Management of Helicobacter pylori in Children and Adolescents
Publication Date: June 1, 2017
Recommendations
We recommend that the primary goal of clinical investigation of gastrointestinal symptoms should be to determine the underlying cause of the symptoms and not solely the presence of H pylori infection. (N)
622
We recommend that during endoscopy additional biopsies for rapid urease test (RUT) and culture should only be taken if treatment is likely to be offered if infection is confirmed. (N)
622
We suggest that if H pylori infection is an incidental finding at endoscopy, treatment may be considered following careful discussion with the patient/parents. (W, L)
622
We recommend against a “test and treat” strategy for H pylori infection in children. (S, L)
622
We recommend that testing for H pylori be performed in children with gastric or duodenal PUD. If H pylori infection is identified then treatment should be administered and eradication confirmed. (S, H)
622
We recommend against diagnostic testing for H pylori infection in children with functional abdominal pain disorders. (S, H)
622
We recommend against diagnostic testing for H pylori infection as part of the initial investigation in children with iron deficiency anemia (IDA). (S, M)
622
We suggest that in children with refractory IDA in which other causes have been ruled out, testing for H pylori during upper endoscopy may be considered. (W, L)
622
We suggest that noninvasive diagnostic testing for H pylori infection may be considered when investigating causes of chronic immune thrombocytopenic purpura (ITP). (W, L)
622
We recommend against diagnostic testing for H pylori infection when investigating causes of short stature. (S, M)
622
We recommend that before testing for H pylori, wait at least 2 weeks after stopping PPIs and 4 weeks after stopping antibiotics. (S, L)
622
We recommend that the diagnosis of H pylori infection should be based on either: positive culture or H pylori gastritis on histopathology with at least 1 other positive biopsy-based test. (S, H)
622
We recommend that at least 6 gastric biopsies should be obtained for the diagnosis of H pylori infection during upper endoscopy. (S, L)
622
We recommend against antibody-based tests (immunoglobulin G [IgG], IgA) for H pylori in serum, whole blood, urine, and saliva in the clinical setting. (S, H)
622
We recommend that antimicrobial susceptibility be obtained for the infecting H pylori strain(s) and, the eradication treatment tailored accordingly. (S, L)
622
We recommend that the effectiveness of first-line therapy be evaluated in national/regional centers. (S, L)
622
We recommend that the physician explain to the family the importance of adherence to the anti–H pylori therapy to enhance successful eradication. (S, M)
622
We recommend the following as first-line therapy for H pylori infection as outlined in Table. (S)
| Table: Recommended options for first-line therapy for H. pylori infection | |
| H. pylori antimicrobial susceptibility | Suggested treatment |
| Known Susceptible to CLA and to MET Resistant to CLA, susceptible to MET Resistant to MET, susceptible to CLA Resistant to CLA and to MET |
PPI-AMO-CLA 14d with standard dose* PPI-AMO-MET l4d or bismuth-based† PPI-AMO-CLA 14d or bismuth-based† PPI-AMO-MET 14d with high dose for amoxicillin or bismuth-based†,‡ |
| Unknown | High-dose (Table 5) PPI-AMO-MET 14d or bismuth-based†,‡ |
| AMO= amoxicillin; CLA = clarithromycin; MET= metronidazole; PPI= proton pump inhibitor * Or sequential therapy for 10d † In the case of penicillin allergy: If the strain is susceptible to CLA and MET, use standard dose triple therapy. If the strain is resistant to CLA then use bismuth-based therapy with tetracycline instcad of AMO if older than 8 years. ‡ or concomitant therapy (PPI-AMO-MET-CLA) for 14d |
|
(moderate to low for suggested regimens; low for duration)
622
We recommend that the outcome of anti-H. pylori therapy be assessed at least 4 weeks following completion of therapy. (S, M)
622
We recommend that one of the following tests be used to determine whether H. pylori treatment was successful:
- a) the 13C-urea breath (13C-UBT) test or
- b) a two-step monoclonal stool H. pylori antigen test.
622
We recommend that when H. pylori treatment fails, rescue therapy should be individualized considering antibiotic susceptibility, the age of the child, and available antimicrobial options. (S, L)
622
Recommendation Grading
Disclaimer
Overview
Title
Management of Helicobacter pylori in Children and Adolescents
Authoring Organization
Consensus and Physician Experts
Publication Month/Year
June 1, 2017
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adolescent, Adult, Infant
Health Care Settings
Ambulatory
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Diagnosis, Management, Treatment
Diseases/Conditions (MeSH)
D016998 - Helicobacter
Keywords
children, adolescents, antibiotic susceptibility, 13C-urea breath test, eradication, Helicobacter pylori, triple therapy
Methodology
Number of Source Documents
235
Literature Search Start Date
October 1, 2009
Literature Search End Date
September 1, 2014