Τίτλος:
Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016)
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Jones, N.L.
Koletzko, S.
Goodman, K.
Bontems, P.
Cadranel, S.
Casswall, T.
Czinn, S.
Gold, B.D.
Guarner, J.
Elitsur, Y.
Homan, M.
Kalach, N.
Kori, M.
Madrazo, A.
Megraud, F.
Papadopoulou, A.
Rowland, M.
Περιοδικό:
Journal of Pediatric Gastroenterology and Nutrition,
Εκδότης:
Lippincott Williams and Wilkins
Λέξεις-κλειδιά:
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
DOI:
10.1097/MPG.0000000000001594
