Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

Changes in the Treatment Strategies for Helicobacter pylori Infection in Children and Adolescents in Korea

  • Jun, Jin-Su (Department of Pediatrics, Gyeongsang National Institute of Health Sciences, Gyeongsang National University College of Medicine) ;
  • Seo, Ji-Hyun (Department of Pediatrics, Gyeongsang National Institute of Health Sciences, Gyeongsang National University College of Medicine) ;
  • Park, Ji-Sook (Department of Pediatrics, Gyeongsang National Institute of Health Sciences, Gyeongsang National University College of Medicine) ;
  • Rhee, Kwang-Ho (Department of Microbiology, Gyeongsang National University College of Medicine) ;
  • Youn, Hee-Shang (Department of Pediatrics, Gyeongsang National Institute of Health Sciences, Gyeongsang National University College of Medicine)
  • Received : 2019.08.18
  • Accepted : 2019.08.30
  • Published : 2019.09.15
Download PDF
⟨ Previous Next ⟩

Abstract

The policies developed for the treatment of Helicobacter pylori infection in adults may not be the most suitable ones to treat children and adolescents. Methods used to treat children and adolescents in Europe and North America may not be appropriate for treating children and adolescents in Korea due to differences in epidemiological characteristics of H. pylori between regions. Moreover, the agreed standard guidelines for the treatment of H. pylori infection in children and adolescents in Korea have not been established yet. In this study, the optimal treatment strategy for H. pylori infection control in children and adolescents in Korea is discussed based on these guidelines, and recent progress on the use and misuse of antimicrobial agents is elaborated. Non-invasive as well as invasive diagnostic test and treatment strategy for H. pylori infection are not recommendable in children aged less than ten years or children with body weight under 35 kg, except in cases of clinically suspected or endoscopically identified peptic ulcers. The uncertainty, whether enough antimicrobial concentrations to eradicate H. pylori can be maintained when administered according to body weight-based dosing, and the costs and adverse effects outweighing the anticipated benefits of treatment make it difficult to decide to eradicate H. pylori in a positive noninvasive diagnostic test in this age group. However, adolescents over ten years of age or with a bodyweight of more than 35 kg can be managed aggressively as adults, because they can tolerate the adult doses of anti-H. pylori therapy. In adolescents, the prevention of future peptic ulcers and gastric cancers is expected after the eradication of H. pylori. Bismuth-based quadruple therapy (bismuth-proton pump inhibitor-amoxicillin/tetracycline-metronidazole) with maximal tolerable doses and optimal dose intervals of 14 days is recommended, because in Korea, the antibiotic susceptibility test for H. pylori is not performed at the initial diagnostic evaluation. If the first-line treatment fails, concomitant therapy plus bismuth can be attempted for 14 days as an empirical rescue therapy. Finally, the salvage therapy, if needed, must be administered after the H. pylori antibiotic susceptibility test.

Keywords

References

  1. Malfertheiner P, Megraud F, O'Morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut 2017;66:6-30. https://doi.org/10.1136/gutjnl-2016-312288
  2. Sugano K, Tack J, Kuipers EJ, Graham DY, El-Omar EM, Miura S, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut 2015;64:1353-67. https://doi.org/10.1136/gutjnl-2015-309252
  3. Kim SG, Jung HK, Lee HL, Jang JY, Lee H, Kim CG, et al. Guidelines for the diagnosis and treatment of Helicobacter pylori infection in Korea, 2013 revised edition. Korean J Gastroenterol 2013;62:3-26. https://doi.org/10.4166/kjg.2013.62.1.3
  4. Jones NL, Koletzko S, Goodman K, Bontems P, Cadranel S, Casswall T, et al. Joint ESPGHAN/NASPGHAN guidelines for the management of Helicobacter pylori in children and adolescents (update 2016). J Pediatr Gastroenterol Nutr 2017;64:991-1003. https://doi.org/10.1097/MPG.0000000000001594
  5. IARC Helicobacter pylori Working Group. Helicobacter pylori eradication as a strategy for preventing gastric cancer. Lyon: International Agency for Research on Cancer, 2014.
  6. Kato M, Ota H, Okuda M, Kikuchi S, Satoh K, Shimoyama T, et al. Guidelines for the management of Helicobacter pylori infection in Japan: 2016 revised edition. Helicobacter 2019;24:e12597. https://doi.org/10.1111/hel.12597
  7. Honma H, Nakayama Y, Kato S, Hidaka N, Kusakari M, Sado T, et al. Clinical features of Helicobacter pylori antibody-positive junior high school students in Nagano Prefecture, Japan. Helicobacter 2019;24:e12559. https://doi.org/10.1111/hel.12559
  8. Jung KW, Won YJ, Kong HJ, Lee ES. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2016. Cancer Res Treat 2019;51:417-30. https://doi.org/10.4143/crt.2019.138
  9. Graham DY, Lee YC, Wu MS. Rational Helicobacter pylori therapy: evidence-based medicine rather than medicine-based evidence. Clin Gastroenterol Hepatol 2014;12:177-86.e3; Discussion e12-3. https://doi.org/10.1016/j.cgh.2013.05.028
  10. Seo J, Koo S, Youn H, Jun J, Lim J, Park C, et al. Comparison of the antibiotic resistance of Helicobacter pylori isolated in jinju over a 15-year period. J Bacteriol Virol 2012;42:305-12. https://doi.org/10.4167/jbv.2012.42.4.305
  11. Seo JH, Jun JS, Yeom JS, Park JS, Youn HS, Ko GH, et al. Changing pattern of antibiotic resistance of Helicobacter pylori in children during 20 years in Jinju, South Korea. Pediatr Int 2013;55:332-6. https://doi.org/10.1111/ped.12048
  12. Lee JH, Ahn JY, Choi KD, Jung HY, Kim JM, Baik GH, et al.; Korean College of Helicobacter. Nationwide antibiotic resistance mapping of Helicobacter pylori in Korea: a prospective multicenter study. Helicobacter 2019;24:e12592. https://doi.org/10.1111/hel.12592
  13. Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol 2017;112:212-39. https://doi.org/10.1038/ajg.2016.563
  14. Okuda M, Kikuchi S, Mabe K, Osaki T, Kamiya S, Fukuda Y, et al. Nationwide survey of Helicobacter pylori treatment for children and adolescents in Japan. Pediatr Int 2017;59:57-61. https://doi.org/10.1111/ped.13038
  15. Seo JH, Park JS, Rhee KH, Youn HS. Diagnosis of Helicobacter pylori infection in children and adolescents in Korea. Pediatr Gastroenterol Hepatol Nutr 2018;21:219-33. https://doi.org/10.5223/pghn.2018.21.4.219
  16. Rhee KH, Youn HS, Baik SC, Lee WK, Cho MJ, Choi HJ, et al. Prevalence of Helicobacter pylori infection in Korea. J Korean Soc Microbiol 1990;25:475-90.
  17. Borody TJ, Cole P, Noonan S, Morgan A, Lenne J, Hyland L, et al. Recurrence of duodenal ulcer and Campylobacter pylori infection after eradication. Med J Aust 1989;151:431-5. https://doi.org/10.5694/j.1326-5377.1989.tb101251.x
  18. Drumm B, Sherman P, Chiasson D, Karmali M, Cutz E. Treatment of Campylobacter pylori-associated antral gastritis in children with bismuth subsalicylate and ampicillin. J Pediatr 1988;113:908-12. https://doi.org/10.1016/S0022-3476(88)80030-1
  19. Oderda G, Vaira D, Holton J, Ainley C, Altare F, Ansaldi N. Amoxycillin plus tinidazole for Campylobacter pylori gastritis in children: assessment by serum IgG antibody, pepsinogen I, and gastrin levels. Lancet 1989;1:690-2.
  20. Israel DM, Hassall E. Treatment and long-term follow-up of Helicobacter pylori-associated duodenal ulcer disease in children. J Pediatr 1993;123:53-8. https://doi.org/10.1016/S0022-3476(05)81536-7
  21. Park C, Choi H, Youn H, Lee W, Cho M, Kang K, et al. Chemotherapy of Helicobacter pylori infection. J Kor Soc Microbiol 1994;29:421-35.
  22. Choi MB, Kim YO, Cho YK, Sin SK, Kim SJ, Woo HO, et al. Histopathological changes of gastroduodenal mucosa after chemotherapy of Helicobacter pylori-chronic gastritis. Korean J Gastroenterol 1997;29:41-52.
  23. Graham DY, Shiotani A. New concepts of resistance in the treatment of Helicobacter pylori infections. Nat Clin Pract Gastroenterol Hepatol 2008;5:321-31. https://doi.org/10.1038/ncpgasthep1138
  24. Bae SH, Koh JS, Seo JK. Therapeutic efficacy of dual therapy and triple therapy for Helicobacter pylori infection in children. J Korean Pediatr Soc 1998;41:323-30.
  25. Choi J, Jang JY, Kim JS, Park HY, Choe YH, Kim KM. Efficacy of two triple eradication regimens in children with Helicobacter pylori infection. J Korean Med Sci 2006;21:1037-40. https://doi.org/10.3346/jkms.2006.21.6.1037
  26. Hong J, Yang HR. Efficacy of proton pump inhibitor-based triple therapy and bismuth-based quadruple therapy for Helicobacter pylori eradication in Korean children. Pediatr Gastroenterol Hepatol Nutr 2012;15:237-42. https://doi.org/10.5223/pghn.2012.15.4.237
  27. Choi IK, Lee SY, Chung KS. Effect of one- or two-week triple therapy with omeprazole, amoxicillin, and clarithromycin on eradication of Helicobacter pylori infection in children. Korean J Pediatr Gastroenterol Nutr 2002;5:19-25. https://doi.org/10.5223/kjpgn.2002.5.1.19
  28. Youn JH, Kim SJ, Seo JH, Kim JY, Youn HS, Ko JS, et al. National survey assessing treatment of Helicobacter pylori infection in Korean children: a pilot study. Korean J Helicobacter Up Gastrointest Res 2017;17:195-9. https://doi.org/10.7704/kjhugr.2017.17.4.195
  29. Gisbert JP, McNicholl AG. Optimization strategies aimed to increase the efficacy of H. pylori eradication therapies. Helicobacter 2017;22:e12392. https://doi.org/10.1111/hel.12392
  30. Graham DY, Dore MP. Helicobacter pylori therapy: a paradigm shift. Expert Rev Anti Infect Ther 2016;14:577-85. https://doi.org/10.1080/14787210.2016.1178065
  31. Graham DY, Dore MP, Lu H. Understanding treatment guidelines with bismuth and non-bismuth quadruple Helicobacter pylori eradication therapies. Expert Rev Anti Infect Ther 2018;16:679-87. https://doi.org/10.1080/14787210.2018.1511427
  32. Li H, Wang R, Sun H. Systems approaches for unveiling the mechanism of action of bismuth drugs: new medicinal applications beyond Helicobacter pylori infection. Acc Chem Res 2019;52:216-27. https://doi.org/10.1021/acs.accounts.8b00439
  33. Leussink BT, Slikkerveer A, Engelbrecht MR, van der Voet GB, Nouwen EJ, de Heer E, et al. Bismuth overdosing-induced reversible nephropathy in rats. Arch Toxicol 2001;74:745-54. https://doi.org/10.1007/s002040000190
  34. Youn YS, Lee KY. Mycoplasma pneumoniae pneumonia in children. Korean J Pediatr 2012;55:42-7. https://doi.org/10.3345/kjp.2012.55.2.42
  35. Lee JW, Kim N, Kim JM, Nam RH, Chang H, Kim JY, et al. Prevalence of primary and secondary antimicrobial resistance of Helicobacter pylori in Korea from 2003 through 2012. Helicobacter 2013;18:206-14. https://doi.org/10.1111/hel.12031
  36. Choe JW, Jung SW, Kim SY, Hyun JJ, Jung YK, Koo JS, et al. Comparative study of Helicobacter pylori eradication rates of concomitant therapy vs modified quadruple therapy comprising proton-pump inhibitor, bismuth, amoxicillin, and metronidazole in Korea. Helicobacter 2018;23:e12466. https://doi.org/10.1111/hel.12466
  37. Graham DY, Lee SY. How to Effectively use bismuth quadruple therapy: the good, the bad, and the ugly. Gastroenterol Clin North Am 2015;44:537-63. https://doi.org/10.1016/j.gtc.2015.05.003
  38. Furuta T, Sugimoto M, Yamade M, Uotani T, Sahara S, Ichikawa H, et al. Effect of dosing schemes of amoxicillin on eradication rates of Helicobacter pylori with amoxicillin-based triple therapy. J Clin Pharmacol 2014;54:258-66. https://doi.org/10.1002/jcph.195
  39. Ahn HS, Shin HY. (Hong Chang-Yee) Pediatrics. 11th ed. Seoul: MiraeN, 2016:554-5.
  40. Lee E, Cho HJ, Hong SJ, Lee J, Sung H, Yu J. Prevalence and clinical manifestations of macrolide resistant Mycoplasma pneumoniae pneumonia in Korean children. Korean J Pediatr 2017;60:151-7. https://doi.org/10.3345/kjp.2017.60.5.151

Cited by

  1. Pediatric gastritis and its impact on hematologic parameters vol.99, pp.35, 2019, https://doi.org/10.1097/md.0000000000021985
  2. Review: Helicobacter pylori infection in children vol.25, pp.suppl, 2020, https://doi.org/10.1111/hel.12742
  3. Changing prevalence of Helicobacter pylori infection in children and adolescents vol.64, pp.1, 2019, https://doi.org/10.3345/cep.2019.01543
  4. Recent Changes in the Treatment of Helicobacter pylori Infection in Children and Adolescents vol.21, pp.3, 2019, https://doi.org/10.7704/kjhugr.2021.0025