H. pylori infection in children
Helicobacter pylori infection is much less prevalent in children than in adults, and infection is an unlikely cause of abdominal pain. Overall prevalence in children in Australia is about 5% or less, but higher-risk groups include migrant children, or children born of migrants, from high-prevalence regions (eg East Asia, Mediterranean).
In children, the role of clinical investigations to determine the presence of H. pylori infection is limited. The primary goal of investigation in children with upper gastrointestinal symptoms is to determine the cause of the symptoms rather than the presence of H. pylori infection. Testing for H. pylori is not recommended in children with functional abdominal pain. Most children who are infected with H. pylori are asymptomatic.
If H. pylori infection is suspected in a child, refer to a paediatric gastroenterologist for investigation and treatment. While awaiting referral, testing for H. pylori using stool antigen testing may be considered but is not necessary. Urease breath testing should not be used to test for H. pylori in children because it has a high rate of false-positive results.
In children, empirical H. pylori eradication therapy should be avoided. The ‘test-and-treat’ strategy for upper gastrointestinal tract symptoms used for adults is not appropriate in children.