Letters to the Editor
To the Editor:
We surveyed the British Society of Paediatric Gastroenterology, Hepatology, and Nutrition (BSPGHAN) to compare UK practice against recent European Society of Paediatric Gastroenterology, Hepatology, and Nutrition/North American Society of Paediatric Gastroenterology, Hepatology, and Nutrition guidelines (1) on paediatric Helicobacter pylori. The survey elicited 39 responses from throughout the United Kingdom. Questions based on the guidelines pertained to “a 10-year-old boy with dyspepsia and a positive family history of H pylori–associated peptic ulcers.”
All of the respondents bar 1 would test for H pylori, correctly choosing an endoscopic investigation. Paediatric guidelines are in contrast to their adult counterparts, particularly in their support of endoscopy for diagnosis (2,3). Ninety-seven percent of responses selected an appropriate triple therapy regimen; however, nobody selected sequential therapy. All agreed treatment for 7 to 14 days. Interestingly, 39% would not test for eradication if symptoms improved, despite this being a recommendation. When asked how long to wait before retesting, 72% would wait the appropriate 4 to 8 weeks. Almost all agreed with stool enzyme-linked immunosorbent assay or urea breath test to confirm eradication, agreeing that 4 weeks without antibiotics and 2 weeks without PPIs were appropriate beforehand.
Respondents would universally eradicate H pylori in the presence of peptic ulceration at endoscopy. Interestingly, responses were universally in favour of treating gastritis and overwhelmingly (79%) in favour of treating an endoscopically normal stomach, in the presence of H pylori, despite ambiguity in the guidelines. Evidence is growing that childhood H pylori may be beneficial in a number of ways (4). Eradication of H pylori has little effect on recurrent abdominal pain (5). Our approach to the eradication of incidental H pylori merits further debate.
1. Koletzko S, Jones NL, Goodman KJ, et al. Evidence-based guidelines from ESPGHAN and NASPGHAN for Helicobacter pylori
infection in children. J Pediatr Gastroenterol Nutr
2. National Institute for Health and Clinical Excellence. Dyspepsia: Management of Dyspepsia in Adults in Primary Care [CG17]
. London: National Institute for Health and Clinical Excellence; 2005.
3. Talley NJ. American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology
4. Blaser MJ, Chen Y, Reibman J. Does Helicobacter pylori
protect against asthma and allergy? Gut
5. Merja A, Tiina R, Jorma K, et al. Symptomatic response to Helicobacter pylori
eradication in children with recurrent abdominal pain: double blind randomized placebo-controlled trial. J Clin Gastroenterol