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H. pylori – no test-and-treat — RACP Paediatrics MCQ

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HardGIH. pylori – no test-and-treatRACP Paediatrics

A 10-year-old has chronic functional-type abdominal pain, normal growth, normal inflammatory markers and no ulcer alarm features. A parent requests a stool Helicobacter pylori antigen test and eradication treatment if positive. What is the best response?

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Correct answer: C — Investigate symptom cause; reserve biopsy testing for clinically indicated endoscopy

Explanation lettering: C = shown as B · D = shown as C · B = shown as D

D is correct because paediatric guidance rejects adult-style test-and-treat: the primary aim is to identify the cause of symptoms, and H. pylori diagnosis is pursued with biopsies when endoscopy is clinically indicated. A risks resistance and treats a non-causal finding without susceptibility guidance. B repeats the same inappropriate population strategy. C serology cannot establish active infection or confirm eradication. E makes family exposure alone an indication for invasive testing in an otherwise low-risk child. The joint paediatric gastroenterology guideline is internationally accepted, applicable in Australia and consistent with antimicrobial stewardship.

Reference: Royal Children’s Hospital Melbourne, Helicobacter pylori: https://www.rch.org.au/immigranthealth/clinical/Helicobacter_pylori/; ESPGHAN/NASPGHAN 2024 guideline, Helicobacter pylori in children and adolescents: https://naspghan.org/wp-content/uploads/2024/10/J-pediatr-gastroenterol-nutr-2024-Homan-Updated-joint-ESPGHAN-NASPGHAN-guidelines-for-management-of-Helicobacter.pdf