TY - JOUR
TI - Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016)
AU - Jones, N.L.
AU - Koletzko, S.
AU - Goodman, K.
AU - Bontems, P.
AU - Cadranel, S.
AU - Casswall, T.
AU - Czinn, S.
AU - Gold, B.D.
AU - Guarner, J.
AU - Elitsur, Y.
AU - Homan, M.
AU - Kalach, N.
AU - Kori, M.
AU - Madrazo, A.
AU - Megraud, F.
AU - Papadopoulou, A.
AU - Rowland, M.
JO - Journal of Pediatric Gastroenterology and Nutrition,
PY - 2017
VL - 64
TODO - 6
SP - 991-1003
PB - Lippincott Williams and Wilkins
SN - 0277-2116
TODO - 10.1097/MPG.0000000000001594
TODO - 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
TODO - 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.
ER -