Pylori Eradication In Children Research Articles

The effect of Saccharomyces boulardii supplementation on Helicobacter pylori eradication in children: a systematic review and meta-analysis of Randomized controlled trials

BackgroundIt is unclear whether Saccharomyces boulardii (S. boulardii) supplementation in standard triple therapy (STT) is effective in eradicating Helicobacter pylori (H. pylori) infection in children. We therefore conducted a meta-analysis of randomized controlled trials (RCTs) to assess the effect of S. boulardii supplementation on H. pylori eradication in children.MethodsWe conducted electronic searches in PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure and Wanfang database from the beginning up to September 2023. A random-effects model was employed to calculate the pooled relative risk (RR) with 95% confidence intervals (CI) through a meta-analysis.ResultsFifteen RCTs (involving 2156 patients) were included in our meta-analysis. Results of the meta-analysis indicated that S. boulardii in combination with STT was more effective than STT alone (intention-to-treat analysis : 87.7% vs. 75.9%, RR = 1.14, 95% CI: 1.10–1.19, P < 0.00001; per-protocol analysis : 88.5% vs. 76.3%, RR = 1.15, 95% CI: 1.10–1.19, P < 0.00001). The S. boulardii supplementation group had a significantly lower incidence of total adverse events (n = 6 RCTs, 9.2% vs. 29.2%, RR = 0.32, 95% CI: 0.21–0.48, P < 0.00001), diarrhea (n = 13 RCTs, 14.7% vs. 32.4%, RR = 0.46, 95% CI: 0.37–0.56, P < 0.00001), and nausea (n = 11 RCTs, 12.7% vs. 21.3%, RR = 0.53, 95% CI: 0.40–0.72, P < 0.0001) than STT group alone. Similar results were also observed in the incidence of vomiting, constipation, abdominal pain, abdominal distention, epigastric discomfort, poor appetite and stomatitis.ConclusionsCurrent evidence indicated that S. boulardii supplementing with STT could improve the eradication rate of H. pylori, and concurrently decrease the incidence of total adverse events and gastrointestinal adverse events in children.

Primary Antibiotic Resistance And Effectiveness Of Clarithromycin Vs Metronidazole Based Therapy For Helicobacter Pylori Infection In Children.

NASPGHAN guidelines recommend regional antibiotic susceptibility profiling for H. pylori eradication treatment. Profiling local antibiotic resistance patterns is mandatory for successful H. pylori eradication in children. The aim of our study was to determine primary resistance to Clarithromycin and Metronidazole, most commonly used in the eradication regimens in children presenting with symptomatic H. pylori infection. This study was conducted at Children Hospital PIMS Islamabad from June 2020 to August 2021. The children of either gender age 2-14 years having symptomatic H. pylori infection (hematemesis, chronic abdominal pain) underwent stool for H. pylori Antigen. Children requiring urgent diagnostic endoscopy underwent rapid urease tests. Biopsies were taken from children having positive stool H. pylori Ag and rapid urease test for histological examination. The biopsy specimens were cultured and subsequently tested for antibiotic sensitivity. Out of 54 children having H. pylori infection 40/54 (74.074%) children had strains susceptible to antimicrobials and 14/54 (25.92%) were having resistance to antimicrobials. According to the pattern of antimicrobial sensitivity, they were further grouped into three (a) Clarithromycin and Metronidazole sensitive group (18/40, 45%) (b) Clarithromycin sensitive and Metronidazole resistant group (12/40, 30%) (c) Metronidazole sensitive group (10/40 25%). Clarithromycin and Metronidazole cannot be used as1stline treatment for H. pylori eradication in children and can only be used with known antimicrobial susceptibility.

Comparison of the Different Protocols for the Eradication of Pediatric Helicobacter Pylori Infection in Iran

Background Helicobacter pylori has become very important recently due to infecting around 50% of the population worldwide. This infection can cause peptic ulcer disease and gastric cancer. This study aimed to evaluate the efficacy of common triple treatment, sequential treatment, and other regimens for Helicobacter pylori eradication in children. Materials and Methods: In this retrospective cohort study, 40 children who were diagnosed with Helicobacter pylori infection by endoscopic and pathologic features in the Children’s Medical Center of Tehran, Iran, in 2018 were included. The questionnaire was completed by telephone interview. Types of protocols include triple therapy (proton pump inhibitors with clarithromycin and amoxicillin or metronidazole for 2 weeks), sequential therapy (proton pump inhibitors with amoxicillin for 5 days followed by proton pump inhibitors with clarithromycin and metronidazole for 5 days), and other treatments (every protocol except triple and sequential regimens). At the end, we compared the efficacy of the different protocols for eradicating this infection by urea breath test or stool antigen test 8 weeks after therapy. Results: The age of patients with and without successful eradication was 8.12 and 7.8 years, respectively (p=0.8). There was no significant difference between both sexes (p=0.999) in the frequencies of eradication. The eradication rate of Helicobacter pylori was 95.5% in sequential therapy, 100% in conventional triple therapy, and 87.5%in other regimens. There was no significant difference between different protocols (p=0.422). Conclusion Determining first-line treatment for eradicating Helicobacter pylori infection is important to increase treatment success and reduce rate of secondary antimicrobial resistance. Our study showed that sequential treatment is as effective as conventional treatment in eradication of this infection in children.

Antibiotic Resistance of Helicobacter pylori Strains Isolated From Pediatric Patients in Southwest China.

The number of antibiotics that are appropriate for Helicobacter pylori eradication in children is limited. Profiling regional or population-specific antibiotic resistance is essential in guiding the H. pylori eradication treatment in children. The aim of this study was to evaluate the antibiotic resistance in H. pylori strains isolated from children and adolescents in Southwest China. Gastric biopsies from 157 pediatric patients with or without previous H. pylori eradication treatment were collected for H. pylori culture. Susceptibility to amoxicillin (AML), clarithromycin (CLR), metronidazole (MTZ), levofloxacin (LEV), tetracycline (TET), furazolidone (FZD), and rifampicin (RIF) was determined by E-test or a disk diffusion assay. A total of 87 patients from three ethnic groups (Han/Tibetan/Yi) were H. pylori culture positive (55.4%). The overall resistance rates were 55.2% for CLR, 71.3% for MTZ, 60.9% for RIF, and 18.4% for LEV. No isolate was found to be resistant to AML, TET, and FZD. Among the 53 treatment-naïve pediatric patients, primary resistance rates to clarithromycin, metronidazole, levofloxacin, and rifampicin were 45.3, 73.6, 15.1, and 60.4%, respectively. Among the 34 treatment-experienced patients, secondary resistance rates to clarithromycin, metronidazole, levofloxacin, and rifampicin were 70.6, 67.6, 23.5, and 61.8%, respectively. Isolates exhibiting simultaneous resistance to clarithromycin and metronidazole were 28.3 and 52.9% among the treatment-naïve and treatment-experienced patients, respectively. In conclusion, among pediatric patients in Southwest China, resistance rates were high for clarithromycin, metronidazole, levofloxacin, and rifampicin, whereas nil resistance was found to amoxicillin, tetracycline, and furazolidone. Our data suggest that the standard clarithromycin-based triple therapy should be abandoned as empiric therapy, whereas the bismuth quadruple therapy (bismuth/PPI/amoxicillin/tetracycline) would be suitable as first-line empiric treatment regimen for this pediatric population. Tetracycline and furazolidone may be considered for treating refractory H. pylori infections in adolescent patients.

Gastric microbiota and probiotics opportunities in helicobacter pylori eradication in children

Gastric microbiota and probiotics opportunities in helicobacter pylori eradication in children

Impact of Helicobacter pylori Eradication in Children with Acute Immune Thrombocytopenia: A Randomized Controlled Study

Background: At present, some evidence supports the role of Helicobacter pylori eradication in treating childhood immune thrombocytopenia (ITP). Objectives: This study was designed to investigate the association between H. pylori eradication and platelet count in children with acute ITP. Methods: Thirty children with a diagnosis of acute ITP and H. pylori infection were studied. This randomized and controlled study was done in Amir-Kabir Hospital, Arak, Iran. Patients were randomly allocated 1:1 to standard ITP and H. pylori treatments or standard ITP treatment. For 6 months, studied subjects had monthly follow-ups. Results: The mean ± standard deviation (SD) age was 11 years with a majority of females (67.9 % vs. 32.1 %). The mean platelet count was 16.93 ± 10.1 (109/L) in the ITP and H. pylori therapy group, and15.0 ± 3.8 (109/L) in the ITP therapy group at the baseline. After 1 week of treatment, mean platelet counts increased to 136.5 ± 55.20 and 124.0 ± 45.70 in the two groups, respectively (109/L). The differences between the two groups were not statistically significant at other time intervals. Children that received ITP and H. pylori therapies had a higher rate of gastrointestinal symptoms (P < 0.01). Conclusions: Our findings suggest that H. pylori eradication did not significantly affect the platelet count compared to standard ITP therapy in children with acute ITP.

Helicobacter pylori Infection and Children's Growth: An Overview.

Helicobacter pylori infection is acquired in early childhood, yet its role in children's health is still not fully clear. In this narrative review, we focused on the association between H pylori infection and children's growth. A literature search of the Ovid MEDLINE (till June 2015) and EMBASE (till August 2015) databases was performed using the terms "Helicobacter pylori, growth, body height, growth disorders and child development." Original studies that addressed the association between H pylori infection or eradication and children's growth were reviewed and the risk of bias of each study was assessed. The existing evidence is based on observational studies (N = 48) and suggests that H pylori infection may adversely influence children's growth; findings were more consistent across studies with low risk of bias. Regarding linear growth, observational studies have repeatedly linked between H pylori infection and slower or diminished linear growth; yet, it is not known whether this association is causal. The association between H pylori infection and ponderal growth has been less consistent. Scarce evidence exists on the effect of H pylori eradication on children's skeletal growth and weight gain, but there is an indication that H pylori eradication may benefit nutritional status. H pylori infection may impair children's growth. Additional studies, especially clinical trials, are needed to elucidate the role of H pylori eradication in children's growth, and the mechanisms that may be involved in such.

Saccharomyces Boulardii in Helicobacter Pylori Eradication in Children: A Randomized Trial From Iran.

Background:Helicobacter pylori infects around 50% of the human population and is asymptomatic in 70% of the cases. H. pylori eradication in childhood will not only result in peptic symptoms relief, but will also prevent late-term complications such as cancer. Today, probiotics are being increasingly studied in the treatment of gastrointestinal infections as an alternative or complement to antibiotics.Objectives:In this study we aimed to assess the effect of S. boulardii supplementation on H. pylori eradication among children in our region.Patients and Methods:In this randomized double-blind placebo-controlled clinical trial 28 asymptomatic primary school children with a positive H. pylori stool antigen (HpSA) exam were randomly allocated into the study group, receiving Saccharomyces boulardii, and the control group receiving placebo capsules matched by shape and size, for one month. The children were followed up weekly and were reinvestigated four to eight weeks after accomplished treatment by HpSA testing. The significance level was set at P < 0.05.Results:24 children completed the study. The mean HpSA reduced from 0.40 ± 0.32 to 0.21 ± 0.27 in the study group, indicating a significant difference (P = 0.005). However, such difference was not observed in the control group (P = 0.89). Moreover, the HpSA titer showed a 0.019 ± 0.19 decrease in the study group whereas the same value was 0.0048 ± 0.12 for the controls, again stating a significant difference (P = 0.01).Conclusions:Saccharomyces boulardii has a positive effect on reducing the colonization of H. pylori in the human gastrointestinal system but is not capable of its eradication when used as single therapy.

Sequential Therapy is Superior to Triple Therapy for Helicobacter pylori Infection in Children: A Meta-Analysis.

To assess the efficacy and safety of 10-d sequential therapy compared to 5 to 14-d triple therapy for treating Helicobacter pylori infections in children according to the eradication rates. The Cochrane Library, MEDLINE, EMBASE, China National Knowledge Infrastructure databases, and other sources were searched in November 2014 without language restrictions. Randomized controlled trials (RCTs) that compared sequential therapy with triple therapy for H. pylori eradication in children were included. Dichotomous data were pooled to obtain the relative risk (RR) of the eradication rate with a 95% confidence interval (CI). Fourteen RCTs with 1698 participants (718 and 980 for sequential and triple therapy, respectively) were included. The intention-to-treat eradication rates were 73% (95% CI: 70-76) and 66% (95% CI: 64-70) for sequential and triple therapy, respectively. The pooled RR was 1.16 (95% CI: 1.09-1.23), resulting in a number needed to treat of 16 (95% CI: 10-48), favoring sequential therapy. Sequential therapy was superior to 7- and 10-d triple therapy. Sequential and triple therapy did not differ significantly in the overall risk of adverse effects. In children, sequential therapy appears to be superior to triple therapy for H. pylori eradication, although the eradication rates remain lower than the expected goal with both treatments. Factors-associated with a higher risk of eradication failure, such as compliance and antimicrobial resistance, remain insufficiently investigated. Therefore, further high-quality RCTs are needed to compare these different eradication treatment approaches.

Sequential (as Opposed to Simultaneous) Antibiotic Therapy Improves Helicobacter pylori Eradication in the Pediatric Population: A Meta-Analysis.

Helicobacter pylori is a common infection associated with many gastrointestinal diseases. Triple or quadruple therapy is the current recommendation for H pylori eradication in children but is associated with success rates as low as 50%. Recent studies have demonstrated that a 10-day sequential therapy regimen, rather than simultaneous antibiotic administration, achieved eradication rates of nearly 95%. This meta-analysis found that sequential therapy increased eradication rates by 14.2% (relative risk [RR] = 1.142; 95% confidence interval [CI] = 1.082-1.207; P < .001). Ten-day sequential therapy significantly improved H pylori eradication rates compared to the 7-day standard therapy (RR = 1.182; 95% CI = 1.102-1.269; p < .001) and 10-day standard therapy (RR = 1.179; 95% CI = 1.074-1.295; P = .001), but had lower eradication rates compared to 14-day standard therapy (RR = 0.926; 95% CI = 0.811-1.059; P = .261). The use of sequential therapy is associated with increased H pylori eradication rates in children compared to standard therapy of equal or shorter duration.

The effects of probiotics on treatment of Helicobacter pylori eradication in children.

Objectives:To investigate the eradication rates and side effects of probiotics added in standard triple therapy for the treatment of Helicobacter pylori (H. pylori).Methods:A prospective open study was performed in the outpatient clinics of the Department of Pediatric Gastroenterology, School of Medicine, Suleyman Demirel University, Isparta, Turkey between March 2012 and May 2013. Sixty-one symptomatic children (range 7-18 years) with H. pylori infection were randomized to 2 groups: group 1 received standard triple therapy (lansoprazole, amoxicillin, and clarithromycin for 14 days), group 2 received the standard triple therapy plus probiotics (Lactobacillus casei, Lactobacillus acidophilus, and Bifidobacterium lactis). Side effects of the drugs were recorded. The 14C-urea breath test was performed for 6 weeks after discontinuation of the therapy.Results:Helicobacter pylori infection was detected in 61 of 95 (64.2%) children. Fifty-six patients (38 girls and 18 boys) completed the study. Their mean age was 13.9 ± 2.7 years. Helicobacter pylori eradication rate was 68.9% in group 1, and 66.6% in group 2 (p=0.78). No statistically significant difference was observed between the 2 groups in terms of side effects.Conclusion:We found no evidence in terms of eradication of H. pylori, or impact on adverse effects obtained after the addition of probiotics to standard treatment. Larger randomized controlled investigations are needed to clearly understand the effects of probiotics on H. pylori eradication.

The Efficacy of Saccharomyces boulardii CNCM I-745 in Addition to Standard Helicobacter pylori Eradication Treatment in Children.

PurposeThis study aims to investigate Saccharomyces boulardii CNCM I-745 during Helicobacter pylori eradication in children.MethodsOne hundred ninety-four H. pylori positive children were randomized in two groups. Therapy (omeprazole+clarithromycin+amoxicillin or omeprazole+clarithromycin+metronidazole in case of penicillin allergy) was given to both groups during two weeks. In the treatment group (n: 102) S. boulardii was added to the triple therapy, while the control group (n: 92) only received triple therapy. The incidence, onset, duration and severity of diarrhea and compliance to the eradication treatment were compared. A 13C urea breath test was done 4 weeks after the end of eradication therapy in two groups of 21 patients aged 12 years and older to test the H. pylori eradication rate.ResultsIn the treatment group, diarrhea occurred in 12 cases (11.76%), starting after 6.25±1.24 days, lasting 3.17±1.08 days, and compliance to eradication treatment was 100%. In the control group, diarrhea occurred in 26 cases (28.26%), starting after 4.05±1.11 days, lasting 4.02±0.87 days, and in six cases eradication treatment was stopped prematurely (p<0.05). The 13C urea breath test showed successful H. pylori eradication in 71.4% of the patients in the treatment and in 61.9 % in the control group (not significant).ConclusionS. boulardii has a beneficial effect on the prevention and treatment of diarrhea during H. pylori eradication in children. Although S. boulardii did only slightly increase H. pylori eradication rate, compliance to eradication treatment was improved.

Sequential therapy versus standard triple therapy for Helicobacter pylori eradication in children: any advantage in clarithromycin-resistant strains?

There has been a marked decrease in the eradication rates of Helicobacter pylori infection with standard triple therapy worldwide. Hence, sequential therapy has gained attention as a promising treatment during the last few years. This study was carried out to compare the efficacy of sequential versus standard triple therapy in the context of clarithromycin (CLA) resistance. In this study, children between 3 and 18 years of age, who had documented H. pylori infection, were randomized to receive either standard triple or sequential therapy. H. pylori eradication was ascertained using the C-urea breath test 4-6 weeks after the completion of the treatment. Real-time PCR was performed on gastric biopsy samples for assessment of CLA resistance. In all, 148 children (median age: 12.18±3.51 years) were recruited randomly into the study. The intention-to-treat eradication rates were 50% (37/74) for the sequential treatment group and 52.7% (39/74) for the standard triple treatment group (P=0.87). A total of 136 children completed the study. The per-protocol eradication rates were 56% (37/66) and 55.7% (39/70) for sequential and standard triple therapy groups, respectively. CLA resistance was assessed and 113 children were included in the final analysis. Of 113 participants, 53 were in the sequential treatment group and 60 were in the standard triple treatment group. The success rates of the respective therapies (29/53=54.7% in sequential, 33/60=55% in standard therapy) were similar (P=0.98). CLA resistance was detected in 29 (25.7%) of the patients. Eradication rates with sequential therapy in CLA susceptible and resistant cases were 60.5% (23/38) and 40% (6/15), respectively (P=0.23). The corresponding figures for the standard triple treatment group were 63% (29/46) and 28.6% (4/14) (P=0.033). Although a higher eradication rate was observed in CLA-resistant cases with sequential therapy, the difference did not reach statistical significance (P=0.69). In this study, standard triple treatment failed to eradicate H. pylori infection in the majority of the children, and sequential therapy offered only a small advantage over standard triple therapy in the eradication of CLA-resistant strains.

Is Helicobacter pylori Always a "Bad Guy"?

Various clinical presentations have been ascribed to Helicobacter (H.) pylori. Most importantly, H. pylori is considered the leading cause of gastric cancer worldwide and because of that, in adult population, it is listed as a number one carcinogen. However, children are less prone to develop H. pylori related serious diseases such as peptic ulcer disease (PUD) and cases of malignancy are only sporadically reported. On the other hand, there is an increasing level of evidence suggesting that H. pylori in children could also have a beneficial effect. Recently, several data confirmed previously described inverse relationship of H. pylori infection and gastroesophageal reflux disease. Furthermore, it has been hypothesized that an increased prevalence of allergic diseases could be, at least partially, explained by the decreased incidence of H. pylori infection. H. pylori can, to some degree, influence immunological response. It has an ability to promote high proinflammatory cytokine expression in the gastric mucosa shifting immunity towards Th1 response, which could be a plausible explanation for the down-regulated clinical expression of allergies (including asthma) in patients with H. pylori gastritis. Based on these findings the aim of this review is to present "pros and cons" for H. pylori eradication in children.

Analysis of the efficiency of using different triple-therapy schemes of helicobacter pylori eradication in children with destructive changes of the duodenal mucosa

The study was conducted in the gastroenterological department of Donetsk City Children Clinical Hospital No. 1. The study involved 120 children aged 12-17 years old with erosive and ulcerative changes in the duodenal mucosa on the background of Helicobacter pylori persistence. All patients were divided into four groups of comparison. Patients of group I received omeprazole + amoxicillin + nifuratel, group II – amoxicillin + clarithromycin + colloidal bismuth subcitrate, group III – omeprazole + clarithromycin + nifuratel, group IV – omeprazole + clarithromycin + amoxicillin. The efficiency of different methods of Helicobacter pylori eradication in children with duodenal ulcer and erosive bulbitis has been studied. None of the schemes of anti-HP therapy used allows to achieve Helicobacter pylori elimination in 100% of the cases in children with destructive changes of duodenal mucosa. It has been found that the combination of clarithromycin and amoxicillin with omeprazole or colloidal bismuth subcitrate allows to achieve eradication of Helicobacter pylori in 80% of cases in children with erosive and ulcerative changes in the duodenal mucosa. It is necessary to develop new, combined, more effective schemes for the treatment of erosive-ulcerative changes in the duodenal mucosa, which would be available and safe for application in pediatric practice.

Ornidazole-based sequential therapy is not effective in Helicobacter pylori eradication in children

Sequential therapy is one of the recent answers given to the problem of increasing antibiotic resistance and decreasing eradication rates of Helicobacter pylori infection. The aim of this study is to compare the ornidazole-based sequentialtherapy with the standard triple therapy in Helicobacter pylori eradication. Children aged 4-18 years diagnosed with Helicobacter pylori infection based on histology and at least one of 13 C urea breath test and rapid urease test positivity were included in the study. Children were randomized to standard triple therapy with amoxicillin, clarithromycin, and lansoprazole for 14 days and sequential therapy with amoxicillin and lansoprazole for the first 5 days and clarithromycin, ornidazole and lansoprazole for another 5 days in 2:3 randomization. At the end of the treatment, families were contacted by phone, and side effects of and the compliance to the treatment were noted. Patients were requested to do 13 C urea breath test 6-8 weeks after the treatment. Sixty-one children were included for the final analysis. Per-protocol eradication rates were 48.6% for sequential therapy group and 54.2% for standard triple therapy group. Intention to treat eradication rates were 40.9% and 46.0%, respectively. There were no differences between eradication rates in the two study groups. Side effect rates were also similar between the two groups. Ornidazole-based sequential therapy did not show any superiority compared to the standard triple treatment in children with Helicobacter pylori infection.

An Adaptive Evolution of Helicobacter pylori: Role of the CagA Presence in the Outcome of H. pylori Eradication in Children

Introduction: The aim of the study was to determine the evolutionary role of the Cag A presence in the outcome of eradication treatment of H. pylori. Materials and methods: Sixty-seven pediatric dyspeptic patients (mean age 13.7 years, range 5 to 17 years, male/female 24/43) underwent endoscopy for H.pylori presence. Gastric biopsy specimens were taken for histology and/or culture and one biopsy sample was used for CagA PCR determination. H. pylori positive patients were treated for 2 weeks by amoxycilline (50 mg/kg/day), bismuth subcitrate (8 mg/kg/day), nifuratel (30 mg/kg/day) plus omeprazole (1 mg/kg, once daily). Results: Forty one of 67 children (61.2%) were H. pylori positive. Nineteen of 41 strains (46.3%) were CagA positive and 22 were CagA negative (53.7%). H. pylori was eradicated in 33 patients (80.4%). Among the patients with successful eradication 18 children were CagA positive, fourteen were CagA negative. Thus, more patients with CagA-negative status had evidence of ongoing H. pylori infection (36.4% (8/22) versus 5.3% (1/19); χ2=4.08, p=0.0021; Fisher’s exact test p= 0.0238). Conclusion: In our study the carriage of CagA-lacking strain was associated with failure of treatment. In our opinion, this phenomenon, related to extraordinary genome plasticity, not only allows the microbe to maintain balanced relationship with the host, but also to survive in antibacterial therapy conditions.

Review article: bismuth‐based therapy for Helicobacter pylori eradication in children

Because of the decrease in the Helicobacter pylori eradication rate after standard triple therapy with a proton pump inhibitor and two antibiotics, bismuth-based therapy has recently been recommended as alternate first-line regimen in children. To comprehensively review the clinical, pharmacologic and microbiologic properties of bismuth salts, and to summarise the evidence for the therapeutic efficacy of bismuth-based therapy for H. pylori eradication in children. Bibliographical searches were performed in MEDLINE. Results on the efficacy of bismuth-containing regimens on H. pylori eradication were combined using the inverse variance method. Bismuth monotherapy showed a very low efficacy. Overall, the mean eradication rate with bismuth-based dual therapy was 68% (95% CI, 60-76%) (intention-to-treat analysis-ITT) and 73% (95% CI, 64-81%) (per protocol-PP). In case series, the overall percentages of children with successful eradication for triple therapy containing bismuth were 82% (95% CI, 76-88%) and 86% (95% CI, 80-92%) according to ITT and PP respectively. In comparative studies, H. pylori eradication rates ranged between 69% and 85% according to ITT and between 74% and 96% PP. Side effects included dark stools, urine discoloration, black tongue, burning tongue, and marked darkness of the gums. The evidence in favour of bismuth compounds for treating infected children is still not clear. Well-designed, randomised, multi-centre studies of H. pylori eradication trials in children comparing bismuth-based triple therapy with the best available recommended first-line therapies are needed. The evidence obtained from audited case series that produce an eradication rate of >95% on PP analysis should also be considered.

Sequential Therapy Compared with Standard Triple Therapy for Helicobacter Pylori Eradication in Children: A Double-Blind, Randomized, Controlled Trial

To determine the effectiveness of sequential therapy compared with standard triple therapy for Helicobacter pylori eradication in children. In 107 children with H pylori infection confirmed with 2 of 3 tests ((13)C-urea breath test, histopathology, rapid urease test), we conducted a double-blind, randomized, controlled trial comparing a sequential treatment (amoxicillin and omeprazole for 5 days followed by clarithromycin, tinidazole, and omeprazole for 5 days) to a 7-day standard triple eradication regimen (amoxicillin and clarithromycin plus omeprazole) followed by placebo for 3 days. In the experimental group (n=52) compared with the control group (n=51), there was a significant difference in the H pylori eradication rate at 6 to 8 weeks after the completion of treatment (primary outcome), as confirmed with negative results on (13)C-urea breath test (45/52 or 86.5% versus 35/51 or 68.6%; relative risk, 1.26; 95% CI, 1.02-1.60). Groups did not differ in any of the secondary outcomes (ie, adverse effects, the need for discontinuation of the H pylori therapy, compliance with therapy). In children with H pylori infection, sequential eradication therapy compared with standard triple therapy resulted in a higher eradication rate, although the difference was of borderline statistical significance.

A 10-day sequential therapy: New option for Helicobacter pylori eradication in children

A 10-day sequential therapy: New option for Helicobacter pylori eradication in children