Multicenter data presented by Silvana Bonilla, MD, at NASPGHAN 2025 highlight regional variation in pediatric H. pylori prevalence and support selective biopsy practices guided by clinical suspicion.
At the 2025 North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) Annual Meeting, held in Chicago, Illinois, from November 5–9, 2025, researchers presented findings from a multicenter prospective study evaluating the relationship between Helicobacter pylori infection (HPI) and immune-mediated digestive diseases (IMDD) in children. The study, led by Silvana Bonilla, MD, attending physician, Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, assessed the prevalence of HPI in children with newly diagnosed IMDD, for conditions such as inflammatory bowel disease (IBD), celiac disease (CeD), and eosinophilic esophagitis (EoE).1
The study included 365 children ≤18 years (mean age, 11.6 ± 4.8 years; 53.4% male) enrolled between July 2024 and April 2025 across five countries: the United States (86.6%), Colombia (7.4%), Chile (3.8%), Peru (1.1%), and Cuba (1.1%). Overall, 31 patients (9.3%) tested positive for HPI, with significant geographic variation—Colombia accounted for more than half of positive cases (51.6%), followed by the United States (29%), Cuba (12.9%), and Chile (6.5%) (P < 0.0001).
Children with EoE were significantly more likely to be HPI-positive (48.4% vs 27.2%; P = 0.0131), while CeD was more frequent among those without HPI (52.1% vs 32.3%; P = 0.0346). There was no significant difference in overall IBD prevalence (P = 0.6129). Although HPI prevalence was lower among children with IMDD compared with those with nonspecific gastrointestinal symptoms, none of the differences reached statistical significance (P > 0.05).
“This is very important to mention because there’s a huge difference between adults and children in how we diagnose and treat H. pylori infection,” said Bonilla. “In adults, the standard of care is noninvasive test-and-treat, but in children, we proceed with endoscopy and biopsies based on clinical suspicion to confirm active infection before treatment.”
Bonilla explained that the current findings reinforce existing guideline recommendations. “Our data support the idea that biopsies and culture for H. pylori should be guided mainly by clinical suspicion,” she said. “If you are doing endoscopy and you see nodularity or a duodenal ulcer—anything that suggests H. pylori—then proceed with biopsies for diagnosis, but otherwise not routinely at this point with what we have found.”
The results align with the 2023 joint NASPGHAN/ESPGHAN guidelines, which conditionally recommend against routine H. pylori biopsies in children being evaluated for IBD, CeD, or EoE due to limited evidence suggesting possible protective immune effects.
Looking ahead, Bonilla noted that her team plans to follow these patients longitudinally to better understand how infection status, eradication, and environmental shifts influence disease trajectories. “One key next step is to determine whether H. pylori has a protective effect in certain immune-mediated conditions,” she said. “If that’s the case, it raises important questions about timing—whether we should reconsider early eradication when complications from H. pylori are rare in childhood. We’re also very interested in what happens when children move from high- to low-prevalence regions, like Latin America to North America. Does the immune modulation persist, or does it change with new environmental exposures? So to address these questions, definitely, we plan to follow up these patients over time to better understand how the infection eradication, the shifting environments influence the trajectory of the immune-mediated digestive diseases."
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