Helicobacter pylori is generally acquired in childhood, and the prevalence of this infection varies between and within populations and is decreasing in the developed world. The clinical manifestation of diseases is dependent on the interaction between host, environmental and bacterial factors. The mode of transmission is likely person to person. Strong evidence has accumulated, establishing the causal link between peptic ulcer disease, gastric cancer and mucosal associated lymphoma with H. pylori infection. The association with refractory iron deficiency anemia and idiopathic thrombocytosis purpura are compelling but need more studies. New indications for the eradication of H. pylori are emerging - such as those with strong family history of gastric cancer. Prevention of gastric cancer may require eradication of this bacterium in childhood prior to the development of precancerous lesions. A test-and-treat strategy is not indicated for those with recurrent abdominal pain. In addition, the rate of antibiotic resistance has increased in some populations. Novel eradication strategies need to be developed. Improving the children socioeconomic situation, such as better housing, sanitation and hygiene, remains one of the major pillars in reducing the prevalence of H. pylori children and its diseases burden.

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