Helicobacter pylori Infection in Pediatric Patients Living in Europe

Abstract

Objectives: The aim of the study was to assess clinical presentation, endoscopic findings, antibiotic susceptibility and treatment success of Helicobacter pylori (H. pylori) infected pediatric patients. Methods: Between 2013 and 2016, 23 pediatric hospitals from 17 countries prospectively submitted data on consecutive H. pylori-infected (culture positive) patients to the EuroPedHP-Registry. Results: Of 1333 patients recruited (55.1% girls, median age 12.6 years), 1168 (87.6%) were therapy naïve (group A) and 165 (12.4%) had failed treatment (group B). Patients resided in North/Western (29.6%), Southern (34.1%) and Eastern Europe (23.0%), or Israel/Turkey (13.4%). Main indications for endoscopy were abdominal pain or dyspepsia (81.2%, 1078/1328). Antral nodularity was reported in 77.8% (1031/1326) of patients, gastric or duodenal ulcers and erosions in 5.1% and 12.8%, respectively. Primary resistance to clarithromycin (CLA) and metronidazole (MET) occurred in 25% and 21%, respectively, and increased after failed therapy. Bacterial strains were fully susceptible in 60.5% of group A, but in only 27.4% of group B. Primary CLA resistance was higher in Southern and Eastern Europe (adjusted odds ratio [ORadj] = 3.44, 95% confidence interval [CI] 2.22–5.32, P < 0.001 and 2.62, 95% CI: 1.63–4.22, P < 0.001, respectively) compared with Northern/Western Europe. Children born outside Europe showed higher primary MET resistance (ORadj = 3.81, 95% CI: 2.25–6.45, P < 0.001). Treatment success in group A reached only 79.8% (568/712) with 7 to 14 days triple therapy tailored to antibiotic susceptibility. Conclusions: Peptic ulcers are rare in dyspeptic H. pylori-infected children. Primary resistance to CLA and MET is markedly dependent on geographical regions of birth and residence. The ongoing survey will show whether implementation of the updated ESPGHAN/NASPGHAN guidelines will improve the eradication success.

Efficacy of Phenotype-vs. Genotype-Guided Therapy Based on Clarithromycin Resistance for Helicobacter pylori Infection in Children

“…The success rate of phenotype-guided tailored therapy in our study was 70.4% and did not achieve the target rate of > 90%. Our results are similar to those of a respective study published by Kori et al ( 10 ) which revealed an eradication rate of 79.8% after susceptibility-based treatment. A study in Belgium and one in Spain reported eradication rates of 72 and 78.7% in children with culture results ( 13 , 14 ).…”

“…Thirteen studies investigating the effectiveness of culture-based tailored therapy in children are shown in Table 1 . The eradication rate was over 90% in five studies ( 9 , 11 , 17 , 20 , 21 ) but ranged from 70 to 90% in the other eight studies ( 10 , 12 – 16 , 18 , 19 ). For the tailored therapy based on molecular tests with gastric biopsy, there is a paucity of data for children, though the eradication rate in most adult studies was over 90% ( 22 – 25 ).…”

Worldwide Prevalence and Risk Factors of Helicobacter pylori Infection in Children

“…Contrariwise, a study on Bulgarian children did not reveal any significant association between age and H. pylori infection [ 136 ]. Similar to most studies worldwide, the male gender was also reported to be a risk factor in European children [ 151 ]. Nevertheless, a recent study from Romania indicated that females were more prone to develop H. pylori -associated gastritis when compared to males in a cohort of children [ 152 ].…”

Efficacy and safety of bismuth‐based quadruple therapy forHelicobacterpylorieradication in children

“…In the recently published analysis of the survey from 23 pediatric hospitals from 17 European Countries during the 2013–2016 period (EuroPedHP‐Registry), primary resistance to metronidazole was detected in 20.9% (95% CI: 18.4–23.5) and primary resistance to clarithromycin in 24.8% (95% CI: 22.1–27.5) of the strains from 1333 patients. Double resistance was detected in 5.8% of the strains 30 . In the same study, it is shown that in therapy naïve children, a 10‐day triple therapy tailored to antimicrobial susceptibility reached only 75.6% success and a 14‐day therapy 85% success in per protocol analysis.…”