Joint ESPGHAN/NASPGHAN guidelines for the management of helicobacter pylori in children and adolescents (Update 2016)
J. pediatr. gastroenterol. nutr
; 64(6)Jun. 2017.
Artigo
em Inglês
| BIGG - guias GRADE
| ID: biblio-948131
Biblioteca responsável:
BR1.1
ABSTRACT
BACKGROUND:
Because of the changing epidemiology of Helicobacter pylori infection and low efficacy of currently recommended therapies, an update of the European Society for Paediatric Gastroenterology Hepatology and Nutrition/North American Society for Pediatric Gastroenterology, Hepatology and Nutrition recommendations for the diagnosis and management of H pylori infection in children and adolescents is required.METHODS:
A systematic review of the literature (time period 2009-2014) was performed. Representatives of both societies evaluated the quality of evidence using GRADE (Grading of Recommendation Assessment, Development, and Evaluation) to formulate recommendations, which were voted upon and finalized using a Delphi process and face-to-face meeting.RESULTS:
The consensus group recommended that invasive diagnostic testing for H pylori be performed only when treatment will be offered if tests are positive. To reach the aim of a 90% eradication rate with initial therapy, antibiotics should be tailored according to susceptibility testing. Therapy should be administered for 14 days, emphasizing strict adherence. Clarithromycin-containing regimens should be restricted to children infected with susceptible strains. When antibiotic susceptibility profiles are not known, high-dose triple therapy with proton pump inhibitor, amoxicillin, and metronidazole for 14 days or bismuth-based quadruple therapy is recommended. Success of therapy should be monitored after 4 to 8 weeks by reliable noninvasive tests.CONCLUSIONS:
The primary goal of clinical investigation is to identify the cause of upper gastrointestinal symptoms rather than H pylori infection. Therefore, we recommend against a test and treat strategy. Decreasing eradication rates with previously recommended treatments call for changes to first-line therapies and broader availability of culture or molecular-based testing to tailor treatment to the individual child.
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BIGG - guias GRADE
Assunto principal:
Helicobacter pylori
/
Infecções por Helicobacter
/
Inibidores da Bomba de Prótons
/
Metronidazol
/
Antibacterianos
Tipo de estudo:
Estudo diagnóstico
/
Guia de prática clínica
/
Estudo prognóstico
Idioma:
Inglês
Revista:
J. pediatr. gastroenterol. nutr
Ano de publicação:
2017
Tipo de documento:
Artigo
Instituição/País de afiliação:
Catholic University/FR
/
Centro Medico Nacional Siglo XXI/MX
/
Children's Center for Digestive Healthcare/US
/
Emory University/US
/
Hebrew University/IL
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Hôpital Universitaire des Enfants Reine Fabiola/BE
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Karolinska University Hospital/SE
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Ludwig Maximilians University/DE
/
Marshall University/US
/
University Children's Hospital Ljubljana/SI