Helicobacter Pylori Infection in Pediatric Patients Living in Europe: Results of the EuroPedHP Registry 2013-2016.

OBJECTIVES To assess clinical presentation, endoscopic findings, antibiotic susceptibility and treatment success of Helicobacter pylori (H. pylori) infected pediatric patients. METHODS Between 2013-2016, 23 pediatric hospitals from 17 countries prospectively submitted data on consecutive H. pylori infected (culture positive) patients to the EuroPedHP-Registry. RESULTS Of 1333 patients recruited (55.1% females, median age 12.6 years), 1168 (87.6%) were therapy naive (group A) and 165 (12.4%) had failed treatment (group B). Patients resided in North/Western (29.6%), Southern (34.1%) and Eastern Europe (23.0%) or Israel/Turkey (13.4%). Main indications for endoscopy were abdominal pain or dyspepsia (81.2%, 1078/1328). Antral nodularity was reported in 77.8% (1031/1326) of patients, gastric or duodenal ulcers and erosions in 5.1% and 12.8%, respectively. Primary resistance to clarithromycin (CLA) and metronidazole (MET) occurred in 25% and 21%, respectively, and increased after failed therapy. Bacterial strains were fully susceptible in 60.5% of group A, but in only 27.4% of group B. Primary CLA resistance was higher in Southern and Eastern Europe (ORadj = 3.44, 95%CI 2.22-5.32, p < 0.001 and 2.62, 95% CI 1.63-4.22 p < 0.001, respectively) compared to Northern/Western Europe. Children born outside Europe showed higher primary MET resistance (ORadj = 3.81, 95%CI: 2.25-6.45, p < 0.001). Treatment success in group A reached only 79.8% (568/712) with 7-14 days triple therapy tailored to antibiotic susceptibility. CONCLUSION Peptic ulcers are rare in dyspeptic H. pylori infected children. Primary resistance to CLA and MET is markedly dependent on geographical regions of birth and residence. The ongoing survey will show whether implementation of the updated ESPGHAN/NASPGHAN guidelines will improve the eradication success.