BSPGHAN 2021 Virtual Annual Meeting

27- 29 April 2021

HELICOBACTER PYLORI CULTURE IN ROUTINE PRACTICE: A PAEDIATRIC RETROSPECTIVE STUDY

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kyl
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kyl
5 months ago

Thank you for your poster. It is interesting to note your use of Helicobacter stool antigen in the initial diagnostics – very pragmatic and reflects what we see in daily clinical practice. However as you know, ESPGHAN guidance does not currently support this.

Has your centre produced a guideline/ pathway that reflects your practice?

Rime Hicham
Rime Hicham
5 months ago
Reply to  kyl

Thank you for your comment. We are currently auditing the Helicobacter pylori screening process in our region to get a better understanding of the local practice before submitting a local guideline. For example, it seems like a lot of H. pylori serology is still prescribed and the aim would be to orientate towards a H. pylori stool antigen screen ONLY. If the stool antigen is positive we then advise to give an eradication therapy course based on the ESPGHAN guideline, and to confirm eradication on a further stool antigen. If the eradication failed (Ongoing positive stool antigen/ongoing symptoms), the patient are then referred to us.

Julian Thomas
Julian Thomas
5 months ago

Thank you for this data. H.pylori can cause duodenal ulcer in a small number of infected children, but I am not aware of any data that shows H.pylori colonisation causes any symptoms in children without duodenal ulcer. There is a large body of published data showing that H.pylori colonisation is asymptomatic, which is why the ESPGHAN guidelines do not recommend Helicobacter stool antigen test as a primary screening tool.
How did you decide which children to test? Do you think their ongoing management, with courses of antibiotics and endoscopy for some, can be justified based upon our current knowledge of H.pylori colonisation in childhood?

Rime Hicham
Rime Hicham
5 months ago
Reply to  Julian Thomas

Thanks for your comment.
We advise to screen for H. pylori only if the patient are symptomatic (Epigastric pain resistant to PPI, chronic nausea or vomiting upper GI bleeding) , especially if there is a strong family history of gastric cancer, and to ONLY screen the patients where there is an aim of diagnosing a cause of specific symptoms rather than simply identifying H. pylori. I know that the fact that a H. pylori gastritis in itself without PUD causes symptoms in children is controversial in the literature, but from experience and based on an audit we are currently doing in our centre (results TBC) where the management is primarily based on the faecal stool antigen, a lot of children with symptoms and positive stool antigen have clinically improved after eradication therapy and their stool antigen have subsequently confirmed eradication. They also might have had a small PUD that we have treated without demonstrating it on an endoscopy. But our local practice of treating symptomatic patients ahead of an endoscopic diagnosis is probably also a consequence of our lack of access to endoscopy, especially in COVID times…