The Unique Aspects of H. pylori in Paediatric Gastroenterology

In this episode of The Good GP, Dr Madhur Ravikumara (Ravi), a paediatric gastroenterologist, joins host Dr Sean Stevens to discuss the topic of Helicobacter pylori (H. pylori) infection in children.  Dr Ravi explains the differences between H. pylori infection in children and adults, highlighting that most children with this infection are asymptomatic. He emphasises that there is no evidence to support treating or eradicating H. pylori in children unless they have peptic ulcer disease. Dr Ravi also discusses the low risk of complications, such as peptic ulcer disease and gastric malignancies, in children with H. pylori infection.

Dr Ravi further explains that the current paediatric guidelines strongly recommend against the test and treat strategy for H. pylori in children. He emphasises that the primary goal of investigating GI symptoms in children is to find the cause and manage it, but there is no specific clinical symptom that indicates the presence of H. pylori. Therefore, routine testing for H. pylori in children is not recommended.

The episode delves into the potential beneficial effects of H. pylori in the stomach lining, such as protection against allergic conditions like asthma, eczema, and eosinophilic esophagitis, as well as a potential inverse relationship with the development of inflammatory bowel disease. Dr Ravi highlights that while these associations do not necessarily indicate causation, experiments have shown specific benefits of H. pylori in mitigating inflammatory bowel disease.

The episode concludes with Dr Ravi addressing the question of when to treat H. pylori in children and the need for further research to determine follow-up protocols and risk factors for gastric cancer in those with H. pylori infection.

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Links & Resources: Helicobacter pylori in children: think before you kill the bug! Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016)