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J Pediatr Gastroenterol Nutr. 2017 Jun;64(6):991-1003. doi: 10.1097/MPG.0000000000001594.

Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016).

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*Division of Gastroenterology, Hepatology and Nutrition, Cell Biology Program, Sickkids Toronto, Departments of Paediatrics and Physiology, University of Toronto, Toronto, Canada†Division of Gastroenterology and Hepatology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany‡Department of Medicine and School of Public Health, Centre of Excellence for Gastrointestinal Inflammation and Immunity Research, University of Alberta, Edmonton, Alberta, Canada§Paediatric Gastroenterology Department, Hôpital Universitaire des Enfants Reine Fabiola||Department of Paediatric Gastroenterology, Queen Fabiola University Children's Hospital, Université Libre de Bruxelles, Brussels, Belgium¶Pediatric Gastroenterology, Hepatology, and Nutrition, CLINTEC, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden#Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD**Children's Center for Digestive Healthcare, LLC, Gi Care for Kids, LLC, Children's Healthcare of Atlanta††Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA‡‡Department of Pediatrics, Gastroenterology Division, Marshall University School of Medicine, Huntington, WV§§Faculty of Medicine, Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia||||Saint Antoine Pediatric Clinic, Saint Vincent de Paul Hospital, Groupement de l'Institut Catholique de Lille (GH-ICL), Catholic University, Lille, France¶¶Kaplan Medical Center, Hadassah Medical School, Hebrew University, Jerusalem, Israel##Pediatric Gastroenterology Division, Hospital de Pediatría, Centro Medico Nacional Siglo XXI, I.M.S.S. Mexico City, Mexico***Laboratoire de Bactériologie, Université de Bordeaux, Bordeaux, France†††Division of Gastroenterology, Hepatology and Nutrition, First Department of Pediatrics, University of Athens, Children's Hospital "Ag. Sofia", Athens, Greece‡‡‡School of Medicine, University College Dublin, Dublin, Ireland.



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.


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.


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.


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.

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