Management of Helicobacter pylori infection in children.

When trying to decide which children with Helicobacter pylori infection should be treated and at what stage they should be tested, we should take into account the fact that eradication of the infection may be useful both to induce symptom remission and to prevent later complications in adulthood. However, well designed studies to identify those infected children who are at risk of developing complications or have symptoms due to the infection are still lacking. Current literature only gives information on how to treat children with H pylori infection. Treatment regimens that include two drugs are usually more effective than in adults, and produce an eradication rate of 70-80%, but they should be given for at least two weeks, shorter treatments being less effective. Antibiotic resistance can impair eradication rate and the frequency of resistant strains in children should be studied. Combinations of antibiotics with antisecretory drugs are highly effective in adults, but triple therapy with two antibiotics and an antisecretory drug has been seldom tried in children; compliance is often poor so that the eradication rate is often similar to that produced by dual therapy. Compliance strongly influences eradication, and short simple treatment regimens that produce rapid symptom remission with few side effects are needed to optimise patient compliance. After treatment, eradication must be proved. Serological tests can help, provided that pretreatment serum is available and three to six months have passed since the treatment. A 13C-ureabreath test (13C-UBT) should be performed at least six weeks after treatment, but false negative results can occur and cut-off must be adjusted.