What are the ESPGHAN/NASPGH diagnostic guidelines for pediatric Helicobacter pylori (Hp) infection?

Updated: Nov 16, 2018
  • Author: Mutaz I Sultan, MBChB, MD; Chief Editor: Carmen Cuffari, MD  more...
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Answer

The European Society for Paediatric Gastroenterology Hepatology and Nutrition/North American Society for Pediatric Gastroenterology, Hepatology and Nutrition made the following recommendations in 2017 for the Management of Helicobacter pylori in Children and Adolescents [31] :

1. 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.

2a. Additional biopsies for rapid urease test and culture should only be taken during endoscopy if treatment is to be offered upon confirmation of infection.

2b. If H pylori infection is an incidental finding at endoscopy, treatment may be considered after a thorough discussion of the risks and benefits of treatment with the patient and or parents.

2c. The guidelines do not recommend a ‘‘test and treat’’ strategy for pediatric H pylori infection.

3. Testing for H pylori should be performed in children with gastric or duodenal ulcers. If H pylori infection is identified, then treatment should be advised and eradication be confirmed.

4. Diagnostic testing for H pylori infection in children with functional abdominal pain is not recommended.

5a. Diagnostic testing for H pylori infection as part of the initial investigation in children with iron deficiency anemia is not recommended.

5b. Testing for H pylori during upper endoscopy may be considered for children with refractory iron deficiency anemia in which other causes have been ruled out.

6. Noninvasive diagnostic testing for H pylori infection may be considered when investigating causes of chronic immune thrombocytopenic purpura.

7. Diagnostic testing for H pylori infection when investigating causes of short stature is not recommended.

8. Wait at least 2 weeks after stopping proton pump inhibitor and 4 weeks after stopping antibiotics before testing for H pylori.

9a. Diagnosis of H pylori infection should be based on either (a) histopathology (H pylori–positive gastritis) plus at least 1 other positive biopsy-based test or (b) positive culture.

9b. During upper endoscopy, at least 6 gastric biopsies should be taken for the diagnosis of H pylori infection.

10. Using antibody-based tests (IgG, IgA) for H pylori in serum, whole blood, urine, and saliva in the clinical setting is not recommended.


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