Michal Kori1, Thu Giang Le Thi2, Katharina Werkstetter2, Andrea Sustmann2, Patrick Bontems3, Ana Isabel Lopes4, Monica Oleastro5, Barbara Iwanczak6, Nicolas Kalach7, Zrinjka Misak8, José Cabral9, Matjaž Homan9, Maria Luz Cilleruelo Pascual10, Ender Pehlivanoglu11, Thomas Casswall12, Pedro Urruzuno13, Maria José Martinez Gomez14, Alexandra Papadopoulou15, Eleftheria Roma16, Jernej Dolinsek17, Maria Rogalidou18, Vaidotas Urbonas19, Sonny Chong20, Angelika Kindermann21, Erasmo Miele22, Francesca Rea23, Áron Cseh24, Sibylle Koletzko1,2. 1. Pediatric Gastroenterology, Kaplan Medical Centre, Rehovot, Israel. 2. Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum of the Universtiy Munich, Munich, Germany. 3. Université Libre de Bruxelles, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium. 4. Pediatrics Department, Gastroenterology Unit, Hospital Santa Maria, Medical Faculty, University of Lisbon. 5. Department of Infectious Diseases, National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal. 6. Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Wroclaw, Poland. 7. Saint Antoine Pediatric clinic, Saint Vincent de Paul Hospital, Catholic University, Lille-France. 8. Referral Centre for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia. 9. Pediatric Gastroenterology Unit, Dona Estefânia Hospital, University Hospital Centre of Central Lisbon, Lisbon, Portugal. 10. Department of Gastroenterology, Hepatology, and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. 11. Pediatrics Department, Gastroenterology Unit, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain. 12. Department of Child health & development, Istanbul Kent University, Turkey. 13. Pediatric Gastroenterology, Hepatology and Nutrition, Karolinska University Hospital and Clintec, Karolinska Institutet, Stockholm, Sweden. 14. Pediatric Gastroenterology Unit. Hospital 12 de Octubre. 15. Gastroenterology and Nutrition Department, Niño Jesús University Children Hospital, Madrid, Spain. 16. Division of Pediatric Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Athens Children's Hospital "Agia Sofia", Athens, Greece. 17. University Medical Centre Maribor, Department of Pediatrics, Gastroenterology, Hepatology and Nutrition Unit, Medical Faculty, Department of Pediatrics, University of Maribor, Maribor, Slovenia. 18. Pediatrics Department & Pediatric Gastroenterology, University Hospital of Ioannina, Greece. 19. Clinic of Children's Diseases of Vilnius University Faculty of Medicine, Vilnius, Lithuania. 20. Queen Mary Hospital for Children, Epsom & St Helier NHS Trust, Carshalton, Surrey, UK. 21. Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 22. Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Italy. 23. Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy. 24. First Department of Pediatrics, Semmelweis University, Budapest, Hungary.
Abstract
OBJECTIVES: The aim of the study was to assess clinical presentation, endoscopic findings, antibiotic susceptibility and treatment success of Helicobacter pylori (H. pylori) infected pediatric patients. METHODS: Between 2013 and 2016, 23 pediatric hospitals from 17 countries prospectively submitted data on consecutive H. pylori-infected (culture positive) patients to the EuroPedHP-Registry. RESULTS: Of 1333 patients recruited (55.1% girls, median age 12.6 years), 1168 (87.6%) were therapy naïve (group A) and 165 (12.4%) had failed treatment (group B). Patients resided in North/Western (29.6%), Southern (34.1%) and Eastern Europe (23.0%), or Israel/Turkey (13.4%). Main indications for endoscopy were abdominal pain or dyspepsia (81.2%, 1078/1328). Antral nodularity was reported in 77.8% (1031/1326) of patients, gastric or duodenal ulcers and erosions in 5.1% and 12.8%, respectively. Primary resistance to clarithromycin (CLA) and metronidazole (MET) occurred in 25% and 21%, respectively, and increased after failed therapy. Bacterial strains were fully susceptible in 60.5% of group A, but in only 27.4% of group B. Primary CLA resistance was higher in Southern and Eastern Europe (adjusted odds ratio [ORadj] = 3.44, 95% confidence interval [CI] 2.22-5.32, P < 0.001 and 2.62, 95% CI: 1.63-4.22, P < 0.001, respectively) compared with Northern/Western Europe. Children born outside Europe showed higher primary MET resistance (ORadj = 3.81, 95% CI: 2.25-6.45, P < 0.001). Treatment success in group A reached only 79.8% (568/712) with 7 to 14 days triple therapy tailored to antibiotic susceptibility. CONCLUSIONS: Peptic ulcers are rare in dyspeptic H. pylori-infected children. Primary resistance to CLA and MET is markedly dependent on geographical regions of birth and residence. The ongoing survey will show whether implementation of the updated ESPGHAN/NASPGHAN guidelines will improve the eradication success.
OBJECTIVES: The aim of the study was to assess clinical presentation, endoscopic findings, antibiotic susceptibility and treatment success of Helicobacter pylori (H. pylori) infected pediatric patients. METHODS: Between 2013 and 2016, 23 pediatric hospitals from 17 countries prospectively submitted data on consecutive H. pylori-infected (culture positive) patients to the EuroPedHP-Registry. RESULTS: Of 1333 patients recruited (55.1% girls, median age 12.6 years), 1168 (87.6%) were therapy naïve (group A) and 165 (12.4%) had failed treatment (group B). Patients resided in North/Western (29.6%), Southern (34.1%) and Eastern Europe (23.0%), or Israel/Turkey (13.4%). Main indications for endoscopy were abdominal pain or dyspepsia (81.2%, 1078/1328). Antral nodularity was reported in 77.8% (1031/1326) of patients, gastric or duodenal ulcers and erosions in 5.1% and 12.8%, respectively. Primary resistance to clarithromycin (CLA) and metronidazole (MET) occurred in 25% and 21%, respectively, and increased after failed therapy. Bacterial strains were fully susceptible in 60.5% of group A, but in only 27.4% of group B. Primary CLA resistance was higher in Southern and Eastern Europe (adjusted odds ratio [ORadj] = 3.44, 95% confidence interval [CI] 2.22-5.32, P < 0.001 and 2.62, 95% CI: 1.63-4.22, P < 0.001, respectively) compared with Northern/Western Europe. Children born outside Europe showed higher primary MET resistance (ORadj = 3.81, 95% CI: 2.25-6.45, P < 0.001). Treatment success in group A reached only 79.8% (568/712) with 7 to 14 days triple therapy tailored to antibiotic susceptibility. CONCLUSIONS:Peptic ulcers are rare in dyspeptic H. pylori-infectedchildren. Primary resistance to CLA and MET is markedly dependent on geographical regions of birth and residence. The ongoing survey will show whether implementation of the updated ESPGHAN/NASPGHAN guidelines will improve the eradication success.