H. pylori infection occurs worldwide and is usually acquired in early childhood. This infection typically goes undetected at onset because it does not induce a specific constellation of symp-toms. While H. pylori infection can persist indefinitely with-out treatment, evidence suggests that acute infection can occur and resolve spontaneously before the development of detectable antibodies. Chronic H. pylori infection is nearly always accom-panied by chronic gastritis and is involved in the pathogen-esis of duodenal ulcers, gastric ulcers, and more rarely, gastric carcinoma. Chronic gastritis and peptic ulcer disease are more common in older and low-income populations. Chronic H. pylori-associated gastritis is generally asymptomatic, particu-larly in children. Symptomatic disease associated with H. pylori infection generally arises from long-term infection and occurs primarily in adults.
Various studies have investigated hypotheses pertaining to H. pylori infection as a cause of a wide variety of extragastric diseases in children such as otitis media, upper respiratory tract infections, periodontal disease, food allergies, sudden infant death syndrome, idiopathic thrombocytopenic purpura, and short stat-ure. At present, there is no clear evidence that H. pylori plays a role in the pathogenesis of any of these conditions.
Studies of the relationship of H. pylori infection to iron deficiency in chil-dren have had inconsistent results.In 2011, the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN and NASPGHAN) released updated guidelines for the management of H. pylori infection in children. These guide-lines, developed using a systematic evaluation of the evidence, comprised recommendations to pediatricians for investigating gastrointestinal symptoms. The guidelines state that a “test and treat” approach, a strategy that uses a noninvasive test rather than upper gastrointestinal endoscopy to diagnose H. pylori infection and treat patients with positive results, is not recom-mended for pediatric patients, with the exception of specified circumstances.
Unlike guidelines for adult populations, testing for H. pylori is not recommended for children presenting with functional abdominal pain.A test and treat strategy is recom-mended, however, for children who have first-degree relatives with a history of gastric cancer.The guidelines also recommend that testing for H. pylori infection be considered in children with refractory iron deficiency anemia after other causes have been ruled-out.
The identification of treatment regimens that are effective at eliminating pediatric H. pylori infections remains a challenge, particularly for high-prevalence populations, which often experience high frequencies of antimicrobial resistance and treatment failure.
The 2011 guidelines recommend monitor-ing the local prevalence of antibiotic-resistant H. pylori
strains in children and adolescents and tailoring treatment regimens accordingly.Policy analysis shows that H. pylori test and treat strategies targeting adults at moderate to high risk of H. pylori-induced dis-ease is likely to be cost-effective for preventing digestive diseases responsible for a large global disease burden. Little is known, however, about health benefits to children from eliminating this infection. We conducted a systematic review of the evidence regarding health benefits to children from treatment to eliminate H. pylori infection.