Pediatric H. Pylori Infections

H. pylori is a spiral-shaped germ (bacteria) that infects the stomach.

It can damage the tissue in your child’s stomach and the first part of the small intestine (duodenum). This can cause redness and swelling (inflammation). It may also cause painful sores called peptic ulcers in the upper digestive tract.

How to say it

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Health experts don’t know for sure how H. pylori infection is spread. They believe it's passed through the fecal-oral route, meaning you take the germs into your body through contact with excreted H. pylori from another person.

Your child may also come into contact with the bacteria if your child:

• Eats food that was not cleaned or cooked in a safe way
• Drinks water that is infected with the bacteria
• Doesn’t wash their hands well after going to the bathroom

Most people are first exposed to the bacteria during childhood, adolescence, or by early adulthood.

Most people first get the bacteria when they are children. But adults can get it, too.

Experts are not sure if H. pylori infection runs in families (hereditary). It is more common where people live in crowded or unclean conditions. It may affect up to 75% of children in developing countries. It occurs at a lower rate in the U.S. but is still common.

Most people have the H. pylori bacteria for years without knowing it because they don’t have any symptoms. Experts don’t know why.

After being infected with H. pylori, your child may have an inflammation of the stomach lining. This is called gastritis. They may develop ulcers in their stomachs or duodenum (first part of the small intestine). But most people never have symptoms or problems from the infection.

When symptoms do occur, they may include belly pain, which can:

• Be a dull, gnawing pain
• Happen two to three hours after a meal or immediately after
• Come and go for a few days or weeks
• Occur in the middle of the night when your child’s stomach is empty
• Be eased by eating or taking an antacid medicine

Other symptoms may include:

• Loss of weight
• Loss of appetite
• Swelling or bloating
• Burping
• Having an upset stomach or nausea
• Vomiting

H. pylori symptoms may look like other health conditions. Always see your child's healthcare provider for a diagnosis.

Your child’s healthcare provider will take a health history and do a physical exam. The provider may also order other tests, including:

• Stool antigen test. This looks for any abnormal bacteria in your child’s digestive tract that may cause diarrhea and other problems. A small stool sample is collected and sent to a lab. A specific test called an H pylori antigen test will check directly for H pylori. However this test is not recommended in children in recent guidelines.
• Breath tests. These tests check if there is any labelled carbon dioxide present after your child drinks a special fluid. If labelled carbon dioxide is found, that means that H. pylori is present. In recent guidelines, this test is recommended to check if H pylori is cured after treatment in children.
• Upper endoscopy (EGD). This test looks at the lining of the food pipe (esophagus), the stomach, and the first part of the small intestine (duodenum). It uses a thin, lighted tube or endoscope. The tube has a camera at one end. The tube is put into your child’s mouth and throat. Then it goes down into the esophagus, stomach, and duodenum. Your child’s healthcare provider can see the inside of these organs. A small tissue sample or biopsy is taken if needed. The tissue sample can be checked under the microscope for signs of infection or of H. pylori bacteria. A special H pylori test called a urease test can also be done on the biopsy sample. Testing of the H pylori to check what antibiotics will work is done on the samples. This test is the recommended way to check for H pylori and decide on treatment, in children in recent guidelines.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

Your child’s treatment will include antibiotics to kill the bacteria.

Your child will also take medicines to decrease stomach acid, and allow the antibiotics to work better. These acid blocking medicines are called proton pump inhibitors.

A very bad ulcer can wear away your child’s stomach or duodenum (first part of the small intestine) lining. It can also cause problems, such as:

• Bleeding when a blood vessel is worn away
• A hole (perforation) in the stomach or small intestine wall
• Blockage when the ulcer is in a spot that blocks food from leaving the stomach
• Stomach cancer (after years to decades of having H pylori)

Health experts don’t know for sure how the H. pylori bacteria passes from person to person. But having good health habits or personal hygiene can help keep your child safe. These habits include making sure that your child:

• Practices good hand hygiene by scrubbing their hands for at least 20 seconds with soap and water. It is very important for your child to do this after using the bathroom, after touching pets, after sneezing, coughing or blowing their nose, after playing outside and before eating.
• Eats food that has been cleaned and cooked safely
• Drinks water that is safe and clean

Call your child's healthcare provider if your child has:

• Ongoing belly (abdominal) pain
• Loss of appetite
• Weight loss
• Vomiting that continues
• Blood in the vomit or stools
• Burning stomach pain that is worse between meals and in the early morning hours but gets better after eating
• Difficulty taking the medicines, or the medicines have negative side effects
• Symptoms that get worse or are new