@article{3108634,
    title = "Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016)",
    author = "Jones, N.L. and Koletzko, S. and Goodman, K. and Bontems, P. and Cadranel, S. and Casswall, T. and Czinn, S. and Gold, B.D. and Guarner, J. and Elitsur, Y. and Homan, M. and Kalach, N. and Kori, M. and Madrazo, A. and Megraud, F. and Papadopoulou, A. and Rowland, M.",
    journal = "Journal of Pediatric Gastroenterology and Nutrition,",
    year = "2017",
    volume = "64",
    number = "6",
    pages = "991-1003",
    publisher = "Lippincott Williams and Wilkins",
    issn = "0277-2116",
    doi = "10.1097/MPG.0000000000001594",
    keywords = "amoxicillin;  bismuth;  clarithromycin;  levofloxacin;  metronidazole;  proton pump inhibitor;  tetracycline;  antacid agent;  antiinfective agent;  proton pump inhibitor, abdominal pain;  adolescent;  antibiotic sensitivity;  antibiotic therapy;  child;  consensus;  Delphi study;  diagnostic test;  drug megadose;  eradication therapy;  gastrointestinal symptom;  health care cost;  Helicobacter infection;  Helicobacter pylori;  human;  invasive procedure;  nonhuman;  polypharmacy;  practice guideline;  priority journal;  randomized controlled trial (topic);  Review;  stomach biopsy;  systematic review;  treatment failure;  upper gastrointestinal tract;  antibiotic resistance;  combination drug therapy;  consensus development;  drug administration;  Helicobacter infection;  isolation and purification;  practice guideline, Adolescent;  Antacids;  Anti-Bacterial Agents;  Child;  Delphi Technique;  Drug Administration Schedule;  Drug Resistance, Bacterial;  Drug Therapy, Combination;  Helicobacter Infections;  Helicobacter pylori;  Humans;  Proton Pump Inhibitors",
    abstract = "Background: Because of the changing epidemiology of Helicobacter pylori infection and low efficacy of currently recommended therapies, an update of the European Society for Paediatric Gastroenterology Hepatology and Nutrition/North American Society for Pediatric Gastroenterology, Hepatology and Nutrition recommendations for the diagnosis and management of H pylori infection in children and adolescents is required. Methods: A systematic review of the literature (time period: 2009-2014) was performed. Representatives of both societies evaluated the quality of evidence using GRADE (Grading of Recommendation Assessment, Development, and Evaluation) to formulate recommendations, which were voted upon and finalized using a Delphi process and face-To-face meeting. Results: The consensus group recommended that invasive diagnostic testing for H pylori be performed only when treatment will be offered if tests are positive. To reach the aim of a 90% eradication rate with initial therapy, antibiotics should be tailored according to susceptibility testing. Therapy should be administered for 14 days, emphasizing strict adherence. Clarithromycin-containing regimens should be restricted to children infected with susceptible strains. When antibiotic susceptibility profiles are not known, high-dose triple therapy with proton pump inhibitor, amoxicillin, and metronidazole for 14 days or bismuth-based quadruple therapy is recommended. Success of therapy should be monitored after 4 to 8 weeks by reliable noninvasive tests. Conclusions: The primary goal of clinical investigation is to identify the cause of upper gastrointestinal symptoms rather than H pylori infection. Therefore, we recommend against a test and treat strategy. Decreasing eradication rates with previously recommended treatments call for changes to first-line therapies and broader availability of culture or molecular-based testing to tailor treatment to the individual child. Copyright © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition."
}