Journal of Pediatric Gastroenterology and Nutrition (JPGN)Updated Joint ESPGHAN/NASPGHAN Guidelines for Management of Helicobacter pylori Infection in Children and Adolescents (2023)

✅ Major Guideline Update

The European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition updated their joint guidance for management of Helicobacter pylori infection in children and adolescents. The revised recommendations reflect declining infection prevalence, increasing antibiotic resistance, and evolving evidence regarding appropriate testing, diagnosis, and eradication strategies. Several longstanding recommendations remain unchanged, while new guidance emphasizes susceptibility-guided treatment and more selective use of diagnostic testing.

Clinical Considerations

• The guideline continues to emphasize that evaluation of gastrointestinal symptoms should focus on identifying the underlying cause rather than simply diagnosing H. pylori infection.
• Testing remains recommended for children with gastric or duodenal ulcers or erosions, with eradication therapy and confirmation of cure if infection is detected.
• Diagnostic testing is not recommended for children with functional abdominal pain or disorders of gut-brain interaction.
• Antimicrobial susceptibility testing is now strongly emphasized, including culture-based testing and molecular detection of resistance markers from gastric biopsy specimens.
• Clarithromycin-containing regimens should generally be avoided when susceptibility testing has not been performed because of increasing resistance rates.
• New recommendations advise against testing for H. pylori during evaluation of chronic immune thrombocytopenic purpura and against treatment solely to improve platelet counts.
• Children with a first-degree relative with gastric cancer may undergo noninvasive H. pylori testing.
• Routine screening is not recommended for children from racial or ethnic groups at elevated gastric cancer risk who reside in North America or Europe.
• Specific H. pylori biopsies are not recommended during evaluation of inflammatory bowel disease, celiac disease, or eosinophilic esophagitis; however, treatment may be considered when infection is found incidentally.
• Bismuth-based quadruple therapy is suggested when antimicrobial susceptibility testing is unavailable.

Practice Applications

• Avoid pediatric “test-and-treat” approaches for H. pylori infection.
• Reserve testing for guideline-supported indications, particularly ulcer disease and select high-risk situations.
• Obtain antimicrobial susceptibility information whenever feasible before selecting eradication therapy.
• Reevaluate empiric clarithromycin use in areas with significant antimicrobial resistance.
• Discuss risks and benefits of treatment when H. pylori is identified incidentally during endoscopy for another gastrointestinal condition.
• Confirm eradication after treatment using recommended noninvasive testing methods.
• Incorporate antibiotic stewardship principles into routine management decisions.