H. pylori Does Not Usually Cause Symptoms in Children Without Underlying Issues: The current understanding is that H. pylori infection alone doesn't typically lead to noticeable symptoms in children unless there are pre-existing conditions like peptic ulcers (PUD) or erosions in the stomach or duodenum.
"Test and Treat" Strategy Not Recommended: Due to the above, routinely performing noninvasive tests for H. pylori infection is not advised. There's no strong scientific backing for a "test and treat" approach in children without symptoms and/or underlying conditions.
Recurrent Abdominal Pain Likely Due to DGBI: Children experiencing recurrent abdominal pain without accompanying "alarm" signs or symptoms (as categorized by Rome criteria 11) are more likely to have a Disorders of Gut-Brain Interaction (DGBI), which is not directly related to H. pylori.
H. pylori Eradication Not Helpful for Recurrent Abdominal Pain (Without Ulcers): If endoscopy reveals no ulcers or erosions in children with recurrent abdominal pain, eradicating H. pylori has not been proven to alleviate symptoms. Therefore, H. pylori treatment in this scenario is not favored over standard care for DGBI.
Avoid Unnecessary Testing in DGBI Cases: Routine noninvasive H. pylori testing in children with suspected DGBI should be avoided. A positive result can lead to undue anxiety for the child and family, and may prompt an unneeded endoscopy.
Biopsies Should Be Taken During Endoscopy with Visible Issues: When erosions, ulcers, or scarring are observed during an upper endoscopy, biopsies are recommended to identify the presence of H. pylori.
H. pylori is Treatable but Not Only Cause: H. pylori is only one of several possible reasons for erosions, ulceration in children. While it is a treatable condition, it is not the sole underlying cause of such gastrointestinal issues in kids.
H. pylori Eradication Prevents Ulcer Recurrence: If H. pylori is present and treated, it can help prevent ulcer recurrence in children.
Biopsies Should Guide Treatment: When performing endoscopy, biopsies for H. pylori diagnosis should only be done if the plan is to treat the infection upon confirmation. There is no need to biopsy for H. pylori if you are not going to treat.
Detailed Breakdown:
No Routine Testing:
The central point is that simply having H. pylori infection doesn't mean a child will experience symptoms.
Noninvasive tests are deemed unnecessary if PUD or erosions aren't present.
This contradicts a "find and eradicate" approach, suggesting that overtreatment may occur using that method.
DGBI and H. Pylori:
Children with non-alarm abdominal pain more often have DGBI.
The cause of DGBI is independent of H. pylori presence.
Eradication is NOT Standard Care for Recurrent Abdominal Pain:
It’s crucial to understand that if no damage (ulcers, erosions) is visible on endoscopy, clearing H. pylori is not a standard recommendation.
The treatment is not shown to improve symptoms.
Avoid Anxiety with Testing:
Testing for H. pylori in children suspected to have DGBI is not generally recommended due to the possibility of anxiety and more medical procedures.
The recommendation implies a “do no harm” approach and consideration of cost/benefit.
Biopsy when Problems are Seen:
Biopsies during an upper endoscopy are important if erosions, ulcers, or scarring are present.
These are key for diagnosing H. pylori in a patient that may require treatment.
Treatable and a Common Cause:
H. pylori is noted to be only one of multiple possibilities causing erosions/ulcerations in children.
Eradicating H. pylori can treat these conditions and prevent future ulceration.
Diagnosis Should Lead to Action:
Biopsy for diagnosis of H. pylori is unnecessary if treatment is not going to follow.
There is no point in diagnosis unless a treatment is going to be offered.
"Test and Treat" Strategy Not Recommended: Due to the above, routinely performing noninvasive tests for H. pylori infection is not advised. There's no strong scientific backing for a "test and treat" approach in children without symptoms and/or underlying conditions.
Recurrent Abdominal Pain Likely Due to DGBI: Children experiencing recurrent abdominal pain without accompanying "alarm" signs or symptoms (as categorized by Rome criteria 11) are more likely to have a Disorders of Gut-Brain Interaction (DGBI), which is not directly related to H. pylori.
H. pylori Eradication Not Helpful for Recurrent Abdominal Pain (Without Ulcers): If endoscopy reveals no ulcers or erosions in children with recurrent abdominal pain, eradicating H. pylori has not been proven to alleviate symptoms. Therefore, H. pylori treatment in this scenario is not favored over standard care for DGBI.
Avoid Unnecessary Testing in DGBI Cases: Routine noninvasive H. pylori testing in children with suspected DGBI should be avoided. A positive result can lead to undue anxiety for the child and family, and may prompt an unneeded endoscopy.
Biopsies Should Be Taken During Endoscopy with Visible Issues: When erosions, ulcers, or scarring are observed during an upper endoscopy, biopsies are recommended to identify the presence of H. pylori.
H. pylori is Treatable but Not Only Cause: H. pylori is only one of several possible reasons for erosions, ulceration in children. While it is a treatable condition, it is not the sole underlying cause of such gastrointestinal issues in kids.
H. pylori Eradication Prevents Ulcer Recurrence: If H. pylori is present and treated, it can help prevent ulcer recurrence in children.
Biopsies Should Guide Treatment: When performing endoscopy, biopsies for H. pylori diagnosis should only be done if the plan is to treat the infection upon confirmation. There is no need to biopsy for H. pylori if you are not going to treat.
Detailed Breakdown:
No Routine Testing:
The central point is that simply having H. pylori infection doesn't mean a child will experience symptoms.
Noninvasive tests are deemed unnecessary if PUD or erosions aren't present.
This contradicts a "find and eradicate" approach, suggesting that overtreatment may occur using that method.
DGBI and H. Pylori:
Children with non-alarm abdominal pain more often have DGBI.
The cause of DGBI is independent of H. pylori presence.
Eradication is NOT Standard Care for Recurrent Abdominal Pain:
It’s crucial to understand that if no damage (ulcers, erosions) is visible on endoscopy, clearing H. pylori is not a standard recommendation.
The treatment is not shown to improve symptoms.
Avoid Anxiety with Testing:
Testing for H. pylori in children suspected to have DGBI is not generally recommended due to the possibility of anxiety and more medical procedures.
The recommendation implies a “do no harm” approach and consideration of cost/benefit.
Biopsy when Problems are Seen:
Biopsies during an upper endoscopy are important if erosions, ulcers, or scarring are present.
These are key for diagnosing H. pylori in a patient that may require treatment.
Treatable and a Common Cause:
H. pylori is noted to be only one of multiple possibilities causing erosions/ulcerations in children.
Eradicating H. pylori can treat these conditions and prevent future ulceration.
Diagnosis Should Lead to Action:
Biopsy for diagnosis of H. pylori is unnecessary if treatment is not going to follow.
There is no point in diagnosis unless a treatment is going to be offered.