THE ROLE OF THE GASTROINTESTIAL MICROBIOTA Helicobacter pylori, AND CLINICAL ALGORITHS FOR THE DIAGNOSIS OF CHRONIC GASTRITIS IN CHILDREN: FROM PATHOPHYSIOLOGY TO PRACTICE
DOI:
https://doi.org/10.61699/cjmps-v3-i3-4-p33-45Keywords:
chronic gastritis, children, Helicobacter pylori, gut microbiota, dysbiosis, diagnosis, eradication therapy, probiotics, personalized approach, allergyAbstract
Chronic gastritis in children is a multifactorial disease in which disturbances of the gastric and intestinal microbiocenosis, as well as persistent Helicobacter pylori infection, play a key role in its pathogenesis. This review focuses on the current understanding of the formation of the microbiota in childhood and its bidirectional interaction with the mucosal immune system, which forms the basis for the development of chronic inflammation. Special attention is given to the impact of H. pylor i on the composition and function of the gastric microbiota, as well as the immunopathological mechanisms that lead to gastritis. The article systematizes clinical diagnostic algorithms based on the principles of evidence-based medicine and risk stratification, justifying the choice between non-invasive tests and endoscopy with biopsy. It also discusses in detail modern strategies for eradication therapy, taking into account regional resistance, as well as the potential role of microbiota modulators (probiotics, prebiotics, and megabiotics) as adjuvants to improve the effectiveness and tolerability of treatment. Practical recommendations supported by clinical cases are aimed at developing a personalized, safe, and effective approach to managing children with chronic gastritis in real clinical practice.
Aim. To conduct a systematic review of current evidence on the role of microbiota in pediatric chronic gastritis development, evaluate diagnostic algorithms, and propose optimized treatment regimens incorporating microbial community modulation.
Results. The review demonstrates that H. pylori acts as a potent “engineer” of the gastric microbial ecosystem and can modulate immune responses, contributing to the “allergy-infection” paradox. A stratified diagnostic approach based on clinical symptoms and “alarm signs” minimizes unwarranted invasive procedures. Modern eradication therapy must account for regional antibiotic resistance patterns and include adjuvant probiotics to enhance efficacy and reduce side effects. For asymptomatic infection in children with atopic conditions, a watchful waiting strategy may be considered.
Conclusion. Effective management of chronic gastritis in children requires a holistic perspective integrating microbiota assessment, clinical presentation, and family history. Treatment personalization based on these factors is paramount for achieving successful long-term outcomes.
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