Pediatric Gastroenterologists' Practice Styles and Compliance With European/North American Helicobacter pylori Guidelines

Objective This study aims to determine pediatric gastroenterologists' adherence to the management, diagnosis, and treatment of <i>Helicobacter pylori</i> (<i>H. pylori</i>) per the joint European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)/North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines for <i>H. pylori </i>in children (update 2016). Methods A survey was sent to the pediatric gastroenterology listserv to assess the knowledge of guidelines, workup, and treatment of <i>H. pylori</i> infection. The survey was open to respondents between 4/13/2022 and 5/12/2022. Results A total of 302 individuals completed the survey, representing 25 countries. The most ordered test for <i>H. pylori</i> was the stool antigen test (n = 151, 56.62%), followed by upper endoscopy (n = 97, 32.12%). Based on positive non-invasive test, 123 (40.72%) providers would never or not often treat <i>H. pylori</i>. Most providers treat <i>H. pylori</i> on histopathology in the absence of peptic ulcer disease. The majority of providers did not send <i>H. pylori</i> susceptibility testing. Most waited for the appropriate time after discontinuing antibiotics/anti-acid medication prior to testing for <i>H. pylori.</i> In the absence of susceptibility testing, 121 (40.5%) providers utilized proton pump inhibitors, amoxicillin, and clarithromycin to treat <i>H. pylori</i> compared to 79 (26.4%) providers who utilized proton pump inhibitors, high-dose amoxicillin, and metronidazole. Conclusion Areas where gastroenterologists adhere to the 2016 guidelines include waiting time after stopping antibiotics/anti-acid therapy and testing for eradication. Pediatric gastroenterologists had less adherence with the use of non-invasive testing for the diagnosis of <i>H. pylori</i>, treatment based on non-invasive test, diagnosis of <i>H. pylori</i> by endoscopy, utilizing culture and susceptibility testing, and antibiotic regimen used to treat <i>H. pylori</i>. Our survey results indicate that pediatric gastroenterologists require further education, especially now that the updated 2024 guidelines have been released.