Gastric infection with Helicobacter pylori is common in both children and adults, but children are considerably less susceptible to peptic ulcers and other pathological sequelae. As a result, the risk to benefit ratio of diagnostic studies and therapeutic regimens for H pylori in adults are likely different from those in pediatric populations. These guidelines for the management of pediatric H pylori infection, developed by the Canadian Helicobacter Study Group, are designed to identify when the diagnosis and treatment of H pylori may improve patient care. Given the low prevalence of this infection in Canada, it is important to recognize that indiscriminate testing and treatment programs in children are not recommended, and indeed may threaten the optimal care of children. Diagnostic tests should be employed judiciously and be reserved for children who are most likely to derive measurable benefit, such as those likely to have peptic ulcer disease. At this time a test and treat strategy in children cannot be considered prudent, evidence based or cost effective. It is appropriate to limit diagnosis and treatment to children and adolescents in whom H pylori has been identified during endoscopic investigation.

Helicobacter pylori is one of the most common bacterial infections in humans, and has been found in differing rates in persons of all age groups, nationalities and socioeconomic classes (1). Because the role of H pylori in human disease continues to be explored, there is an increased need for rapid, reliable and inexpensive diagnostic tests (2,3). The most commonly used standard tests are listed in Table 1. To date, the only test that can detect infection and disease activity is endoscopy with biopsy, which is invasive and expensive.Five recently developed tests that offer potential advantages because they are less invasive or permit easier acquisition of samples are assessed. These tests are whole blood, saliva and urine assays that measure systemic antibody response to H pylori, stool tests that measure H pylori antigens and string tests that use methodology less invasive than upper gastrointestinal endoscopy to recover H pylori organisms.The tests are compared with current standard tests and criteria for optimal tests. The criteria are non-or minimally invasive nature; high sensitivity, specificity, and positive and negative predictive values in diagnosing infection and assessing disease activity and effectiveness of therapy; convenience, including ease of acquisition of samples and rapid determination of results; and low cost. WHOLE BLOOD ANTIBODY TESTS Background:Whole blood antibody tests are based on the fact that systemic antibodies to H pylori are found in whole blood, making testing possible in a primary care setting (2-9). Whole blood tests have several important potential advantages compared with standard serological tests; the samples are easier to obtain, testing can be done in an office setting and the results can be available within 10 mins. In addition, the cost is projected to be less than that for the standard serological tests. CANADIAN HELICOBACTER CONSENSUS CONFERENCE ON PEDIATRIC ISSUES