Update on the Management of Helicobacter pylori Infection in Children and Adolescents.

PURPOSE OF REVIEW: This review provides an update on the management of Helicobacter pylori (H. pylori) infection in children and adolescents, incorporating newly available data and highlighting how it differs from adults. It explores emerging diagnostic tools and evolving therapeutic approaches to improve eradication rates.

RECENT FINDINGS: Pediatric data confirm that antimicrobial resistance rates are rising, mirroring trends in the adult population. Novel molecular methods to assess H. pylori antimicrobial susceptibility demonstrate good correlation with culture and are less dependent on transport conditions, timing, and laboratory expertise. These assays, already studied in adults, show promise in pediatric populations, particularly in patients with upper gastrointestinal bleeding, and may eventually extend to stool-based applications. Recent large studies in both high- and low-incidence populations confirm that H. pylori eradication reduces gastric cancer risk in adults, while emerging pediatric studies report on the prevalence and natural history of premalignant lesions. New therapeutic strategies include antibiotic and acid suppression dose optimization, and incorporation of new agents such as potassium-competitive acid blockers. Advances in molecular diagnostics and acid-suppressive therapies have the potential to significantly improve H. pylori eradication in children. While guideline endorsement is pending, these innovations may reduce reliance on repeated empiric therapies and increase the likelihood of successful, tailored treatment.