Pediatric Helicobacter Pylori Infection Workup

  • Author: Mutaz I Sultan, MBChB, MD; Chief Editor: Carmen Cuffari, MD  more...
 
Updated: May 02, 2016
 

Laboratory Studies

The indications of testing for H pylori as recommended by the recent guidelines from North European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) for H pylori infection in children are as follows[30] :

  • The primary goal of clinical investigation of gastrointestinal symptoms is to determine the underlying cause of the symptoms and not solely the presence of H pylori infection.
  • Diagnostic testing for H pylori infection is not recommended in children with functional abdominal pain. At present, there is inadequate evidence supporting a causal relation between H pylori gastritis and abdominal symptoms in the absence of ulcer disease. Therefore, cases of abdominal pain consistent with the diagnostic criteria of functional pain should not be investigated for H pylori, unless upper endoscopy is performed during the diagnostic workup in search for organic disease.
  • In children with first-degree relatives with gastric cancer, testing for H pylori may be considered.
  • In children with refractory iron-deficiency anemia in which other causes have been ruled out, testing for H pylori infection may be considered.
  • There is insufficient evidence that H pylori infection is causally related to otitis media, upper respiratory tract infections, periodontal disease, food allergy, sudden infant death syndrome, idiopathic thrombocytopenic purpura, and short stature.
  • To confirm eradication of infection in selected children with complicated peptic ulcer disease or lymphoma and in children who remain symptomatic.

The recommendations for diagnostic tests that should be applied are as follows[30] :

  • For the diagnosis of H pylori infection during esophagogastroduodenoscopy(EGD), it is recommended that gastric biopsy samples (antrum and corpus) for histopathology be obtained.
  • It is recommended that the initial diagnosis of H pylori infection be based on either a positive histopathology plus a positive rapid urease test or a positive culture.
  • The 13C-urea breath test (UBT) is a reliable noninvasive test to determine whether H pylori has been eradicated.
  • A validated enzyme-linked immunosorbent assay (ELISA) test for detection of H pylori antigen in stool is a reliable noninvasive test to determine whether H pylori has been eradicated. Several methods are available for the detection of H pylori antigen in stool, such as enzyme immunoassay (EIA) based on polyclonal or monoclonal antibodies, and immunochromatographic tests (so-called rapid or quick tests). Stool tests are generally more convenient in pediatric patients than the UBT. Neither keeping the samples at room temperature for up to 5 days nor freezing for months or even years seems to influence the accuracy of the stool tests. So far, only the EIA based on monoclonal antibodies has achieved the accuracy of the UBT.
  • Tests based on the detection of antibodies (IgG, IgA) against H pylori in serum, whole blood, urine, and saliva are not reliable for use in the clinical setting.
  • It is recommended that clinicians wait at least 2 weeks after stopping proton pump inhibitor (PPI) therapy and 4 weeks after stopping antibiotics to perform biopsy-based and noninvasive tests (UBT, stool test) for H pylori.

Of note, these guidelines apply only to children living in Europe and North America, but not to those living in other continents, particularly in developing countries with a high H pylori infection rate in children and adolescents and with limited resources for health care.

Next

Imaging Studies

See the list below:

  • Imaging studies are not helpful in the diagnosis of H pylori infection. They may be useful in patients with complicated disease (eg, ulcer disease, gastric cancer, MALToma).
Previous
Next

Other Tests

See the list below:

  • Urea breath test: The patient ingests a test meal that contains urea labeled with carbon-13 ( 13 C), which is a nonradioactive isotope. H pylori urease activity produces labeled 13 C dioxide that can be detected in exhaled air. A positive result confirms urease activity and H pylori infection. This test is very specific and sensitive in patients older than 6 years. Its most useful application is to verify H pylori eradication after treatment. Experience in children 5 years or younger, particularly in infants, is relatively limited and needs further validation.
Previous
Next

Procedures

See the list below:

  • Upper endoscopy (EGD) is the procedure of choice for detecting gastritis, duodenitis, and PUD in the pediatric population.
    • EGD allows for direct visualization of the mucosa; for localization of the source of bleeding; for the detection of H pylori by means of biopsy, culture, and cytology analysis; and for DNA testing by using PCR.
    • In addition, a quick test based on detection of urease activity (a highly specific marker of H pylori) can be performed. The test, termed the Campylobacter -like organism (CLO) test allows for a diagnosis of H pylori infection within 24 hours.
    • Two modified, rapid urease test kits are now commercially available and are reported to have better accuracy, a shorter reaction time, and better cost-effectiveness than those of the CLO test.
    • In children, endoscopy may reveal a nodular appearance in the gastric antrum resulting from lymphoid hyperplasia.[31] However, only approximately 50% of affected children have endoscopic evidence of changes of H pylori gastritis.
    • The gross appearance of an active ulcer is a round or oval, punched-out lesion with a smooth, white base and with surrounding mucosa that is red and edematous. In H pylori infection, the most common location for ulceration is the duodenal bulb.
    • Biopsy specimens obtained in the prepyloric antrum have the highest yield in H pylori infection. Tissue specimens are often also obtained from the body and the transition zones of the stomach, particularly if the patient has recently taken acid-suppressing medication.
  • Endoscopic biopsy is indicated for the following reasons:
    • Histologic examination of gastric tissue
    • Rapid urease testing (eg, CLO test)
    • Culture of organisms
    • PCR testing to identify H pylori DNA
Previous
Next

Histologic Findings

See the list below:

  • Histologic findings include a superficial infiltrate with substantial numbers of plasma cells and lymphocytes within the gastric mucosa and organisms visible on Giemsa, Diff-Quick, or hematoxylin and eosin staining. Sensitive staining for small numbers of bacteria is possible using silver stains such as Genta or Warthin-Starry.
Previous
Next

Staging

See the list below:

  • Although a staging system for the H pylori infection has not been established, several steps in disease progression are well described.
  • The first step is chronic gastritis, which is followed by the second step, atrophic gastritis. The third step is intestinal metaplasia, which may evolve into dysplasia. The last step in this process is gastric adenocarcinoma.
  • This process is very slow (ie, decades) and may stop at any step because gastric cancers probably require several other factors to develop, not only an H pylori infection.
Previous
 
 
Contributor Information and Disclosures
Author

Mutaz I Sultan, MBChB, MD Assistant Professor of Pediatrics, Al-Quds University Medical College; Pediatric Gastroenterologist and Hepatologist, Division of Pediatrics, Makassed Hospital, Palestine

Mutaz I Sultan, MBChB, MD is a member of the following medical societies: American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Coauthor(s)

B UK Li, MD Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin; Attending Gastroenterologist, Director, Cyclic Vomiting Program, Children’s Hospital of Wisconsin

B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Maria Triantafyllopoulou Greene, MD Assistant Professor of Pediatrics, Northwestern University Feinberg School of Medicine; Attending Physician, Division of Gastroenterology, Hepatology, and Nutrition, Children's Memorial Hospital

Maria Triantafyllopoulou Greene, MD is a member of the following medical societies: American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Stefano Guandalini, MD Founder and Medical Director, Celiac Disease Center, Chief, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Chicago Medical Center; Professor, Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Stefano Guandalini, MD is a member of the following medical societies: American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, European Society for Paediatric Gastroenterology, Hepatology & Nutrition, North American Society for the Study of Celiac Disease

Disclosure: Received consulting fee from AbbVie for consulting.

Chief Editor

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching. for: Abbott Nutritional, Abbvie, speakers' bureau.

Additional Contributors

Hisham Nazer, MB, BCh, FRCP, , DTM&H Professor of Pediatrics, Consultant in Pediatric Gastroenterology, Hepatology and Clinical Nutrition, University of Jordan Faculty of Medicine, Jordan

Hisham Nazer, MB, BCh, FRCP, , DTM&H is a member of the following medical societies: American Association for Physician Leadership, Royal College of Paediatrics and Child Health, Royal College of Surgeons in Ireland, Royal Society of Tropical Medicine and Hygiene, Royal College of Physicians and Surgeons of the United Kingdom

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Meta Carroll, MD, to the development and writing of this article.

References
  1. Blecker U. Helicobacter pylori-associated gastroduodenal disease in childhood. South Med J. 1997 Jun. 90(6):570-6; quiz 577. [Medline].

  2. Moodley Y, Linz B, Bond RP, Nieuwoudt M, Soodyall H, Schlebusch CM. Age of the association between Helicobacter pylori and man. PLoS Pathog. 2012. 8(5):e1002693. [Medline].

  3. Appelmelk BJ, Simoons-Smit I, Negrini R, et al. Potential role of molecular mimicry between Helicobacter pylori lipopolysaccharide and host Lewis blood group antigens in autoimmunity. Infect Immun. 1996 Jun. 64(6):2031-40. [Medline].

  4. Figueiredo C, Machado JC, Yamaoka Y. Pathogenesis of Helicobacter pylori Infection. Helicobacter. 2005. 10 Suppl 1:14-20. [Medline].

  5. Rick JR, Goldman M, Semino-Mora C, et al. In situ expression of cagA and risk of gastroduodenal disease in Helicobacter pylori-infected children. J Pediatr Gastroenterol Nutr. 2010 Feb. 50(2):167-72. [Medline]. [Full Text].

  6. Shiota S, Suzuki R, Yamaoka Y. The significance of virulence factors in Helicobacter pylori. J Dig Dis. 2013 Jul. 14(7):341-9. [Medline].

  7. Shiota S, Matsunari O, Watada M, Yamaoka Y. Serum Helicobacter pylori CagA antibody as a biomarker for gastric cancer in east-Asian countries. Future Microbiol. 2010 Dec. 5(12):1885-93. [Medline].

  8. Baysoy G, Ertem D, Ademoglu E, et al. Gastric histopathology, iron status and iron deficiency anemia in children with Helicobacter pylori infection. J Pediatr Gastroenterol Nutr. 2004 Feb. 38(2):146-51. [Medline].

  9. Williams MP, Pounder RE. Helicobacter pylori: from the benign to the malignant. Am J Gastroenterol. 1999 Nov. 94(11 Suppl):S11-6. [Medline].

  10. Wroblewski LE, Piazuelo MB, Chaturvedi R, Schumacher M, Aihara E, Feng R, et al. Helicobacter pylori targets cancer-associated apical-junctional constituents in gastroids and gastric epithelial cells. Gut. 2015 May. 64 (5):720-30. [Medline].

  11. Rosenberg JJ. Helicobacter pylori. Pediatr Rev. 2010 Feb. 31(2):85-6; discussion 86. [Medline].

  12. Lee YC, Chiang TH, Chou CK, Tu YK, Liao WC, Wu MS, et al. Association Between Helicobacter pylori Eradication and Gastric Cancer Incidence: A Systematic Review and Meta-analysis. Gastroenterology. 2016 May. 150 (5):1113-1124.e5. [Medline].

  13. Douglas D. H. Pylori Eradication Curbs Gastric Cancer Risk. Reuters Health Information. Available at http://www.medscape.com/viewarticle/858643. February 12, 2016; Accessed: May 2, 2016.

  14. Alarcón T, José Martínez-Gómez M, Urruzuno P. Helicobacter pylori in pediatrics. Helicobacter. 2013 Sep. 18 Suppl 1:52-7. [Medline].

  15. Ashorn M, Rago T, Kokkonen J, et al. Symptomatic response to Helicobacter pylori eradication in children with recurrent abdominal pain: double blind randomized placebo-controlled trial. J Clin Gastroenterol. 2004 Sep. 38(8):646-50. [Medline].

  16. [Guideline] Gold BD, Colletti RB, Abbott M, et al. Helicobacter pylori infection in children: recommendations for diagnosis and treatment. J Pediatr Gastroenterol Nutr. 2000 Nov. 31(5):490-7. [Medline].

  17. Spee LA, Madderom MB, Pijpers M, van Leeuwen Y, Berger MY. Association between helicobacter pylori and gastrointestinal symptoms in children. Pediatrics. 2010 Mar. 125(3):e651-69. [Medline].

  18. Yaghoobi M, Farrokhyar F, Yuan Y, Hunt RH. Is There an Increased Risk of GERD After Helicobacter pylori Eradication?: A Meta-Analysis. Am J Gastroenterol. 2010 Jan 19. [Medline].

  19. Moon A, Solomon A, Beneck D, Cunningham-Rundles S. Positive association between Helicobacter pylori and gastroesophageal reflux disease in children. J Pediatr Gastroenterol Nutr. 2009 Sep. 49(3):283-8. [Medline]. [Full Text].

  20. Fischbach LA, Nordenstedt H, Kramer JR, Gandhi S, Dick-Onuoha S, Lewis A, et al. The Association Between Barrett's Esophagus and Helicobacter pylori Infection: A Meta-Analysis. Helicobacter. 2012 Jun. 17(3):163-75. [Medline]. [Full Text].

  21. Deng ZH, Chu B, Xu YZ, Zhang B, Jiang LR. Influence of Helicobacter pylori infection on ghrelin levels in children. World J Gastroenterol. 2012 Sep 28. 18(36):5096-100. [Medline].

  22. Arnold DM, Bernotas A, Nazi I, Stasi R, Kuwana M, Liu Y, et al. Platelet count response to H. pylori treatment in patients with immune thrombocytopenic purpura with and without H. pylori infection: a systematic review. Haematologica. 2009 Jun. 94(6):850-6. [Medline]. [Full Text].

  23. Sullivan PB, Thomas JE, Wight DG, et al. Helicobacter pylori in Gambian children with chronic diarrhoea and malnutrition. Arch Dis Child. 1990 Feb. 65(2):189-91. [Medline].

  24. Muhsen K, Jurban M, Goren S, Cohen D. Incidence, age of acquisition and risk factors of Helicobacter pylori infection among Israeli Arab infants. J Trop Pediatr. 2012 Jun. 58(3):208-13. [Medline].

  25. Konno M, Fujii N, Yokota S, Sato K, Takahashi M, Sato K, et al. Five-year follow-up study of mother-to-child transmission of Helicobacter pylori infection detected by a random amplified polymorphic DNA fingerprinting method. J Clin Microbiol. 2005 May. 43(5):2246-50. [Medline]. [Full Text].

  26. Cervantes DT, Fischbach LA, Goodman KJ, Phillips CV, Chen S, Broussard CS. Exposure to Helicobacter pylori-positive siblings and persistence of Helicobacter pylori infection in early childhood. J Pediatr Gastroenterol Nutr. 2010 May. 50(5):481-5. [Medline]. [Full Text].

  27. Bastos J, Carreira H, La Vecchia C, Lunet N. Childcare attendance and Helicobacter pylori infection: systematic review and meta-analysis. Eur J Cancer Prev. 2013 Jul. 22(4):311-9. [Medline].

  28. Ahmed KS, Khan AA, Ahmed I, et al. Impact of household hygiene and water source on the prevalence and transmission of Helicobacter pylori: a South Indian perspective. Singapore Med J. 2007 Jun. 48(6):543-9. [Medline].

  29. Grubel P, Huang L, Masubuchi N, Stutzenberger FJ, Cave DR. Detection of Helicobacter pylori DNA in houseflies (Musca domestica) on three continents. Lancet. 1998 Sep 5. 352(9130):788-9. [Medline].

  30. [Guideline] 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. 2011 Aug. 53(2):230-43. [Medline].

  31. Bujanover Y, Konikoff F, Baratz M. Nodular gastritis and Helicobacter pylori. J Pediatr Gastroenterol Nutr. 1990 Jul. 11(1):41-4. [Medline].

  32. Megraud F, Coenen S, Versporten A, Kist M, Lopez-Brea M, Hirschl AM. Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption. Gut. 2013 Jan. 62(1):34-42. [Medline].

  33. Zullo A, Hassan C, Ridola L, De Francesco V, Vaira D. Standard triple and sequential therapies for Helicobacter pylori eradication: an update. Eur J Intern Med. 2013 Jan. 24(1):16-9. [Medline].

  34. Lionetti E, Miniello VL, Castellaneta SP, et al. Lactobacillus reuteri therapy to reduce side-effects during anti-Helicobacter pylori treatment in children: a randomized placebo controlled trial. Aliment Pharmacol Ther. 2006 Nov 15. 24(10):1461-8. [Medline].

  35. Goldman CG, Barrado DA, Balcarce N, et al. Effect of a probiotic food as an adjuvant to triple therapy for eradication of Helicobacter pylori infection in children. Nutrition. 2006 Oct. 22(10):984-8. [Medline].

  36. Zojaji H, Talaie R, Mirsattari D, et al. The efficacy of Helicobacter pylori eradication regimen with and without vitamin C supplementation. Dig Liver Dis. 2009 Sep. 41(9):644-7. [Medline].

  37. Zeng M, Mao XH, Li JX, Tong WD, Wang B, Zhang YJ, et al. Efficacy, safety, and immunogenicity of an oral recombinant Helicobacter pylori vaccine in children in China: a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2015 Oct 10. 386 (10002):1457-64. [Medline].

  38. Boggs W. New Oral Vaccine Protects Children From Helicobacter Pylori Infection. Reuters Health Information. Available at http://www.medscape.com/viewarticle/848072. July 16, 2015; Accessed: May 2, 2016.

  39. Ruggiero P. Helicobacter pylori infection: what's new. Curr Opin Infect Dis. 2012 Jun. 25(3):337-44. [Medline].

  40. Bahremand S, Nematollahi LR, Fourutan H, et al. Evaluation of triple and quadruple Helicobacter pylori eradication therapies in Iranian children: a randomized clinical trial. Eur J Gastroenterol Hepatol. 2006 May. 18(5):511-4. [Medline].

  41. Bhasin DK, Sharma BC, Ray P, et al. Comparison of seven and fourteen days of lansoprazole, clarithromycin, andamoxicillin therapy for eradication of Helicobacter pylori: a report from India. . Helicobacter. Jun 2000. 5(2):84-7.

  42. Bonamico M, Strappini PM, Bonci E, et al. Evaluation of stool antigen test, PCR on ORAL samples and serology for the noninvasive detection of Helicobacter pylori infection in children. Helicobacter. 2004 Feb. 9(1):69-76. [Medline].

  43. Booka M, Okuda M, Shin K, et al. Polymerase chain reaction--restriction fragment length polymorphism analysis of clarithromycin-resistant Helicobacter pylori infection in children using stool sample. Helicobacter. 2005 Jun. 10(3):205-13. [Medline].

  44. Bourke B, Ceponis P, Chiba N, et al. Canadian Helicobacter Study Group Consensus Conference: Update on the approach to Helicobacter pylori infection in children and adolescents--an evidence-based evaluation. Can J Gastroenterol. 2005 Jul. 19(7):399-408. [Medline].

  45. Cammarota G, Cianci R, Cannizzaro O, et al. High-dose versus low-dose clarithromycin in 1-week triple therapy, including rabeprazole and levofloxacin, for Helicobacter pylori eradication. J Clin Gastroenterol. 2004 Feb. 38(2):110-4. [Medline].

  46. Chan KL, Zhou H, Ng DK, Tam PK. A prospective study of a one-week nonbismuth quadruple therapy for childhood Helicobacter pylori infection. J Pediatr Surg. 2001 Jul. 36(7):1008-11. [Medline].

  47. Chan KL, Zhou H, Ng DK, Tam PK. A prospective study of a one-week nonbismuth quadruple therapy for childhood Helicobacter pylori infection. J Pediatr Surg. 2001 Jul. 36(7):1008-11. [Medline].

  48. Chong SK, Lou Q, Asnicar MA, et al. Helicobacter pylori infection in recurrent abdominal pain in childhood: comparison of diagnostic tests and therapy. Pediatrics. 1995 Aug. 96(2 Pt 1):211-5. [Medline].

  49. Czinn SJ. Helicobacter pylori infection: detection, investigation, and management. J Pediatr. 2005 Mar. 146(3 Suppl):S21-6. [Medline].

  50. Di Caro S, Franceschi F, Mariani A, et al. Second-line levofloxacin-based triple schemes for Helicobacter pylori eradication. Dig Liver Dis. 2009 Jul. 41(7):480-5. [Medline].

  51. Drumm B. Helicobacter pylori in the pediatric patient. Gastroenterol Clin North Am. 1993 Mar. 22(1):169-82. [Medline].

  52. El-Omar EM, Oien K, Murray LS, et al. Increased prevalence of precancerous changes in relatives of gastric cancer patients: critical role of H. pylori. Gastroenterology. 2000 Jan. 118(1):22-30. [Medline].

  53. Ernst PB, Gold BD. Helicobacter pylori in childhood: new insights into the immunopathogenesis of gastric disease and implications for managing infection in children. J Pediatr Gastroenterol Nutr. 1999 May. 28(5):462-73. [Medline].

  54. Farrell MK. Dr. Apley meets Helicobacter pylori. J Pediatr Gastroenterol Nutr. 1993 Feb. 16(2):118-9. [Medline].

  55. Feydt-Schmidt A, Kindermann A, Konstantopoulos N, et al. Reinfection rate in children after successful Helicobacter pylori eradication. Eur J Gastroenterol Hepatol. 2002 Oct. 14(10):1119-23. [Medline].

  56. Fiedorek SC, Casteel HB, Pumphrey CL, et al. The role of Helicobacter pylori in recurrent, functional abdominal pain in children. Am J Gastroenterol. 1992 Mar. 87(3):347-9. [Medline].

  57. Francavilla R, Lionetti E, Castellaneta SP, et al. Improved efficacy of 10-Day sequential treatment for Helicobacter pylori eradication in children: a randomized trial. Gastroenterology. 2005 Nov. 129(5):1414-9. [Medline].

  58. Gillen D, el-Omar EM, Wirz AA, et al. The acid response to gastrin distinguishes duodenal ulcer patients from Helicobacter pylori-infected healthy subjects. Gastroenterology. 1998 Jan. 114(1):50-7. [Medline].

  59. Gisbert JP, Luna M, Gomez B, et al. Recurrence of Helicobacter pylori infection after several eradication therapies: long-term follow-up of 1000 patients. Aliment Pharmacol Ther. 2006 Mar 15. 23(6):713-9. [Medline].

  60. Gisbert JP, Perez-Aisa A, Castro-Fernandez M, et al. Helicobacter pylori first-line treatment and rescue option containing levofloxacin in patients allergic to penicillin. Dig Liver Dis. 2010 Apr. 42(4):287-90. [Medline].

  61. Glassman MS. Helicobacter pylori infection in children. A clinical overview. Clin Pediatr (Phila). 1992 Aug. 31(8):481-7. [Medline].

  62. Gormally S, Drumm B. Helicobacter pylori and gastrointestinal symptoms. Arch Dis Child. 1994 Mar. 70(3):165-6. [Medline].

  63. Graham DY, Rakel RE, Fendrick AM, et al. Practical advice on eradicating Helicobacter pylori infection. Postgrad Med. 1999 Mar. 105(3):137-40, 145-8. [Medline].

  64. Graham DY, Shiotani A. The time to eradicate gastric cancer is now. Gut. 2005 Jun. 54(6):735-8. [Medline].

  65. Guo CY, Wu YB, Liu HL, et al. Clinical evaluation of four one-week triple therapy regimens in eradicating Helicobacter pylori infection. World J Gastroenterol. 2004 Mar 1. 10(5):747-9. [Medline].

  66. Hardikar W, Feekery C, Smith A, et al. Helicobacter pylori and recurrent abdominal pain in children. J Pediatr Gastroenterol Nutr. 1996 Feb. 22(2):148-52. [Medline].

  67. Heldenberg D, Wagner Y, Heldenberg E, et al. The role of Helicobacter pylori in children with recurrent abdominal pain. Am J Gastroenterol. 1995 Jun. 90(6):906-9. [Medline].

  68. Horvitz G, Gold BD. Gastroduodenal diseases of childhood. Curr Opin Gastroenterol. 2006 Nov. 22(6):632-40. [Medline].

  69. Huang FC, Chang MH, Hsu HY, et al. Long-term follow-up of duodenal ulcer in children before and after eradication of Helicobacter pylori. J Pediatr Gastroenterol Nutr. 1999 Jan. 28(1):76-80. [Medline].

  70. Huebner ES, Surawicz CM. Probiotics in the prevention and treatment of gastrointestinal infections. Gastroenterol Clin North Am. 2006 June. 35:355-65. [Medline].

  71. Israel DM, Hassall E. Treatment and long-term follow-up of Helicobacter pylori-associated duodenal ulcer disease in children. J Pediatr. 1993 Jul. 123(1):53-8. [Medline].

  72. Judd RH. Helicobacter pylori, gastritis, and ulcers in pediatrics. Adv Pediatr. 1992. 39:283-306. [Medline].

  73. Khurana R, Fischbach L, Chiba N, et al. Meta-analysis: Helicobacter pylori eradication treatment efficacy in children. Aliment Pharmacol Ther. 2007 Mar 1. 25(5):523-36. [Medline].

  74. Kimia A, Zahavi I, Shapiro R, et al. The role of Helicobacter pylori and gastritis in children with recurrent abdominalpain. Isr Med Assoc J. 2000 Feb. 2(2):126-8. [Medline].

  75. Kiriya K, Watanabe N, Nishio A, et al. Essential role of Peyer's patches in the development of Helicobacter-induced gastritis. Int Immunol. 2007 Apr. 19(4):435-46. [Medline].

  76. Kiyota K, Habu Y, Sugano Y, et al. Comparison of 1-week and 2-week triple therapy with omeprazole, amoxicillin,and clarithromycin in peptic ulcer patients with Helicobacter pylori infection: results of a randomized controlled trial. J Gastroenterol. 1999. 34 Suppl 11:76-9. [Medline].

  77. Knippig C, Arand F, Leodolter A, et al. Prevalence of H. pylori-infection in family members of H. pylori positive and its influence on the reinfection rate after successful eradication therapy: a two-year follow-up. Z Gastroenterol. 2002 Jun. 40(6):383-7. [Medline].

  78. Koivisto TT, Rautelin HI, Voutilainen ME, et al. First-line eradication therapy for Helicobacter pylori in primary health care based on antibiotic resistance: results of three eradication regimens. Aliment Pharmacol Ther. 2005 Mar 15. 21(6):773-82. [Medline].

  79. Logan RP, Gummett PA, Schaufelberger HD, et al. Eradication of Helicobacter pylori with clarithromycin and omeprazole. Gut. 1994 Mar. 35(3):323-6. [Medline].

  80. Long SS, Pickering LK, Prober CG, eds. Helicobacter pylori. Principles and Practice of Pediatric Infectious Diseases. New York, NY: Churchill Livingstone; 1997. 1029-33.

  81. Moshkowitz M, Reif S, Brill S, et al. One-week triple therapy with omeprazole, clarithromycin, and nitroimidazole for Helicobacter pylori infection in children and adolescents. Pediatrics. 1998 Jul. 102(1):e14. [Medline]. [Full Text].

  82. Nagai S, Mimuro H, Yamada T, et al. Role of Peyer's patches in the induction of Helicobacter pylori-induced gastritis. Proc Natl Acad Sci U S A. 2007 May 22. 104(21):8971-6. [Medline].

  83. Nista EC, Candelli M, Cremonini F, et al. Levofloxacin-based triple therapy vs. quadruple therapy in second-line Helicobacter pylori treatment: a randomized trial. Aliment Pharmacol Ther. 2003 Sep 15. 18(6):627-33. [Medline].

  84. Paoluzi OA, Visconti E, Andrei F, et al. Ten and eight-day sequential therapy in comparison to standard triple therapy for eradicating Helicobacter pylori infection: a randomized controlled study on efficacy and tolerability. J Clin Gastroenterol. 2010 Apr. 44(4):261-6. [Medline].

  85. Parsonnet J. Helicobacter pylori. Infect Dis Clin North Am. 1998 Mar. 12(1):185-97. [Medline].

  86. Parsonnet J, Hansen S, Rodriguez L, et al. Helicobacter pylori infection and gastric lymphoma. N Engl J Med. 1994 May 5. 330(18):1267-71. [Medline]. [Full Text].

  87. Raguza D, Machado RS, Ogata SK, et al. Validation of a monoclonal stool antigen test for diagnosing Helicobacter pylori infection in young children. J Pediatr Gastroenterol Nutr. 2010 Apr. 50(4):400-3. [Medline].

  88. Siberry GK, Iannone R, eds. Formulary: drug doses. The Harriet Lane Handbook. 15th ed. St Louis, MO: Mosby; 2000. 622, 630, 645-6, 674-5, 772-3, 795, 837.

  89. Vinette KM, Gibney KM, Proujansky R, Fawcett PT. Comparison of PCR and clinical laboratory tests for diagnosing H. pylori infection in pediatric patients. BMC Microbiol. 2004 Jan 27. 4:5. [Medline]. [Full Text].

  90. Wewer V, Andersen LP, Paerregaard A, et al. Treatment of Helicobacter pylori in children with recurrent abdominal pain. Helicobacter. 2001 Sep. 6(3):244-8. [Medline].

  91. Windle HJ, Kelleher D, Crabtree JE. Childhood Helicobacter pylori infection and growth impairment in developing countries: a vicious cycle?. Pediatrics. 2007 Mar. 119(3):e754-9. [Medline].

 
Previous
Next
 
Helicobacter pylori infection revealed by endoscopy (nodular gastropathy).
Helicobacter pylori–associated peptic ulcer in the duodenal bulb.
 
Medscape Consult
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.