Author(s):
Kori, M ; Le Thi, TG ; Werkstetter, K ; Sustmann, A ; Bontems, P ; Lopes, AI ; Oleastro, M ; Iwanczak, B ; Kalach, N ; Misak, Z ; Cabral, J ; Homan, M ; Cilleruelo Pascual, ML ; Pehlivanoglu, E ; Casswall, T ; Urruzuno, P ; Martinez Gomez, MJ ; Papadopoulou, A ; Roma, E ; Dolinsek, J ; Rogalidou, M ; Urbonas, V ; Chong, S ; Kindermann, A ; Miele, E ; Rea, F ; Cseh, A ; Koletzko, S
Date: 2020
Persistent ID: http://hdl.handle.net/10400.17/3749
Origin: Repositório do Centro Hospitalar de Lisboa Central, EPE
Subject(s): Amoxicillin; Anti-Bacterial Agents; Child; Clarithromycin; Drug Therapy, Combination; Europe; Female; Humans; Israel; Male; Metronidazole; Registries; Turkey; Helicobacter Infections; Helicobacter pylori; HDE GAS PED
Description
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.
