Helicobacter pylori infection in children: an overview of global characteristics and the effectiveness of tailored therapy.

INTRODUCTION

No specific symptomatology or typical endoscopic features exist for children infected with Helicobacter pylori, except for nodular gastritis, which, when present, is highly predictive of the infection. Despite international guidelines, empiric antibiotic eradication remains common. This study compares the clinical and endoscopic features of infected and non-infected children and evaluates antimicrobial resistance and eradication rates between tailored and empirical treatments.

METHODS

We retrospectively analyzed all children infected with H. pylori who were diagnosed by gastroscopy and histology over 3 years, matching them with H. pylori-negative controls. Infected children with known antibiotic susceptibility received tailored therapy, while others were treated empirically.

RESULTS

Clinical and endoscopic features did not differ significantly between the groups, confirming that one cannot diagnose H. pylori infection based on these features. Chronic active and non-active gastritis were present in all the infected and non-infected children, respectively. Clarithromycin and metronidazole resistance were 46.2% (6/13) and 23.1% (3/13), respectively. Eradication was obtained in 100% of the patients who received susceptibility-directed therapy compared to 75% in those who received empiric therapy.

DISCUSSION: We confirm that infected and non-infected children present with similar clinical and macroscopic features in gastroscopy and resistance to amoxicillin and tetracycline remains very low. While the small sample sizes limit sweeping conclusions, tailored therapy demonstrated maximum efficacy. Empiric regimens should be avoided if resistance testing is available. Alternatively, clinicians should select antibiotics with the lowest probability of resistance, such as amoxicillin, tetracycline, or metronidazole.