H. pylori is generally acquired in childhood and the prevalence in developed countries is now decreasing. The clinical manifestations of disease are a result of the host, bacteria and environment interaction, and are only seen in a subset of infected individuals. Its association with peptic ulcer disease, gastric cancer and MALT lymphoma is beyond dispute. A test-and-treat strategy is not indicated for children with recurrent abdominal pain. New indications in children are now emerging advocating its eradication, such as refractory iron deficiency, ITP and a strong family history of gastric cancer, although further studies are needed. Stool antigen tests and urea breath tests have emerged as some of the best non-invasive tests for H. pylori. Antibiotic resistance is on the rise, and novel treatment strategies are needed. Improving the social situation of children such as better housing, sanitation and hygiene remain one of the key pillars in reducing the prevalence of this infection in childhood.

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