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Helicobacter Pylori Gastritis and Peptic Ulcer Disease

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Textbook of Pediatric Gastroenterology, Hepatology and Nutrition

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Abstract

Helicobacter (H.) pylori poses a significant health burden worldwide, despite the evidence that the prevalence of the infection is decreasing in some areas. The majority of the H. pylori-infected population remains asymptomatic, but some individuals may develop chronic gastritis, peptic ulcer, gastric mucosa-associated lymphoid tissue (MALT) lymphoma, or even carcinoma. Factors determining the subset of infected individuals who will develop the disease remain unclear and include interplay between H. pylori virulence factors and host immunity. H. pylori infection differs between pediatric and adult patients in many aspects including prevalence of the infection, the complication rate, and the near-absence of gastric malignancies. Testing for H. pylori in children should be performed in properly selected patients. Current recommendations for children do not approve “test-and-treat” approach recommended for adults. Diagnostic procedures should aim to determine underlying disease and not to detect H. pylori. It is recommended that the diagnosis of H. pylori infection should be based on either (a) histopathology (H. pylori-positive gastritis) plus at least one other positive biopsy-based test or (b) positive culture. Besides, endoscopy with histopathology remains the only method that can detect lesions associated with the infection, but also other possible causes of the patient’s symptoms. Eradication therapy should be tailored according to antimicrobial sensitivity obtained for the infecting H. pylori strain(s). The first-line eradication therapy includes triple therapy with a proton pump inhibitor (PPI) and amoxicillin and metronidazole or clarithromycin for 14 days. Assessment of eradication should be performed with noninvasive test at least 4–8 weeks following completion of therapy.

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Abbreviations

AMO:

Amoxicillin

BabA:

Blood antigen-binding adhesin

CagA:

Cytotoxin-associated gene A

CLA:

Clarithromycin

COX-1:

Cyclooxygenase-1

13C-UBT:

13C-urea breath test

dupA:

Duodenal ulcer promoting

ELISA:

Enzyme-linked immunosorbent assay

ESPGHAN:

European Society of Pediatric Gastroenterology, Hepatology and Nutrition

FISH:

Fluorescence in situ hybridization

GGT:

Gamma-glutamyl transpeptidase

H. pylori :

Helicobacter pylori

IDA:

Iron deficiency anemia

MALT:

Mucosa-associated lymphoid tissue

MET:

Metronidazole

NASPGHAN:

North American Society for Pediatric Gastroenterology Hepatology, and Nutrition

NSAIDs:

Nonsteroidal anti-inflammatory drugs

OipA:

Outer inflammatory protein A

OMV:

Outer membrane vesicles

PAMPs:

Pathogen-associated molecular patterns

PCR:

Polymerase chain reaction

PPI:

Proton pump inhibitors

PRRs:

Pattern recognition receptors

SabA:

Sialic acid-binding adhesin

T4SS:

Type IV secretion system

VacA:

Vacuolating cytotoxin A

WB:

Western Blot

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  1. Referral Center for Pediatric Gastroenterology and Nutrition, Children’s Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia

    Zrinjka Mišak & Iva Hojsak

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  1. Zrinjka Mišak
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  1. Section of Pediatric Gastroenterology Hepatology and Nutrition, University of Chicago, Chicago, IL, USA

    Stefano Guandalini

  2. Pediatric Liver, GI and Nutrition Center, Child Health, King’s College Hospital, London, UK

    Anil Dhawan

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Mišak, Z., Hojsak, I. (2022). Helicobacter Pylori Gastritis and Peptic Ulcer Disease. In: Guandalini, S., Dhawan, A. (eds) Textbook of Pediatric Gastroenterology, Hepatology and Nutrition. Springer, Cham. https://doi.org/10.1007/978-3-030-80068-0_12

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