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Knowledge, Attitudes, and Practice Styles of North American Pediatric Gastroenterologists:Helicobacter pylori Infection

Chang, Howard Y.*; Sharma, Virender K.†; Howden, Colin W.*; Gold, Benjamin D.‡

Journal of Pediatric Gastroenterology & Nutrition: February 2003 - Volume 36 - Issue 2 - pp 235-240
Original Articles: Gastroenterology

Objective: Most Helicobacter pylori infections are acquired during childhood. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) recently published practice guidelines for managing pediatric H. pylori infection. Before this publication, the authors conducted a survey to assess pediatric gastroenterologists' knowledge and practices regarding H. pylori.

Methods: One hundred nine of 514 NASPGHAN members completed an Internet-based questionnaire on H. pylori infection.

Results: Eighty-two percent of respondents performed outpatient testing for H. pylori. Of these, only 31% restricted testing to children aged >5 years. Most recommended testing for H. pylori in guideline-recommended conditions; some would not treat infected patients. Ninety-seven percent would test for H. pylori in a child with new duodenal ulcer (DU), 79% in a child with a history of DU, and 91% in a child with new gastric ulcer. However, only 86%, 60%, and 91%, respectively, would treat H. pylori infection in those conditions. A proton pump inhibitor (PPI)-based triple regimen was the first-choice therapy for 78% of respondents. Correct estimates of rates of resistance to amoxicillin, clarithromycin, metronidazole, and tetracycline were 10%, 17%, 43%, and 12%, respectively. Eighty-six percent believed there was insufficient research on H. pylori in children.

Conclusions: North American pediatric gastroenterologists seem well informed about H. pylori infection in children despite the lack of published guidelines at the time of survey. Knowledge about antibiotic resistance rates was deficient. Most offered some outpatient testing for H. pylori and would test children with ulcer disease. However, some would not treat patients based on a positive result.

*Northwestern University School of Medicine, Chicago, Illinois, †Mayo Clinic, Scottsdale, Arizona, and ‡Emory University School of Medicine, Atlanta, Georgia, U.S.A.

Received May 14, 2002; accepted October 3, 2002.

Supported in part by a grant from the National Institutes of Health (DK-53708).

Address correspondence and reprint requests to Dr. Benjamin D. Gold, Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, 2040 Ridgewood Drive, NE, Atlanta, GA 30322 (e-mail:

© 2003 Lippincott Williams & Wilkins, Inc.