Treating children with Helicobacter pylori gastritis in East London: is it time for new guidelines?

Abstract

Aim: The joint guidelines for the management of Helicobacter pylori (H. pylori) in children and adolescents by the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) were last updated in 2016 More recent guidelines from the National Institute for Health and Care Excellence (NICE) updated in 2019 only focus on adult patients.. Our study aimed to benchmark practices at a tertiary paediatric gastroenterology unit against national and international guidelines. Materials and Methods: Retrospective data from children diagnosed with H. pylori gastritis between 2015 and 2017 were collected and analysed by two independent reviewers. Baseline characteristics (age at time of diagnosis, gender, co-morbidities) and details related to H. pylori gastritis (H. pylori faecal antigen result, symptoms at diagnosis, endoscopic and histological findings, treatments and follow-up) were recorded in an anonymised Excel spreadsheet and evaluated. Results: 638 (18.5%) of 3451 children investigated in East London during the study period had a positive stool antigen test. During the same time period, 40 children were referred to our tertiary centre for an upper GI endoscopy that confirmed H. pylori gastritis. Only 26 children (65%) were re-tested to confirm eradication, which was achieved in 18. Only 30% of family members were tested in the community and treated if positive. Conclusion: Further integration between general practice and specialist paediatric care and guideline updates are needed to ensure efficacy of eradication and to tackle the risk of a re-infection within the patient’s household.