Paeds · gastroenterology-hepatology-and-nutrition
Peptic disease and Helicobacter pylori
Also known as Peptic ulcer disease in children · Helicobacter pylori infection · H. pylori gastritis · Duodenal ulcer · Gastric ulcer · Paediatric dyspepsia
A fellowship approach to peptic disease and Helicobacter pylori in children: separate primary H. pylori-associated ulceration from NSAID and stress-related injury and from functional dyspepsia, understand why test-and-treat is rejected in paediatrics, diagnose with endoscopy and biopsy plus susceptibility testing, deliver susceptibility-guided eradication, and confirm cure non-invasively at least four weeks later.
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Target exams
Red flags
- Haematemesis, coffee-ground vomiting or melaena — suspect bleeding peptic ulcer
- Haemodynamic instability or a falling haemoglobin in a child with dyspepsia
- Weight loss, faltering growth or persistent anorexia with epigastric pain
- Persistent vomiting, dysphagia or odynophagia
- Nocturnal pain that wakes the child from sleep
- Iron-deficiency anaemia unexplained by diet in a child with upper GI symptoms
- A palpable mass, organomegaly or a first-degree relative with gastric cancer or ulcer
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Gastroenterology and Hepatology
- Infectious Diseases
- Current 2026 PREP curriculum — Learning Objective: Assess and manage the child with recurrent abdominal pain and dyspepsia
- Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Clinical management – essential general paediatrics
- Gastroenterology
- Clinical Applications
- Medical Sciences
- Long Cases
- Short Cases
- 4. Professional skills and knowledge: Patient management
- 7. Patient safety, including safe prescribing
- 10. Gastroenterology, Hepatology and Nutrition
- Foundation of Practice (FOP)
- Theory and Science (TAS)
- Applied Knowledge in Practice (AKP)
- Clinical
- History
- Communication
- General Pediatrics Content Outline — Gastroenterology
- General Pediatrics Content Outline — Universal Task 3: Diagnosis
- General Pediatrics Content Outline — Universal Task 4: Management and Treatment
- Patient Care 4: Clinical Reasoning
- Patient Care 5: Patient Management
- Medical Knowledge 2: Gastroenterology
- Systems-Based Practice 1: Patient Safety
- Medical Expert
- Pediatrics: Gastroenterology
- Pediatrics: Foundations EPA #8 — Communicating assessment findings and management plans to patients and families
A ten-year-old is referred with three months of gnawing epigastric pain, sometimes waking her at night, and one episode of black stool. Her father had a duodenal ulcer. Before you reach for a breath test or a course of antibiotics, decide what you are actually looking for and how paediatric practice differs from the adult clinic next door. [1] [10]
This page owns the presentation and management logic for peptic disease and H. pylori in childhood. Sister pages carry the deeper algorithms for recurrent and functional abdominal pain, upper gastrointestinal bleeding, and gastro-oesophageal reflux disease. [10] [11]
Overview & Definition
Peptic disease means mucosal injury of the stomach and duodenum driven by acid and pepsin acting on a defence that has been breached. The breach in children comes most often from Helicobacter pylori infection or from drugs and physiological stress, rather than from acid excess alone. A peptic ulcer is a mucosal break that penetrates the muscularis mucosae; a shallower lesion is an erosion or gastritis. [1] [2]
Helicobacter pylori is a spiral, flagellated, gram-negative bacterium that colonises the gastric mucus layer. It is acquired in early childhood, usually by faecal-oral or oral-oral spread within the household, and it persists for decades if untreated. Most infected children never develop an ulcer, which is exactly why indiscriminate testing causes harm. [1] [3]
The decisive paediatric distinction is between primary peptic disease, where H. pylori drives antral gastritis and duodenal ulceration, and secondary disease from NSAIDs, critical-illness stress, or a hypersecretory state. A third and larger group of children has functional dyspepsia with normal mucosa, and they must not be mislabelled or given antibiotics. [2] [10]
References12ShowHide
- [1]Homan M Updated joint ESPGHAN/NASPGHAN guidelines for management of Helicobacter pylori infection in children and adolescents (2023). J Pediatr Gastroenterol Nutr, 2024.PMID 39148213
- [2]Jones NL Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016). J Pediatr Gastroenterol Nutr, 2017.PMID 28541262
- [3]Işık K Temporal trends and correlates of Helicobacter pylori prevalence in children undergoing upper gastrointestinal endoscopy. Eur J Pediatr, 2026.PMID 41954671
- [4]Menbari S Global Profile of Drug Resistance Related to Helicobacter pylori Infection in Children: A Systematic Review and Meta-Analysis. Health Sci Rep, 2025.PMID 40959185
- [5]Chan C Antimicrobial susceptibility-guided treatment is superior to empiric therapy for Helicobacter pylori infection in children. J Pediatr Gastroenterol Nutr, 2025.PMID 40778419
- [6]Vécsei A Helicobacter pylori eradication rates in children upon susceptibility testing based on noninvasive stool polymerase chain reaction versus gastric tissue culture. J Pediatr Gastroenterol Nutr, 2011.PMID 21694538
- [7]Thung I Review article: the global emergence of Helicobacter pylori antibiotic resistance. Aliment Pharmacol Ther, 2016.PMID 26694080
- [8]Malfertheiner P Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut, 2022.PMID 35944925
- [9]Rogalidou M Balancing therapeutic benefits and hidden risks of proton pump inhibitors in pediatric practice: a narrative review and update. Clin Exp Pediatr, 2026.PMID 41736231
- [10]Seetharaman J Recurrent Abdominal Pain in a Child - Evaluation and Management. Indian J Pediatr, 2025.PMID 40148656
- [11]Xu QC Advances in standardized diagnosis and management of pediatric gastrointestinal bleeding. World J Pediatr, 2025.PMID 41045337
- [12]Merola E Helicobacter pylori and Cancer: What's the Link? Clin Exp Gastroenterol, 2026.PMID 41531650