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Table 2 Self-reported practices of primary-care pediatricians regarding the management of H. pylori infection in children

From: A survey of primary-care pediatricians regarding the management of Helicobacter pylori infection and celiac disease

 Number/ Total (percent)Weighted percent*Relevant Recommendations [5]
Reasons for testing for H. pylori diagnosis in the case of **
 Suspected duodenal ulcer76/98 (78%)78%Recommended
 First-degree relatives of gastric cancer patients45/96 (47%)46%Testing for H. pylori may be considered
 Recurrent abdominal pain45/101 (44%)46%Not recommended
 Unexplained IDA51/99 (52%)52%Recommended in children with refractory IDA, in which other causes have been ruled out
First choice diagnostic test for H. pylori
 UBT27/102 (27%)25% 
 Gastroscopy2/102 (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 gastroenterology20/102 (20%)19% 
 Stool antigen EIA52/102 (51%)53% 
 Serology1/102 (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/ amoxicillin60/102 (59%)58% 
 PPIs/ amoxicillin / metronidazole21/102 (21%)22% 
 PPIs/clarithromycin/ amoxicillin /metronidazole4/102 (4%)4% 
 Refer to a specialist in gastroenterology16/102 (16%)16% 
Duration of treatment  7 to 14 days
 7 days15/102 (15%)14% 
 10 days41/102 (40%)42% 
 14 days35/102 (34%)34% 
 Refer to a specialist in gastroenterology11/102 (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 therapy19/102 (19%)19% 
 Refer to a specialist in gastroenterology11/102 (11%)11% 
 Stool antigen detection EIA at least 1 month after therapy17/102 (17%)17% 
 Do not refer to follow-up test if symptoms resolved55/102 (54%)53% 
In case of treatment failure  EGD, with culture and susceptibility testing including alternative antibiotics; modification of therapy.
 Refer to a specialist in gastroenterology72/102 (71%)71% 
 Do nothing if symptoms resolved14/102 (14%)13% 
 The same treatment for longer duration4/102 (4%)5% 
 Recommend a different treatment12/102 (12%)12% 
  1. *Inverse probability weighting; **Physicians who answered “always” or “usually”. EIA Enzyme immunoassay, EGD Esophagogastroduodenoscopy, IDA Iron deficiency anemia, IgA Immunoglobulin A, IgG Immunoglobulin G, PPIs Proton pump inhibitors, UBT Urea breath test