Treatment practices for Helicobacter pylori infection among pediatric gastroenterologists in Latin America.
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OBJECTIVES: Helicobacter pylori infection remains highly prevalent among children in Latin America, affecting more than 50% of the population. The 2016 pediatric clinical guidelines, adapted to the Latin American context in 2020, were developed to guide treatment practices among pediatric gastroenterologists in the region. However, data on real-world treatment practices and eradication outcomes remain limited. Therefore, we evaluated the management and outcomes of H. pylori infection among previously untreated, symptomatic pediatric patients managed by practicing pediatric gastroenterologists in Latin America. METHODS: Multicenter retrospective observational study conducted from 01/2018 to 06/2024 across 48 centers in 9 Latin American countries. Pediatric gastroenterologists reported treatment-naïve children aged ≤18 years with biopsy-proven H. pylori infection. Data included sociodemographic, and clinical characteristics, treatment regimens and adherence, and eradication outcomes. Multivariable logistic regression identified factors associated with H. pylori eradication failure. RESULTS: Among 488 patients (median age 11 years [range, 1-18]; 51.2% female; 35.6% low socioeconomic status), 20.9% had household H. pylori exposure and 9.1% a family history of gastric cancer. Abdominal pain (86.9%) was the main endoscopy indication; nodular gastropathy (79.9%), erosions (32.9%), and ulcers (6.3%) were common endoscopic findings. Eradication success was 82.8%. Weight-based dosing was suboptimal, especially in the 25-34 kg category. Family history of gastric cancer was associated with higher failure (odds ratio 2.3, p = 0.019). CONCLUSION: Empiric first-line therapies' eradication rate was below the ≥90% target but higher than prior reports from similar settings. Variability in guideline-recommended, weight-based dosing highlights opportunities for improvement.