Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Aug 28, 2020; 8(4): 292-308
Published online Aug 28, 2020. doi: 10.13105/wjma.v8.i4.292
Treatment of Helicobacter pylori infection in children: A systematic review
Filipe Antônio França da Silva, Breno Bittencourt de Brito, Maria Luísa Cordeiro Santos, Hanna Santos Marques, Mariana Miranda Sampaio, Ronaldo Teixeira da Silva Júnior, Jonathan Santos Apolonio, Lorena Sousa de Carvalho, Camilo Santana Silva, Luana Kauany de Sá Santos, Márcio Vasconcelos Oliveira, Gifone Aguiar Rocha, Dulciene Maria de Magalhães Queiroz, Fabrício Freire de Melo
Filipe Antônio França da Silva, Breno Bittencourt de Brito, Maria Luísa Cordeiro Santos, Mariana Miranda Sampaio, Ronaldo Teixeira da Silva Júnior, Jonathan Santos Apolonio, Lorena Sousa de Carvalho, Camilo Santana Silva, Luana Kauany de Sá Santos, Márcio Vasconcelos Oliveira, Fabrício Freire de Melo, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
Hanna Santos Marques, Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45083-900, Bahia, Brazil
Gifone Aguiar Rocha, Dulciene Maria de Magalhães Queiroz, Laboratory of Research in Bacteriology, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 30130-100, Minas Gerais, Brazil
Author contributions: All authors equally contributed to the conception and design of the study, literature review and analysis, drafting and critical revision and editing, and approval of the final version.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or coauthors who contributed their efforts in this manuscript.
PRISMA 2009 Checklist statement: A PRISMA checklist was used to guide the development of the systematic review.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fabrício Freire de Melo, PhD, Postdoctoral Fellow, Professor, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Rua Hormindo Barros, 58, Quadra 17, Lote 58, Vitória da Conquista 45029-094, Bahia, Brazil. freiremelo@yahoo.com.br
Received: July 29, 2020
Peer-review started: July 29, 2020
First decision: August 22, 2020
Revised: August 28, 2020
Accepted: August 28, 2020
Article in press: August 28, 2020
Published online: August 28, 2020
Processing time: 43 Days and 8.7 Hours
ARTICLE HIGHLIGHTS
Research background

Helicobacter pylori (H. pylori) is a gram-negative microaerophilic bacterium that infects the gastric epithelium and whose acquisition occurs mainly during childhood. In the last several years, no significant changes in the treatment of infected children have been observed, mainly due to the lack of studies with satisfactory scientific evidence to support the indication of new therapies in clinical practice. This systematic review evaluated the eradication rates of H. pylori infection using various therapeutic regimens and their positive and negative outcomes in pediatric patients.

Research motivation

Standard triple therapy for the eradication of H. pylori infection has been used as first-line treatment in children worldwide. However, the effectiveness of standard triple therapy in eradicating H. pylori is decreasing in various geographical areas as a consequence of increasing bacterial resistance to clarithromycin and nitroimidazoles.

Research objectives

To compare the eradication rates of H. pylori infection in childhood in controlled, randomized, and prospective studies evaluating different therapeutic schemes during the last 10 years.

Research methods

We systematically reviewed in PubMed and MEDLINE relevant publications from 2010 to April 2020. Twenty studies were shortlisted. This systematic review uses guidance from the PRISMA checklist.

Research results

The results were quite heterogeneous. Standard triple therapy is still the most used regimen and its eradication rates vary according to the H. pylori susceptibility profiles in different world regions. The addition of probiotics to therapeutic schemes shows discrepant results in eradication rate, but decrease the incidence of side effects and increases the treatment adherence. Sequential therapy has been associated with higher eradication rates than triple therapies and is a promising therapeutic regimen for this population.

Research conclusions

Currently, standard triple therapy is the most recommended H. pylori eradication regimen for children worldwide. However, other therapeutic schemes have shown promising results in controlled trials and in a near future may be included in the guidelines recommendations.

Research perspectives

There are still few studies with satisfactory evidence levels evaluating the eradication of H. pylori infection in children, mainly due to the difficulties to conduct controlled clinical trials as well as to the low availability of sources for research in many developing countries where the prevalence of H. pylori infection remain elevated. Well-designed studies evaluating treatments for H. pylori eradication in children are needed to further evaluate new therapeutic options in pediatric clinical practice in high bacterial resistance settings.