Factors Associated With Decision to Treat or Not to Treat Helicobacter pylori Infection in Children: Data From the EuroPedHp Registry

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Helicobacter Pub Date : 2024-09-09 DOI:10.1111/hel.13134

Thu Giang Le Thi, Katharina Werkstetter, Kallirroi Kotilea, Patrick Bontems, José Cabral, Maria Luz Cilleruelo, Michal Kori, Josefa Barrio, Matjaž Homan, Nicolas Kalach, Rosa Lima, Marta Tavares, Pedro Urruzuno, Zrinjka Misak, Vaidotas Urbonas, Sibylle Koletzko, for the Helicobacter pylori Special Interest Group of ESPGHAN

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Abstract

Background

European and North-American guidelines on management of H. pylori infection in children provide the option not to treat even if the infection is endoscopically confirmed. We used data from the EuroPedHp Registry to identify factors associated with therapy decisions.

Methods

We included treatment-naïve patients reported between 2017 and 2020 from 30 centers in 17 European countries. Multivariable logistic regression identified factors including comorbidities within and outside the gastrointestinal (GI) tract influencing the decision for or against therapy.

Results

Of 1165 patients (52% females, median age 12.8), 28% (321/1165) reported any alarm symptom, 26% (307/1165) comorbidities, and 16% (192/1165) did not receive eradication treatment. Therapy was initiated less often in children having any GI comorbidity (57%, n = 181), particularly in those with eosinophilic esophagitis (60%, n = 35), inflammatory bowel disease (54%, n = 28), and celiac disease (43%, n = 58), compared to those with non-GI (86%, n = 126) or no comorbidity (89%, n = 858), despite similar frequencies of alarm and non-alarm symptoms, ulcers, erosions, and nodular gastritis. Patients with GI and without comorbidities remained more likely untreated in high versus low H. pylori prevalence countries (p < 0.0001). In children without comorbidities, factors favoring therapy included older age, being overweight, having symptoms, erosions, antral nodularity, and available antibiotic susceptibility results.

Conclusion

In this cohort, H. pylori-infected children with GI comorbidities compared to no comorbidity showed 75% reduced chance of receiving eradication therapy. We found no evidence supporting different management strategies in infected patients with GI comorbidities compared to all pediatric patients with endoscopically proven H. pylori infection.

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决定治疗或不治疗儿童幽门螺杆菌感染的相关因素：来自 EuroPedHp 登记处的数据

背景欧洲和北美的儿童幽门螺杆菌感染管理指南规定，即使内镜确诊感染，也可以选择不治疗。我们利用 EuroPedHp 注册中心的数据来确定与治疗决策相关的因素。方法我们纳入了 17 个欧洲国家 30 个中心在 2017 年至 2020 年间报告的治疗无效患者。多变量逻辑回归确定了影响治疗决定的因素，包括胃肠道（GI）内外的合并症。结果 1165 名患者（52% 为女性，中位年龄为 12.8 岁）中，28%（321/1165）报告有任何报警症状，26%（307/1165）有合并症，16%（192/1165）未接受根除治疗。与非消化道疾病（86%，n = 126）或无合并症（89%，n = 858）的儿童相比，尽管出现报警和非报警症状、溃疡、糜烂和结节性胃炎的频率相似，但有消化道合并症（57%，n = 181）的儿童，尤其是嗜酸性粒细胞食管炎（60%，n = 35）、炎症性肠病（54%，n = 28）和糜烂性胃炎（43%，n = 58）的儿童接受治疗的频率较低。在幽门螺杆菌流行率高的国家和流行率低的国家，有消化道疾病和无合并症的患者更有可能未接受治疗（p < 0.0001）。在无合并症的儿童中，有利于治疗的因素包括年龄较大、超重、有症状、糜烂、前胃结节以及抗生素药敏结果。结论在该队列中，有消化道合并症的幽门螺杆菌感染儿童与无合并症儿童相比，接受根除治疗的几率降低了 75%。与所有经内镜证实感染幽门螺杆菌的儿童患者相比，我们没有发现证据支持对有消化道合并症的感染患者采取不同的治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Helicobacter 医学-微生物学

CiteScore

8.40

自引率

9.10%

发文量

审稿时长

2 months

期刊介绍： Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.