Article Text
Abstract
Introduction The aim of this study was to review management of H. pylori in a regional London area including symptoms and patterns of presentation, investigation routes prior to treatment (stool antigen detection or diagnostic oesophago-gastro-duodenoscopy (OGD) and treatment outcomes through 2020- 2021. It was hypothesised that the pattern and presentation for H. pylori in this regional London area will be incongruous with some of the recommendations with regards to investigations recommended in the joint ESPGHAN/NASPGHAN guidelines from 2016.
Methods This retrospective audit comprised of 598 patients who had either had a H. pylori stool test or OGD in 2020–2021.
Results Demographic Data:
• 598 H . pylori stool antigen tests were requested Dec 2020 – Dec 2021 in the regional area - 14.9% (89) of these samples were positive.
• 103 samples (out of 598) were requested after assessment in one of the paediatric areas of our tertiary paediatric unit after assessment by a member of the paediatric team - Of the 103, 37% (38) were positive.
• H. pylori stool antigen test was requested following history and examination by senior paediatricians.
• Adolescents and older children had the highest positivity rates compared with prepubertal children in our data set.
• 50% of treated patient (out of 103) were successful (negative H. pylori stool test) - In 47% of patients, follow up data was not available.
Conclusions In this regional London centre, H. pylori stool testing is a viable and sensible way to manage H. pylori infection in contrast to current ESPGHAN/NSPGHAN H. pylori guidance. Education of primary care colleagues is needed to prevent excessive number or tests. Advice with regards to primary H. pylori stool testing should be directed at adolescents and not prepubertal children, suggesting that adolescents could follow a modified ‘test and treat’ strategy. Education is also required to ensure follow up testing after eradication is performed.
References
Aguilera Matos I, Diaz Oliva S, Escobedo A, et al. Helicobacter pylori infection in children. BMJ Paediatr. Open. 2020. Online journal article
Jones N, Koletzko S, Goodman K, et al. Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016). J. Pediatr. Gastroenterol. Nutr. 2017;64(6):991–1003. Online journal article