In this section
Helicobacter pylori is a bacterial infection of the stomach that is usually acquired in the early years of life. Transmission is related to living conditions, particularly crowding. The clinical implications of H. pylori infection in children are unclear, although H. pylori is classed as a grade I carcinogen (for gastric cancer) in adults.1
H. pylori is asymptomatic in many children, it is unclear whether H. pylori causes abdominal pain without associated peptic ulcer disease.2 A meta-analysis found H. pylori was not associated with recurrent abdominal pain in children; there was conflicting evidence for an association with epigastric pain, and some evidence of association with short-term (<3 months) recurrent abdominal pain.3
Consider other causes of recurrent abdominal pain in refugee children. Differential diagnoses include parasite infection, lactose intolerance, constipation, liver dysfunction/hepatitis and coeliac disease, depending on area of origin.
First line therapy with metronidazole is not recommended due to reported high resistance rates,10 which are of particular concern in African patients,11 however it may be used in cases of penicillin allergy. Alternate first-line regimens using sequential approaches, or including bismuth salts are sometimes used.
Australian therapeutic guidelines recommend the regimen above (for 7 days), however current international consensus guidelines2 recommend a tailoring therapy based on susceptibility testing (i.e. after endoscopy), and where susceptibility is not known, using 14-day regimen of a proton pump inhibitor, amoxicillin and metronidazole OR bismuth-based quadruple therapy.
Immigrant health clinic resources. Initial: Melanie Thompson and Georgie Paxton, January 2012, most recent review April 2020. Contact firstname.lastname@example.org