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How to use Helicobacter pylori testing in paediatric practice
  1. Eileen Crowley1,
  2. Billy Bourke1,2,3,4,
  3. Séamus Hussey1,2,3
  1. 1National Centre for Paediatric Gastroenterology, Hepatology and Nutrition, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
  2. 2National Children's Research Centre, Crumlin, Dublin, Ireland
  3. 3UCD School of Medicine and Medical Science, Belfield, Dublin, Ireland
  4. 4Conway Institute, University College Dublin, Belfield, Dublin, Ireland
  1. Correspondence to Dr Séamus Hussey, National Centre for Paediatric Gastroenterology, Hepatology and Nutrition, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland; seamus.hussey{at}olchc.ie

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Introduction

Helicobacter pylori is a slowly growing, gram negative microaerophilic bacterium that colonises the gastric mucosa. Cross-sectional epidemiological studies from both developed and developing countries suggest that the prevalence of H. pylori infection worldwide is declining, and may even be less than 10% in ‘westernised’ countries.1 ,2 H. pylori infection is acquired during the first decade of life and infection usually persists without treatment. Spontaneous clearance has been reported, although co-incidental antibiotic exposure may influence such ‘clearance’. H. pylori is the causative agent for diseases including peptic ulcer disease (PUD), chronic gastritis, gastric mucosa associated lymphoid tissue lymphoma and is the single-most important risk factor for developing gastric cancer.3 ,4 Putative extraintestinal associations have included refractory iron deficient anaemia, short stature and idiopathic thrombocytopenic purpura, although data supporting these associations in children must be interpreted with caution.4 ,5 The majority of children infected with H. pylori are asymptomatic. Following successful treatment, the risk of true reinfection in childhood is extremely low, at least in developed countries.6 Recrudescence describes re-colonisation with the same strain within 12 months, while re-infection refers to colonisation with a new strain, more than 12 months after eradication. Clinicians must carefully bear in mind these salient aspects of the pathogenesis and natural history of H. pylori-associated diseases as they consider whether testing their patients for H. pylori is indicated.

Investigations for H. pylori

The primary indication for investigation in children remains to diagnose the cause of significant symptoms and not simply to detect the presence of H. pylori. Testing for H. pylori is not helpful unless it alters clinical management, and consideration of the age-related pre-test probability of particular diseases (rather than infection alone) is essential. There remain certain scenarios in which screening for the presence of H. pylori is not absolutely indicated but may …

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