Helicobacter pylori in children: modern aspects of diagnosis and treatment in the light of the latest international recommendations

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Despite the development of modern medical science, the problem of Helicobacter pylori and Helicobacter pylori-associated diseases has remained relevant in recent decades. Current research is focused on studying the role of Helicobacter pylori in the etiology and pathogenesis of various diseases and the search for optimal schemes of eradication therapy. The issues of diagnosis and treatment of Helicobacter pylori infection in childhood are the most controversial at the present stage. Therefore, the purpose of our work was to review and evaluate new approaches to the diagnosis and treatment of Helicobacter pylori, which are published in the Updated joint ESPGHAN/NASPGHAN guidelines for management of Helicobacter pylori infection in children and adolescents (2023). The unsatisfactory results of classical eradication therapy schemes, growing antibiotic resistance, and the ever-changing prevalence of Helicobacter pylori infection in children are the factors that formed the basis of the decision to update the guidelines of the European and North American Societies for Paediatric Gastroenterology, Hepatology and Nutrition. The change in views and positions in line with the evidence-based medicine set out in the Maastricht VI Consensus was the basis for the revision of the recommendations for children, which were formulated and published in the Journal of Pediatric Gastroenterology and Nutrition in May 2024. The updated consensus contains recommendations that are supported by scientific evidence and those remained unchanged, including: gastric or duodenal ulcer is still a clear and unambiguous indication for Helicobacter pylori eradication, children with functional illnesses should not be screened for Helicobacter pylori. The experts also reviewed a number of provisions and made changes to the diagnosis and treatment of Helicobacter pylori, namely testing for Helicobacter pylori is not recommended when determining the causes of chronic immune thrombocytopenic purpura and in the initial examination of patients with iron deficiency anaemia and short stature; invasive testing for Helicobacter pylori in inflammatory bowel diseases, celiac disease and eosinophilic esophagitis is not indicated as well. When prescribing treatment, sensitivity to antibacterial drugs should be considered, and if it cannot be determined, regimens with clarithromycin to be avoided. The review of the updated guidelines is aimed at familiarising practitioners with the principles of quality practice at the European level and improving the efficiency of diagnosis and treatment of Helicobacter pylori in children, taking into account regional opportunities.