I. About Hp
1.Indications for Hp detection
(1) Peptic ulcer.
(2) Lymphoma of gastric mucosa-associated lymphoid tissue.
(3) Chronic gastritis.
(4) Children with gastric cancer in first-degree relatives.
(5) Refractory iron deficiency anemia of unknown origin.
(6) Long-term use of non-steroidal anti-inflammatory drugs (including low-dose aspirin) is planned.
(7) Routine testing is not recommended: 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 an underlying cause, not to detect the presence of Hp infection. Therefore, Hp testing is not recommended for children with functional abdominal pain.
2. What are the characteristics of various Hp testing methods?
Testing methods include invasive and non-invasive methods. Invasive methods rely on gastroscopy and gastric mucosal tissue biopsy, including rapid urease test, staining of gastric mucosal tissue sections and gastric mucosal Hp culture, nucleic acid detection, etc. Non-invasive methods include urea breath test, fecal Hp antigen test and serum Hp antibody test. Except for serum antibody test, proton pump inhibitors should be stopped for 2 weeks, antibiotics and bismuth for 4 weeks before all other tests.
3.Diagnosis of Hp infection
One of the following four items can be judged as Hp presenting infection.
(1) Positive bacterial culture.
(2) Histopathological examination and RUT are positive.
(3) If histopathological examination and RUT results are inconsistent, further non-invasive testing, such as UBT or SAT, is required.
(4) In the case of bleeding peptic ulcer, positive for either pathological histology or RUT.
II. Treatment of Hp infection in children
1. Indications for Hp infection eradication therapy
Peptic ulcer and gastric MALT lymphoma must be eradicated. Eradication can be considered in the following cases.
(1) chronic gastritis.
(2) Family history of gastric cancer.
(3) Refractory iron deficiency anemia of unknown origin.
(4) Planned long-term use of NSAIDs (including low-dose aspirin).
(5) Strong demand for treatment from guardians, older children.
2, Hp infection eradication treatment
(1) Common drugs used to eradicate Hp.
(1) antibiotics.
②Bismuth agent.
③Anti-acid secretion drugs.
(2) Treatment options for Hp eradication.
①First-line regimen (preferred regimen): for areas with low rate of clarithromycin resistance (<20%), the regimen is: PPI + clarithromycin + amoxicillin for 10 or 14 d.
② Second-line regimen: for those who failed in the first-line regimen, PPI + amoxicillin + metronidazole (or tinidazole) + colloidal bismuth subcitrate or concomitant therapy (PPI + clarithromycin + amoxicillin + metronidazole) for 10 or 14 d.
3.Individualized treatment for Hp eradication: Individualized treatment is to analyze the reasons for failure and propose treatment for children who have failed Hp eradication treatment.
4, adjuvant therapy for Hp eradication: The consensus and Meta-analysis of Hp in adults at home and abroad point out that the combined application of microecological agents can assist in the treatment of Hp infection, reduce the adverse reactions in the process of Hp eradication and improve patient compliance.
5. Judgment of the efficacy of Hp eradication: it should be performed at least 4 weeks after the end of eradication treatment, and it is recommended to review even if the child’s symptoms disappear, and urea breath test is preferred.