Helicobacter pylori Infection in Children-An Update

Abstract

The fourth meeting of the Canadian Helicobacter pylori Study Group was held in Victoria, British Columbia, Canada, on November 20-22, 1998, and focused entirely on pediatric issues of H. pylori infection. The meeting brought together a diverse group of individuals, including basic scientists, adult and pediatric gastroenterologists, epidemiologists, microbiologists and infectious disease experts, pathologists, pharmacists, family practitioners, and pediatricians to discuss the current, evidence-based state of knowledge regarding H. pylori infection in the pediatric patient. The group was then charged with the difficult task of developing a consensus opinion for a variety of clinical and research issues that pertain to H. pylori disease in pediatrics. The conference began Friday evening with comprehensive review of the pathology, epithelial cell biology, and immune responses associated with H. pylori infection. The next morning was dedicated to evidence-based presentations on the pediatric aspects of H. pylori epidemiology and suspected modes of transmission, current diagnostic tests (both available or in development), traditional and novel therapies for eradication of infection, and the current status of vaccine development. The tough work began that afternoon, when the group was divided into five topic-based workshops. The topics included the pediatric issues surrounding the immunopathophysiology, epidemiology, diagnostics, and therapeutics of H. pylori disease. In addition, one workshop focused on the issue of diseminating information and guidelines to primary care providers and pediatricians in Canada. The workshops then prepared an outline of a consensus opinion on each topic, which was presented to the whole group the next morning. The presentations led to a lively discussion. The clear "take-home" message of the meeting was that there currently are few evidence-based studies directing the clinical practice of H. pylori disease in the pediatric population. Information is lacking on issues such as who to test, what test to use, who to treat, and how to treat in pediatrics. We rely, therefore, on adult studies that have limited applicability to the pediatric population and thereby result in inappropriate or unnecessary testing and treatment of H. pylori infection in children. The end results of unsubstantiated approaches in clinical practice are increased medical costs, increased morbidity and possibly mortality, and the hastened emergence of multiple antibiotic-resistant strains of H. pylori. It will be difficult to draft consensus opinion guidelines given the lack of knowledge about H. pylori infection in children, but such guidelines can at least provide a modicum of uniformity to the clinical approach to pediatric H. pylori infection. The Canadian H. pylori Study Group should be applauded for their recognition of the need to consider the unique aspects of H. pylori disease in pediatrics and their willingness to work together as a group to develop these guidelines. The meeting was successful in bringing together clinicians and scientists interested in H. pylori and provided an environment that fostered scientific interaction and collaboration, which will undoubtedly lead to much-needed multicenter pediatric studies in the future. We look forward with anticipation to seeing the pediatric H. pylori consensus guidelines in print. Barry K. Wershil, MD The Children's Hospital, Combined Program in Pediatric Gastroenterology and Nutrition, Harvard Medical School, Boston, MA, U.S.A.