Discrepancies in current practice for diagnosis and treatment against recommended ESPGHAN-NASPGHAN guidelines: a multicentre audit on <i>Helicobacter pylori</i> infection in children

Objective To evaluate the current practice of diagnosing and managing Helicobacter pylori infection in children across UK centres and compare to European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)-North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines. Design/method We conducted a retrospective, multicentre audit across nine National Health Service (NHS) trusts between April 2023 and June 2024 on stool antigen tests performed in children ≤16 years. Information collected included test indication, demographics, treatment regimens and follow-up. Practices were compared with international guideline recommendations. Further data were collected from one of the trusts with regards to symptoms when tests were performed, and primary care data were gathered from a single-practice retrospective audit. Results From over 1900 stool antigen tests, 249 (13%) were positive, with a mean age of the patients investigated of 9.6 years. Of the 249 positive tests, 209 (84%) were for initial diagnosis and 38 (15%) for eradication confirmation. Empirical eradication therapy was common; however, 88% of primary treatment and 60% of re-treatment courses deviated from ESPGHAN-NASPGHAN guidance, particularly in treatment duration. Follow-up stool antigen testing was performed in only 53% of initial diagnosis cases and 64% of eradication therapy cases, often outside the recommended timeframe. Symptom profiles varied between primary and secondary care referrals, but abdominal pain remained the most frequent indication for testing. Conclusion UK paediatric practice in managing H. pylori infection frequently diverges from international guidelines. The findings underscore the need for harmonisation of national guidance with international paediatric-specific recommendations and to improve clinician education in order to promote consistent, evidence-based care and responsible antibiotic use.