Table 2 Self-reported practices of primary-care pediatricians regarding the management of H. pylori infection in children
Number/ Total (percent) | Weighted percent* | Relevant Recommendations [5] | |
|---|---|---|---|
Reasons for testing for H. pylori diagnosis in the case of ** | |||
Suspected duodenal ulcer | 76/98 (78%) | 78% | Recommended |
First-degree relatives of gastric cancer patients | 45/96 (47%) | 46% | Testing for H. pylori may be considered |
Recurrent abdominal pain | 45/101 (44%) | 46% | Not recommended |
Unexplained IDA | 51/99 (52%) | 52% | Recommended in children with refractory IDA, in which other causes have been ruled out |
First choice diagnostic test for H. pylori | |||
UBT | 27/102 (27%) | 25% | |
Gastroscopy | 2/102 (2%) | 2% | The initial diagnosis of H. pylori infection should be based on either a positive histopathology plus a positive rapid urease test or a positive culture. |
Specialist in gastroenterology | 20/102 (20%) | 19% | |
Stool antigen EIA | 52/102 (51%) | 53% | |
Serology | 1/102 (1%) | 1% | |
Prescription of first line therapy | Triple therapy with a PPI/ amoxicillin/ clarithromycin or an imidazole or bismuth saltsamoxicillinan imidazole or sequential therapy. Antibiotic susceptibility testing for clarithromycin is recommended before in areas with a high resistance rate (> 20%). | ||
PPIs/clarithromycin/ amoxicillin | 60/102 (59%) | 58% | |
PPIs/ amoxicillin / metronidazole | 21/102 (21%) | 22% | |
PPIs/clarithromycin/ amoxicillin /metronidazole | 4/102 (4%) | 4% | |
Refer to a specialist in gastroenterology | 16/102 (16%) | 16% | |
Duration of treatment | 7 to 14 days | ||
7 days | 15/102 (15%) | 14% | |
10 days | 41/102 (40%) | 42% | |
14 days | 35/102 (34%) | 34% | |
Refer to a specialist in gastroenterology | 11/102 (11%) | 11% | |
Follow-up | A reliable noninvasive test to confirm eradication at least 4–8 weeks following completion of therapy (UBT or stool EIA). | ||
UBT at least 1 month after therapy | 19/102 (19%) | 19% | |
Refer to a specialist in gastroenterology | 11/102 (11%) | 11% | |
Stool antigen detection EIA at least 1 month after therapy | 17/102 (17%) | 17% | |
Do not refer to follow-up test if symptoms resolved | 55/102 (54%) | 53% | |
In case of treatment failure | EGD, with culture and susceptibility testing including alternative antibiotics; modification of therapy. | ||
Refer to a specialist in gastroenterology | 72/102 (71%) | 71% | |
Do nothing if symptoms resolved | 14/102 (14%) | 13% | |
The same treatment for longer duration | 4/102 (4%) | 5% | |
Recommend a different treatment | 12/102 (12%) | 12% | |