Silvana Bonilla, MD, discusses geographic patterns of H. Pylori in pediatric digestive disease

At the 2025 Annual North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) meeting, held in Chicago, Illinois, from November 5–9, 2025, investigators will present new multicenter data exploring the role of Helicobacter pylori infection (HPI) in children with immune-mediated digestive diseases (IMDD). The study, led by Silvana Bonilla, MD, attending physician, Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, examined HPI prevalence across diverse pediatric populations in the Americas.

“We wanted to add to the literature and the knowledge of H. pylori infection in pediatrics,” Bonilla said. “A lot of the data comes from adults, and believe it or not, a lot of the data, too, comes from geographic regions — mainly Asia and Europe — where it’s more prevalent. But we have really scarce data in our region, particularly in the Americas.”

The multicenter prospective study included 365 children with newly diagnosed eosinophilic esophagitis (EoE), celiac disease (CeD), or inflammatory bowel disease (IBD), comparing them with children who underwent endoscopy for nonspecific gastrointestinal symptoms. Overall, 9.3% tested positive for HPI, with notable geographic variation — over half of positive cases (51.6%) came from Colombia.

“When we see countries like Colombia, for example, there are very high rates overall, up to 50%, and correspondingly higher rates among patients with immune-mediated digestive diseases. If you compare that with Chile, in the same region and the same subcontinent, you see much lower prevalence (6.5%).”

• H. pylori was more common in children with EoE (48.4% vs. 27.2%).
• Celiac disease was more common among HPI-negative patients (52.1% vs. 32.3%).
• No significant difference was observed in overall IBD prevalence.

According to Bonilla, these findings underscore H. pylori’s complex immunologic role. “With EoE, the higher prevalence might suggest that H. pylori could play a role in modulating or even amplifying certain immune pathways involving inflammation,” she explained. “On the other hand, in celiac disease, our findings were pretty much in line with what has been found before — that possible protective effect that kind of guided the guideline recommendations.”

Bonilla added that H. pylori’s influence on the immune system, including its ability to promote regulatory T-cell responses and alter gut microbiota composition, may help explain these divergent effects across diseases. “In certain immune digestive diseases, it may help balance, and then this balance can be lost in other conditions,” she said.

Percentage of patients that tested positive for HPI by geographic variation (P < 0.0001)

Columbia - 51.6%

United States - 29%

Cuba - 12.9%

Chile - 6.5%

Reference:

Bonilla S, et al. HELICOBACTER PYLORI INFECTION AND IMMUNE-MEDIATED DIGESTIVE DISEASES IN CHILDREN OF THE AMERICAS: A CROSS-SECTIONAL STUDY OF COMPARATIVE PREVALENCE. Abstract. Presented at: 2025 NASPGHAN Annual Meeting. November 5-9, 2025. Chicago, Illinois.