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

Nicola L. JonesDivision of Gastroenterology, Hepatology and Nutrition, Cell Biology Program, Sickkids Toronto, Departments of Paediatrics and Physiology, University of Toronto, Toronto, CanadaSibylle KoletzkoDivision of Gastroenterology and Hepatology Dr. von Hauner Children's Hospital Ludwig Maximilians University Munich GermanyKaren J. GoodmanDepartment of Medicine and School of Public Health Centre of Excellence for Gastrointestinal Inflammation and Immunity Research University of Alberta Edmonton Alberta CanadaPatrick BontemsPaediatric Gastroenterology Department Hôpital Universitaire des Enfants Reine FabiolaSamy CadranelSickKids FoundationThomas CasswallPediatric Gastroenterology, Hepatology, and Nutrition, CLINTEC, Karolinska Institutet and Karolinska University Hospital, Stockholm, SwedenSteve CzinnDepartment of Pediatrics University of Maryland School of Medicine Baltimore MDBenjamin D. GoldChildren's CenterJeannette GuarnerDivision of Gastroenterology and Hepatology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University, Munich, GermanyYoram ElitsurDepartment of Medicine and School of Public Health, Centre of Excellence for Gastrointestinal Inflammation and Immunity Research, University of Alberta, Edmonton, Alberta, CanadaMatjaž HomanFaculty of Medicine Department of Gastroenterology, Hepatology and Nutrition University Children's Hospital Ljubljana Ljubljana SloveniaNicolas Kalachzzz School of Medicine, University College Dublin, Dublin, IrelandMichal KoriKaplan Medical CenterArmando MadrazoDepartment of Pediatrics, University of Maryland School of Medicine, Baltimore, MDFrançis MégraudLaboratoire de Bactériologie Université de Bordeaux Bordeaux FranceAlexandra PapadopoulouIaso Children’s HospitalMarion RowlandDepartment of Medicine and School of Public Health, Centre of Excellence for Gastrointestinal Inflammation and Immunity Research, University of Alberta, Edmonton, Alberta, CanadaESPGHAN, NASPGHAN

2017en

ABI

Annotatsiya

BACKGROUND: Because of the changing epidemiology of Helicobacter pylori infection and low efficacy of currently recommended therapies, an update of the European Society for Paediatric Gastroenterology Hepatology and Nutrition/North American Society for Pediatric Gastroenterology, Hepatology and Nutrition recommendations for the diagnosis and management of H pylori infection in children and adolescents is required. METHODS: A systematic review of the literature (time period: 2009-2014) was performed. Representatives of both societies evaluated the quality of evidence using GRADE (Grading of Recommendation Assessment, Development, and Evaluation) to formulate recommendations, which were voted upon and finalized using a Delphi process and face-to-face meeting. RESULTS: The consensus group recommended that invasive diagnostic testing for H pylori be performed only when treatment will be offered if tests are positive. To reach the aim of a 90% eradication rate with initial therapy, antibiotics should be tailored according to susceptibility testing. Therapy should be administered for 14 days, emphasizing strict adherence. Clarithromycin-containing regimens should be restricted to children infected with susceptible strains. When antibiotic susceptibility profiles are not known, high-dose triple therapy with proton pump inhibitor, amoxicillin, and metronidazole for 14 days or bismuth-based quadruple therapy is recommended. Success of therapy should be monitored after 4 to 8 weeks by reliable noninvasive tests. CONCLUSIONS: The primary goal of clinical investigation is to identify the cause of upper gastrointestinal symptoms rather than H pylori infection. Therefore, we recommend against a test and treat strategy. Decreasing eradication rates with previously recommended treatments call for changes to first-line therapies and broader availability of culture or molecular-based testing to tailor treatment to the individual child.

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DOI: 10.1097/mpg.0000000000001594

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