To the Editor: Last year, LASPGHAN convened a working group to analyze the latest joint Helicobacter pylori NASPGHAN and ESPGHAN clinical guidelines (1) published in 2017 regarding their applicability in Latin America (LA), in particular in relation to gastric cancer prevention. After a critical analysis of the literature, with special emphasis on LA data, 2 rounds of voting according to the Delphi consensus technique to establish the “degree of agreement” among a panel of LASPGHAN experts were performed. The results and recommendations were recently published in Spanish and English (https://www.revistachilenadepediatria.cl/index.php/rchped/article/view/2579/3082) (2). We would like to increase the awareness of the gastroenterologists worldwide for local considerations in the application of the joint guidelines. We recommend taking biopsies for rapid urease and histology testing (and samples for culture or molecular techniques, whenever available) during upper endoscopy only if H pylori infection is confirmed and eradication treatment is indicated. If the susceptibility is not known, we recommend the proton pump inhibitor-amoxicillin-clarithromycin scheme for 14 days at standard doses (except in countries with resistance to CLA >20%, based on the scarce LA data available that suggest increasing CLA resistance in last few years). We recommend that selected regional centers conduct antimicrobial susceptibility studies for H pylori, and thus act as reference centers for all LA. In case of failure to eradicate H pylori with first-line treatment, we recommend empiric treatment with quadruple therapy with proton pump inhibitor, amoxicillin, metronidazole, and bismuth for 14 days. In case of eradication failure with the second-line strategy, it is recommended to provide an individualized treatment plan considering the age of the patient, the previous treatment regimen, and the antibiotic sensitivity of the strain, which implies performing a new endoscopy with biopsies for culture and antibiotic sensitivity or molecular resistance studies. In agreement to the previous 2011 ESPGHAN/NASPGHAN Guidelines (3) (later modified in the 2016 updated version), we stated that in symptomatic children referred for endoscopy, who have a history of first or second degree family members with gastric cancer, it is recommended to consider the search for H pylori by direct technique during endoscopy and eradicate it when detected. The evidence supports most of the general concepts of the NASPGHAN/ESPGHAN 2016 Guidelines, but as the 2016 guidelines themself anticipates, it is necessary to adapt them to the reality of LA, with emphasis on the development of regional centers for the study of antibiotic sensitivities and to improve appropriate selection of eradication treatment. In symptomatic children with a family history of first or second degree gastric cancer, the search for and eradication of H pylori should be considered. It is unlikely that any regional Clinical Guidelines can be implemented globally, given the diverse socioeconomic realities and given the differential impact of gastric cancer on different continents and ages. Nevertheless, the Clinical Guidelines should be continually reviewed and adapted to the available evidence. Finally, LA is a region where gastric cancer continues to be a relevant problem, and new cohort studies are needed to evaluate the impact of H pylori eradication on children and its impact on gastric cancer prevention.