Helicobacter pylori (Hp), I believe that many parents are not unfamiliar with it. During the usual work consultation, there are often families who rush into the clinic with a medical report indicating positive H. pylori (Hp), with expressions of great anxiety: How can my child have Hp infection? Is this the cause of the frequent abdominal pain? Do we need to do a gastroscopy? How should I treat this? What is HP? H. pylori is a spiral-shaped bacterium that lives in the digestive tract and adheres to the gastric mucosa, which may cause gastritis, duodenal ulcer, gastric ulcer, lymphoproliferative gastric lymphoma and gastric cancer. Hp infection is a risk factor for gastric cancer, but it is not the only factor for gastric cancer. The current status of Hp infection in children Currently, the Hp infection rate in China is 50%-60% in adults and 30%-40% in children and adolescents; especially in places where the living environment is backward, the Hp infection rate in children is higher, and the high infection rate in children and family aggregation are the most significant features of HP infection, and intra-family transmission may be the main route. The majority of Hp infections occur in childhood, mainly around the age of 5 years. HP infection in children may also present with gastric and duodenal inflammation or peptic ulcers, but statistically, the incidence of inflammatory reactions or ulcers in the gastric and duodenal mucosa of children with Hp infection is much lower than that of adults. Although Hp infection is an important cause of peptic ulcers and gastric cancer, the incidence of peptic ulcers and gastric cancer in children is lower than that in adults. Is it necessary to routinely test for HP? At present, even in regions with high incidence of gastric cancer such as China and Japan, although gastric cancer has occurred at a younger age in recent years, it takes more than a decade or even decades for precancerous diseases and precancerous lesions to progress to gastric cancer. Therefore, even in regions with a high incidence of gastric cancer, it is rare to see pre-cancerous diseases and pre-cancerous lesions such as gastric mucosal atrophy, intestinal metaplasia and atypical hyperplasia occurring in childhood, and it is entirely too late to screen for Hp and eradicate Hp after the age of 18! Moreover, Hp infection in childhood results in more lymphocytes in the stomach and more regulatory T cells, which regulate the immune response and may also benefit the development of the immune system later in the life of the infected person, and is negatively associated with the development of asthma and allergic diseases in children. There is insufficient evidence that Hp infection is associated with otitis media, periodontal disease, food allergies, idiopathic thrombocytopenic purpura, and growth retardation. The purpose of the clinical examination is to look for potential etiologies, not to detect the presence of Hp infection. There is no national or international evidence of evidence of benefit from testing for Hp in children without specific medical conditions. Therefore, both domestic and international guidelines do not recommend routine screening for Hp and routine eradication of Hp in children under 14 years of age. Indications for HP screening in children HP screening in children includes the following indications: 1. peptic ulcer; 2. lymphoma of gastric mucosa-associated lymphoid tissue; 3. chronic gastritis; 4. children with first-degree relatives with gastric cancer; 5. refractory iron deficiency anemia of unknown origin; 6. planned long-term use of nonsteroidal 6. planning to take long-term non-steroidal anti-inflammatory drugs (including low-dose aspirin). Indications for Hp eradication therapy Children requiring HP infection eradication therapy mainly include peptic ulcer, gastric MALT lymphoma must be eradicated. The following conditions can be considered for eradication: (1) chronic gastritis; (2) family history of gastric cancer; (3) unexplained refractory iron deficiency anemia; (4) planned long-term use of NSAID (including low-dose aspirin); (5) guardians, older children strongly request treatment. How can HP infection be eradicated in children? Even if Hp is eradicated in children under 10 years of age, the chances of reinfection within 1 year are much higher than in older children and adults. There is a self-clearance rate of about 10% after Hp infection in children, and it is possible that Hp will self-eliminate for a period of time after infection. Therefore, current guidelines recommend eradication only for Hp-positive patients aged 12 years or older in Japan and 14 years or older in China. The best age for Hp eradication is currently considered to be between 18 and 40 years. In children, due to their young age, their growth and development and drug metabolism, as well as their poor compliance and tolerance, the eradication effect of Hp is reduced and the possibility of Hp-resistant bacteria is increased, making Hp eradication more difficult. Children’s liver and kidney function is not fully developed, and some drugs have high side effects and are prohibited in children, such as furazolidone, quinolones and tetracyclines, and the resistance rate of commonly used drugs is high. The intestinal flora in children is unstable, and the use of antibiotics may change the intestinal microbial composition to a greater extent and adversely affect the organism. Therefore, for children with definite HP infection and considered by physicians to require eradication, individualized treatment plans for Hp eradication should be developed according to the specific situation of each child to avoid failure of eradication therapy.