Abstract

The last decades have been fulfilled of debates on Helicobacter pylori infection, since its discovery in 1982.Various transmission pathways, pathogenic factors, diagnostic workup and therapeutic lines have been discussed. In Romania, the overall incidence of paediatric infection with H. pylori remains unknown; strong risk factors act mainly in rural areas of our country, such as type of householding, low socioeconomic status, high number of family members, bed-sharing, poor sanitation and deficiencies of watter supply network as water transmission of the bacteria has been described. A low rate of exclusively breastfeeded children may be involved, as human milk has been shown to have a protective effect against H. pylori. The H. pylori associated ulcer, with a high prevalence in the last decades is now declining, while a new entity is emerging, namely the non-H.pylori non-NSAID peptic ulcer. The initial diagnosis of the infection include both positivity of rapid urease test and histopathology or a positive culture. In Romania, the standard triple therapy is largely prescribed by family doctors, alternative regimens being reported only from tertiary centres. In paediatric practice, several causes originate treatment failure: side effects, poor compliance, and resistance to antibiotics. Single centres reports various eradication rates; no studies regarding antibiotic resistance in children were conducted so far. Our country helds top position among European countries considering the frequency of non-prescription use of antimicrobials in the general population, estimated as 30%. During the last two decades a widespread use of certain antibiotics (i.e. clarithromycin for respiratory infections) in general population has increased the occurrence of H. pylori resistance in different countries. According to international guidelines if the resistance rate determined in a region is higher than 20%, current recommendations of clarithromycin-based therapies may be reconsidered, as follows: sequential therapy, bismuth-based triple therapy, prolonged duration of first-line therapy or other antibiotic. A reliable noninvasive test for bacterial eradication should be performed at least 4 to 8 weeks following completition of the therapy, including urea breath test or a monoclonal enzyme immunoassay for detection of H. pylori antigen in stool. Vaccination against H. pylori remains the most challenging issue for developing countries, where the high prevalence of infection is a public health problem.