should be studied prior to administration in accordance with the recommendations provided in the guidelines. Moreover, the presence of hetero‐resistant strains in our patients may be a reason for treatment failure.

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Section: Discussionmentioning

confidence: 81%

Helicobacter pylori resistance to clarithromycin and fluoroquinolones in a pediatric population in Turkey: A cross‐sectional study

2019

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“…Increasing evidence has demonstrated the efficacy of serologic tests used for initial screening in epidemiological studies . However, in the clinical setting, the serum antibody test is not recommended to diagnose H pylori infection in children . Another unresolved issue is the suitable age at which a person should receive screening and treatment for H pylori .…”

Section: Discussionmentioning

confidence: 99%

Clinical features of Helicobacter pylori antibody‐positive junior high school students in Nagano Prefecture, Japan

et al. 2018

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Background Previously, we conducted an epidemiological study screening for Helicobacter pylori antibody positivity among Japanese junior high school students. In this study, we updated the epidemiological data and assessed the clinical features of H pylori antibody‐positive junior high school students. Materials and methods We assessed H pylori antibody‐positive subjects who were identified between 2012 and 2015 at four junior high schools in Nagano Prefecture, Japan. H pylori infection was confirmed by urea breath test (UBT) or endoscopic examination. Endoscopy was performed after obtaining consent from the subject and their guardians. Eradication therapy consisted of triple therapy with proton pump inhibitor (PPI), amoxicillin (AMPC), and clarithromycin (CAM) or metronidazole (MNZ) for seven days. Eradication of H pylori was confirmed by UBT. We reviewed subjects’ characteristics, endoscopic findings, histological findings, eradication regimes, outcomes, and adverse effects. Results The overall prevalence of H pylori antibody positivity was 3.2% (42/1298). We assessed thirteen H pylori antibody‐positive subjects. Eight subjects had a family history of H pylori infection. Six subjects had abdominal pain, and two subjects had iron deficiency anemia (IDA). Twelve subjects underwent endoscopy; one subject had duodenal ulcer, eleven subjects had antral nodular gastritis, and six subjects showed grade 2 closed type atrophic border according to the Kimura‐Takemoto classification. All subjects received eradication therapy; CAM was used in five subjects with CAM susceptibility as well as in three subjects with unknown information on CAM susceptibility, and MNZ was used in five subjects with CAM resistance. Eradication was successful in twelve subjects (one unconfirmed). There were three mild adverse effects (abdominal pain or diarrhea). Conclusions Helicobacter pylori test for junior high school students represents an opportunity to diagnose the peptic ulcer, iron deficiency anemia, and gastric atrophy.

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“…Moreover, biopsies for H. pylori diagnosis should only be taken if treatment is likely to be offered and possible side effects have been discussed with the patients/parents. As discussed previously, guidelines state that neither the “test and treat strategy” nor antibody‐based tests (in blood, urine, or saliva) should be used for children . UBT and a two‐step monoclonal stool antigent tests (SAT) are recommended for evaluation of the success of H. pylori eradication therapy.…”

Section: Diagnosismentioning

confidence: 99%

Helicobacter pyloriand some aspects of gut microbiota in children

2018

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Helicobacter pylori infection in children differs from infection in adults in many aspects. The rate of infection, epidemiology, clinical presentations and complications, the applicability of diagnostic tests, antibiotic resistance, treatment options, and success rates differ significantly. Due to all these differences, management guidelines for children and adults differ also substantially. In 2017, the Updated ESPGHAN and NASPGHAN Guidelines on the management of H. pylori infection in children were published, emphasizing the differences in clinical presentation and indications for treatment, stating that the primary goal of clinical investigation in children is to identify the cause of upper gastrointestinal symptoms rather than the presence of H. pylori infection. Therefore, the diagnosis should be based on upper endoscopy, and the "test and treat strategy" should not be used in children. Due to an increasing rate of antibiotic resistance worldwide, the updated guidelines recommend broader use of antimicrobial susceptibility testing for H. pylori strains in order to tailor eradication treatment accordingly. Moreover, treatment in children should be prescribed only when indicated and should be based on the rate of eradication in local populations aiming for treatment success above 90%. During the last two decades there has been a steady decrease in the rate of H. pylori infection in both children and adults in the Western world. Two recent publications studying the incidence of H. pylori infection confirmed that early childhood is a time for acquisition of infection both in industrialized and nonindustrialized countries. In addition, they showed that H. pylori could be acquired outside the family. In respect to the inverse association between H. pylori and allergy, a longitudinal study demonstrated that early exposure to H. pylori at any age was inversely associated with atopy and allergic conditions.

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Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016)

Cited by 403 publications

References 87 publications

Helicobacter pylori resistance to clarithromycin and fluoroquinolones in a pediatric population in Turkey: A cross‐sectional study

Helicobacter pylori resistance to clarithromycin and fluoroquinolones in a pediatric population in Turkey: A cross‐sectional study

Clinical features of Helicobacter pylori antibody‐positive junior high school students in Nagano Prefecture, Japan

Helicobacter pyloriand some aspects of gut microbiota in children

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