# Helicobacter Pylori and Peptic Ulcer in Children > Helicobacter pylori and peptic ulcer in children for NEET-PG Paediatrics: diagnostic tests, when to test, eradication regimens and test of cure. - Canonical URL: https://prepelephant.com/topics/neet-pg/paediatrics/helicobacter-pylori-and-peptic-ulcer-in-children - Exam / course: NEET-PG · Subject: Paediatrics - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-08 - Last updated: 2026-10-08 - Reference basis: Nelson Textbook of Pediatrics; NASPGHAN and ESPGHAN guidance on Helicobacter pylori in children - How to cite: "Helicobacter Pylori and Peptic Ulcer in Children", PrepElephant, https://prepelephant.com/topics/neet-pg/paediatrics/helicobacter-pylori-and-peptic-ulcer-in-children ## Direct answer Helicobacter pylori is a spiral, microaerophilic gram-negative bacterium that colonises the gastric antrum and is the commonest identifiable cause of peptic ulcer disease in children, particularly duodenal ulcers. Testing is indicated for ulcer disease, persistent dyspepsia or unexplained iron deficiency. Eradication uses a 14-day course of a proton pump inhibitor with two antibiotics, followed by a test of cure, because treatment failure is common when clarithromycin resistance is present. ## What you must remember - **Organism:** urease-producing spiral bacillus; urease splits urea into ammonia, buffering the acid around the organism. - **Non-invasive tests:** urea breath test and stool antigen test; both need the PPI withheld for about two weeks beforehand. - **Invasive tests:** endoscopic biopsies for histology, rapid urease test and culture; recent PPI or antibiotics can cause false negatives. - **Serology:** IgG shows past or present exposure but cannot confirm active infection or cure. - **Testing indications:** peptic ulcer, persistent dyspepsia, unexplained iron deficiency, gastric MALT lymphoma and family history of gastric cancer. - **First-line regimen:** PPI with amoxicillin and clarithromycin for 14 days, with local resistance data guiding the choice. - **Penicillin allergy:** metronidazole replaces amoxicillin in the regimen. - **Test of cure:** breath test or stool antigen at least four weeks after therapy ends. ## A stepwise pathway from suspicion to test of cure A 12-year-old presents with epigastric pain, night waking and melaena, with a haemoglobin of 8 g/dL. The task is to confirm H pylori and treat it, rather than relying on acid suppression alone. 1. **Decide on endoscopy.** Bleeding, persistent symptoms or refractory disease need endoscopy, which also gives biopsies for histology and culture. 2. **Choose the test.** When endoscopy is not needed, a urea breath test or stool antigen is used, with the PPI withheld for about two weeks if clinically safe. 3. **Start eradication.** PPI, amoxicillin and clarithromycin for 14 days, with doses by weight as per the national formulary. 4. **Watch for adverse effects.** Diarrhoea, metallic taste and rash are common and usually mild. 5. **Check for cure.** Breath test or stool antigen at least four weeks after the course ends. 6. **Rescue if it fails.** Switch to bismuth quadruple therapy or a susceptibility-guided regimen; tetracycline is generally avoided in young children because of tooth staining. 7. **Review the ulcer.** Confirm healing, and repeat endoscopy if a gastric ulcer or bleeding persists. ## Where the exam tries to catch you Exam vignettes often test whether you can match the test to the clinical situation. - **Trap:** using serology to confirm active infection in a child. **Correct:** IgG indicates exposure, not current infection, so a positive result alone does not establish disease or cure. - **Trap:** doing a breath test while the child is still on a PPI. **Correct:** the PPI causes false negatives, so withhold it where safe, or use biopsy-based tests in a bleeding child. - **Trap:** repeating the same clarithromycin regimen after failure. **Correct:** rescue therapy changes the regimen, such as bismuth quadruple, guided by local resistance patterns. - **Trap:** attributing every childhood ulcer to H pylori. **Correct:** NSAIDs, steroids and rare hypersecretory states such as gastrinoma must be considered when testing is negative. ## Frequently asked questions ### Which test is preferred to confirm eradication of Helicobacter pylori in a child? The urea breath test or stool antigen test is preferred to confirm eradication of Helicobacter pylori in a child. It should be done at least four weeks after the antibiotics finish, with the PPI withheld for about two weeks before the test. ### Why is serology not used to confirm Helicobacter pylori cure in children? Serology measures IgG antibody, which remains positive for a long time after the organism has been cleared. A positive serology therefore cannot separate a past infection from a current one, so it is not used as a test of cure. ### What is the standard first-line eradication regimen for Helicobacter pylori in children? The standard first-line regimen for Helicobacter pylori in children is a proton pump inhibitor with amoxicillin and clarithromycin for 14 days. Local clarithromycin resistance data should guide the choice, and bismuth quadruple therapy is used when resistance is likely. ### Why is tetracycline avoided in younger children receiving Helicobacter pylori therapy? Tetracycline is generally avoided in younger children receiving Helicobacter pylori therapy because it causes permanent tooth staining during tooth development. Regimens for these children are therefore chosen by age and local guidance, with bismuth quadruple therapy reserved for older children. ### Which non-Helicobacter causes of peptic ulcer should be excluded in children? NSAID and steroid use, stress-related mucosal injury and rare hypersecretory states such as gastrinoma should be considered in children with peptic ulcer. Medication history should be taken in every case, because drug-related ulceration is a common and easily missed cause.