Pediatric Helicobacter Pylori Infection Follow-up

Updated: Nov 16, 2018
  • Author: Mutaz I Sultan, MBChB, MD; Chief Editor: Carmen Cuffari, MD  more...
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Follow-up

Further Outpatient Care

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  • Further outpatient care includes monitoring patient symptoms, assessing patient tolerance for the treatment regimen, and follow-up testing to confirm efficacy of treatment. Follow-up testing should occur at least 6 weeks and preferably 3 months after the completion of therapy.

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Further Inpatient Care

In the child with Helicobacter pylori infection who has complications of ulcer disease, including bleeding, severe pain, perforation, or obstruction, inpatient care must include the following:

  • Attention to airway, breathing, and circulatory status

  • Monitoring and fluid resuscitation, with consideration of transfusion

  • Careful nasogastric lavage in the setting of upper-GI bleeding

  • Antacid therapy with proton pump inhibitors (PPIs) at full dosage

  • Appropriate consultation with specialists for endoscopy or other procedures

  • In the child with stress-induced peptic ulcer disease (PUD), treatment of underlying severe medical illness or traumatic injury

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Inpatient & Outpatient Medications

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  • Patients should avoid all irritating medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, and corticosteroid preparations.

  • Iron-replacement therapy is needed for iron-deficiency anemia.

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Transfer

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  • Transfer to a tertiary care children's hospital may be required for the child who is seriously ill and requires critical care or for the patient who needs emergency subspecialty diagnostic and therapeutic intervention.

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Deterrence/Prevention

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  • The mode of transmission of H pylori infection is not fully understood.

  • Data from epidemiologic studies suggest the following measures may help reduce transmission:

    • Policies that support the improvement of living conditions, particularly in developing countries

    • For all patients with chronic GI tract symptoms, appropriate referral for definitive diagnosis and treatment, which may help effect a cure and prevent exposure to family members and close contacts

    • Vaccines against H pylori infection: Several studies, performed with urease-based vaccines, showed limited immunogenicity and scarce efficacy in humans. The vaccine based on recombinant CagA–VacA–NAP proteins showed good immunogenicity and safety profile in phase I, but no subsequent efficacy trials were reported. No further results on clinical trials of H pylori vaccines were disclosed in the most recent years. Presently, there is no licensed anti– H pylori vaccine. [40]

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Complications

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  • PUD - Perforation, GI bleeding

  • Iron-deficiency anemia

  • Malignancy

    • Gastric mucosa-associated lymphoid tissue (MALT) lymphoma

    • Adenocarcinoma of the gastric body and antrum

  • Gastric-outlet obstruction

  • Increased susceptibility to enteric infections such as salmonellosis and giardiasis due to H pylori- induced hypochlorhydria

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Prognosis

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  • The outlook for eradicating H pylori infection with multidrug therapy is good, with reported efficacy rates as high as 95%.

  • Unsuccessful therapy often results from the patient's noncompliance with the medication regimen or from antimicrobial resistance.

  • Once cure is achieved, long-term reinfection rates are low. Among children living in developing countries or among families with infected members, reinfection rates may be increased.

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Patient Education

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  • At present, the nature of transmission of H pylori infection is not fully understood. Therefore, the ability to implement appropriate infection control or preventive measures is limited.

  • The theory that H pylori requires person-to-person transmission, supported by data from epidemiologic studies, may prove instrumental in promoting policies that improve living conditions and sanitation and to reduce crowding.

  • The true effect of educational efforts to reduce H pylori transmission in the patient's family (eg, teaching children about appropriate hygiene and toilet practices) is unknown. However, such efforts may be a part of a common-sense approach to reducing transmission of all pathogens infecting the GI tract.

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