Pediatric Gastroenterologists' Practice Styles and Compliance With European/North American Helicobacter pylori Guidelines

TL;DR

This study finds that pediatric gastroenterologists do not consistently follow updated guidelines for diagnosing and treating Helicobacter pylori in children.

Contribution

The study identifies gaps in adherence to H. pylori guidelines among pediatric gastroenterologists and highlights the need for further education.

Findings

Most providers rely on stool antigen tests and endoscopy for H. pylori diagnosis.

Fewer providers follow guideline recommendations for non-invasive testing and antibiotic regimens.

Many do not perform susceptibility testing before treatment.

Abstract

Objective

This study aims to determine pediatric gastroenterologists’ adherence to the management, diagnosis, and treatment of Helicobacter pylori (H. pylori) per the joint European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)/North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines for H. pylori in children (update 2016).

Methods

A survey was sent to the pediatric gastroenterology listserv to assess the knowledge of guidelines, workup, and treatment of H. pylori infection. The survey was open to respondents between 4/13/2022 and 5/12/2022.

Results

A total of 302 individuals completed the survey, representing 25 countries. The most ordered test for H. pylori was the stool antigen test (n = 151, 56.62%), followed by upper endoscopy (n = 97, 32.12%). Based on positive non-invasive test, 123 (40.72%) providers would never or not often treat H. pylori.

Most providers treat H. pylori on histopathology in the absence of peptic ulcer disease. The majority of providers did not send H. pylori susceptibility testing. Most waited for the appropriate time after discontinuing antibiotics/anti-acid medication prior to testing for H. pylori.

In the absence of susceptibility testing, 121 (40.5%) providers utilized proton pump inhibitors, amoxicillin, and clarithromycin to treat H. pylori compared to 79 (26.4%) providers who utilized proton pump inhibitors, high-dose amoxicillin, and metronidazole.

Conclusion

Areas where gastroenterologists adhere to the 2016 guidelines include waiting time after stopping antibiotics/anti-acid therapy and testing for eradication.

Pediatric gastroenterologists had less adherence with the use of non-invasive testing for the diagnosis of H. pylori, treatment based on non-invasive test, diagnosis of H. pylori by endoscopy, utilizing culture and susceptibility testing, and antibiotic regimen used to treat H. pylori.

Our survey results indicate that pediatric gastroenterologists require further education, especially now that the updated 2024 guidelines have been released.