<i>Helicobacter pylori</i> Infection in Pediatric Patients Living in Europe
Michal Kori, Thu Giang Le Thi, Katharina Werkstetter, Andrea Sustmann, Patrick Bontems, Ana Isabel Lopes, Mónica Oleastro, Barbara Iwańczak, Nicolas Kalach, Zrinjka Mišak, José António Sarsfield Cabral, Matjaž Homan, María Luz Cilleruelo Pascual, Ender Pehlıvanoğlu, Thomas Casswall, Pedro Urruzuno, Maria José Martínez Gómez, Alexandra Papadopoulou, Elefthería Roma, Jernej Dolinšek, Maria Rogalidou, Vaidotas Urbonas, Sonny K. F. Chong, Angelika Kindermann, Erasmo Miele, Francesca Rea, Áron Cseh, Sibylle Koletzko, Helicobacter pylori Working Group of ESPGHAN
Abstract
OBJECTIVES: The aim of the study was to assess clinical presentation, endoscopic findings, antibiotic susceptibility and treatment success of Helicobacter pylori (H. pylori) infected pediatric patients. METHODS: Between 2013 and 2016, 23 pediatric hospitals from 17 countries prospectively submitted data on consecutive H. pylori-infected (culture positive) patients to the EuroPedHP-Registry. RESULTS: Of 1333 patients recruited (55.1% girls, median age 12.6 years), 1168 (87.6%) were therapy naïve (group A) and 165 (12.4%) had failed treatment (group B). Patients resided in North/Western (29.6%), Southern (34.1%) and Eastern Europe (23.0%), or Israel/Turkey (13.4%). Main indications for endoscopy were abdominal pain or dyspepsia (81.2%, 1078/1328). Antral nodularity was reported in 77.8% (1031/1326) of patients, gastric or duodenal ulcers and erosions in 5.1% and 12.8%, respectively. Primary resistance to clarithromycin (CLA) and metronidazole (MET) occurred in 25% and 21%, respectively, and increased after failed therapy. Bacterial strains were fully susceptible in 60.5% of group A, but in only 27.4% of group B. Primary CLA resistance was higher in Southern and Eastern Europe (adjusted odds ratio [ORadj] = 3.44, 95% confidence interval [CI] 2.22-5.32, P < 0.001 and 2.62, 95% CI: 1.63-4.22, P < 0.001, respectively) compared with Northern/Western Europe. Children born outside Europe showed higher primary MET resistance (ORadj = 3.81, 95% CI: 2.25-6.45, P < 0.001). Treatment success in group A reached only 79.8% (568/712) with 7 to 14 days triple therapy tailored to antibiotic susceptibility. CONCLUSIONS: Peptic ulcers are rare in dyspeptic H. pylori-infected children. Primary resistance to CLA and MET is markedly dependent on geographical regions of birth and residence. The ongoing survey will show whether implementation of the updated ESPGHAN/NASPGHAN guidelines will improve the eradication success.