Helicobacter pylori is associated with primary antral gastritis, duodenal ulceration, and gastric cancer. Current regimens for treating infection in children using bismuth and antibiotics for two to six weeks are cumbersome. The aim of this study was to evaluate a one week course of treatment. All children undergoing endoscopy were assessed for the presence of H pylori by culture, histology, rapid urease test, and 13 C urea breath test. Infected children received a one week course of colloidal bismuth subcitrate 480 mg/1.73 m 2 /day (maximum 120 mg four times a day), combined with metronidazole 20 mg/kg/day (maximum 200 mg three times a day), and clarithromycin 15 mg/kg/day (maximum 250 mg twice a day). To optimise compliance, drugs were dispensed in a 'Redidose' box containing a compartment for each day, and subcompartments marked 'breakfast', 'lunch', 'dinner', and 'bedtime'. Compliance and side eVects were assessed immediately after treatment. A urea breath test was performed at least one month after treatment. Twenty two children infected with H pylori were entered into the study; 20 of these took all doses; two children suVered significant side eVects (diarrhoea and vomiting). H pylori was eradicated in 21 of the 22 children (95.45%; 95% confidence interval 77% to 100%). This study shows that H pylori infection in children can be cleared by a one week course of treatment. (Arch Dis Child 1997;76:352-355) Keywords: treatment; Helicobacter pylori Helicobacter pylori is associated with primary antral gastritis in children and adults.1-5 Eradication of H pylori from the gastric mucosa results in healing of gastritis. [6][7][8] There is also a strong association between H pylori gastritis and duodenal ulceration in both adults and children.2 4 5 9 10 Duodenal ulcer disease does not relapse if H pylori is eradicated from the gastric mucosa.7 11-13 Infection with H pylori also appears to be associated with an increased risk of carcinoma of the stomach, especially in those infected as children. [14][15][16][17] Current treatment regimens for H pylori infection in children using bismuth combined with one or two antibiotics for two to six weeks are cumbersome and compliance is diYcult. 11Studies on adult patients suggest that one week courses of treatment are eVective. 18-24The aim of this study was to test the eYcacy of a one week course of treatment combining colloidal bismuth subcitrate, metronidazole, and clarithromycin in eradicating H pylori in children. MethodsChildren undergoing upper endoscopy were routinely assessed for the presence of H pylori. Endoscopy was performed under general anaesthetic using Olympus paediatric gastroscopes QIF-P10 or XQ200. Three biopsy specimens were taken from the antral mucosa. One specimen was used for a rapid urease test (Clo, Delta West, Australia). A second specimen was fixed in 10% neutral formalin, embedded in paraYn wax, and cut at five micron thickness. The sections were then stained with haematoxylin and eosin for light microscopy. Further staining with cresy...

Background-Duodenal ulcer disease is strongly associated with Helicobacter pylori infection of the gastric mucosa. Eradication of H pylori from the gastric mucosa in adults is associated with long term healing of ulcers. Aims-To follow a cohort of children with duodenal ulcer disease for a minimum of two years after the eradication of H pylori. Patients and methods-Over a three year period, all children diagnosed with duodenal ulcer disease had their symptoms documented and their H pylori status evaluated. The histories of these children were carefully screened to determine previous symptoms and to document previous treatment regimens. Results-Sixteen children were diagnosed with ulcers and 15 were available for treatment and long term follow up. The median age at which symptoms first occurred was 10.5 years (range, 6-14) and the median duration of symptoms was 24 months (range, 2-60). Ten of the children had been treated with H 2 receptor antagonists for a median of 3.5 months (range, 1-60). Duodenal ulcers healed in all children after eradication of H pylori and all children have remained asymptomatic for a median of 37 months (range, 26-62). No child has required subsequent admission to hospital. Conclusion-Eradication of H pylori is very eVective in the long term healing of duodenal ulcer disease. H pylori eradication should be the standard treatment for all infected children who present with duodenal ulcer disease. (Arch Dis Child 1998;79:502-505)