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Evidence-based Guidelines From ESPGHAN and NASPGHAN for Helicobacter pylori Infection in Children

Koletzko, Sibylle*; Jones, Nicola L.; Goodman, Karen J.; Gold, Benjamin§; Rowland, Marion||; Cadranel, Samy; Chong, Sonny#; Colletti, Richard B.**; Casswall, Thomas††; Elitsur, Yoram‡‡; Guarner, Jeannette§§; Kalach, Nicolas||||; Madrazo, Armando¶¶; Megraud, Francis##; Oderda, Giuseppina***

Journal of Pediatric Gastroenterology and Nutrition: August 2011 - Volume 53 - Issue 2 - p 230–243
doi: 10.1097/MPG.0b013e3182227e90
Clinical Guidelines

Objective: As the clinical implications of Helicobacter pylori infection in children and adolescents continue to evolve, ESPGHAN and NASPGHAN jointly renewed clinical guidelines using a standardized evidence-based approach to develop updated recommendations for children and adolescents in North America and Europe.

Methods: An international panel of 11 pediatric gastroenterologists, 2 epidemiologists, 1 microbiologist, and 1 pathologist was selected by societies that developed evidence-based guidelines based on the Delphi process with anonymous voting in a final face-to-face meeting. A systematic literature search was performed on 8 databases of relevance including publications from January 2000 to December 2009. After excluding nonrelevant publications, tables of evidence were constructed for different focus areas according to the Oxford classification. Statements and recommendations were formulated in the following areas: whom to test, how to test, whom to treat, and how to treat. Grades of evidence were assigned to each recommendation based on the GRADE system.

Results: A total of 2290 publications were identified, from which 738 were finally reviewed. A total of 21 recommendations were generated, and an algorithm was proposed by the joint committee providing evidence-based guidelines on the diagnostic workup and treatment of children with H pylori infection.

Conclusions: These clinical practice guidelines represent updated, best-available evidence and are meant for children and adolescents living in Europe and North America, but they may not apply to those living on other continents, particularly in developing countries with a high H pylori infection rate and limited health care resources.

*Dr von Haunersches Kinderspital, Ludwig-Maximilians-University of Munich, Munich, Germany

Division of Gastroenterology, Hepatology, and Nutrition, SickKids Hospital, University of Toronto, Toronto

Department of Medicine, University of Alberta, Edmonton, Canada

§Children's Center for Digestive Healthcare, Atlanta, GA

||Children's Research Centre, Our Lady's Hospital for Sick Children, Crumlin, Ireland

Queen Fabiola Children's Hospital, Brussels, Belgium

#Queen Mary's Hospital for Children, Carshalton, Surrey, UK

**Department of Pediatrics, University of Vermont, Burlington, VT

††Division of Paediatrics, Karolinska University Hospital, Stockholm, Sweden

‡‡Department of Pediatrics, Marshall University, Huntington, WV

§§Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA

||||St Antoine Pediatric Clinic, Faculté Libre de Médecine, Lille, France

¶¶Hospital de Pediatria, Centro Medico Nacional Siglo XXI, Mexico City, Mexico

##Laboratoire de Bactériologie, Hôpital Pellegrin, Bordeaux, France

***Scienze Mediche, Clinica Pediatrica, Universita degli Studi di Novara, Novarra, Italy.

Address correspondence and reprint requests to Prof Dr Sibylle Koletzko, MD, Dr von Haunersches Kinderspital, Ludwig-Maximilians-University of Munich, Lindwurmstraße 4, D-80337 Munich, Germany (e-mail:

Received 28 March, 2011

Accepted 29 March, 2011

The authors report no conflicts of interest other than those reported on the ESPGHAN and NASPGHAN Web sites.

Sibylle Koletzko and Nicola Jones contributed equally to this article.

Copyright 2011 by ESPGHAN and NASPGHAN