{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:39:03Z","timestamp":1760150343587,"version":"build-2065373602"},"reference-count":53,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,10,28]],"date-time":"2023-10-28T00:00:00Z","timestamp":1698451200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Helicobacter pylori antibiotic resistance has increased worldwide and affects the effectiveness of current therapies. The recommended first-line empiric treatment should be tailored to the local clarithromycin resistance rate. This study aimed to determine the pediatric patient profile and rate of clarithromycin resistance for patients diagnosed with Helicobacter pylori by gastric biopsy. Methods: We studied 84 positive gastric samples for Helicobacter pylori. Positive results were confirmed by a rapid urease test and histopathological examination, with the type of gastritis established according to the Sydney System. Gastric biopsy samples were stored in RNA saver. Clarithromycin resistance was determined by a real-time polymerase chain reaction-based molecular assay after RNA-DNA extraction. Results: Of the 84 biopsy samples analyzed, 35 (41.6%) were resistant to clarithromycin. Clarithromycin resistance was found mainly in girls (80%) with a mean age of 15 years (range 6\u201317 years). The history of prior exposure to clarithromycin was 91.6%. The concordance between the histopathological examination and the PCR test was 100%. Conclusions: One in 2.4 children infected with Helicobacter pylori had a strain resistant to clarithromycin. This resistant strain may be a reason for treatment failure in Romanian children, yet this is uninvestigated. The high rate of bacterial resistance to this antibiotic among children indicates the need for susceptibility testing before therapy.<\/jats:p>","DOI":"10.3390\/children10111752","type":"journal-article","created":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T09:27:28Z","timestamp":1698658048000},"page":"1752","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pattern of Primary Resistance of Helicobacter pylori to Clarithromycin among Pediatric Patients from North-Eastern Romania"],"prefix":"10.3390","volume":"10","author":[{"given":"Oana-Maria","family":"Rosu","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Str., 540139 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8713-5367","authenticated-orcid":false,"given":"Nicoleta","family":"Gimiga","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2183-0690","authenticated-orcid":false,"given":"Roxana","family":"Popescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ileana","family":"Ioniuc","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen Daniela","family":"Rusu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatiana","family":"Clipa","sequence":"additional","affiliation":[{"name":"Medical Genetics Department, \u201cCuza Voda\u201d Clinical Hospital of Obstetrics and Gynecology, 34 Cuza Voda Str., 700038 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana-Maria","family":"Florea","sequence":"additional","affiliation":[{"name":"Medical Genetics Department, \u201cCuza Voda\u201d Clinical Hospital of Obstetrics and Gynecology, 34 Cuza Voda Str., 700038 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doina-Anca","family":"Ple\u0219ca","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 21 Dionisie Lupu Str., 020021 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4376-4874","authenticated-orcid":false,"given":"Alexandru","family":"Nemtoi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Biological Sciences, \u201cStefan cel Mare\u201d University of Suceava, 13 Universitatii Str., 720229 Suceava, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Tataranu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Biological Sciences, \u201cStefan cel Mare\u201d University of Suceava, 13 Universitatii Str., 720229 Suceava, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1394-8648","authenticated-orcid":false,"given":"Gabriela","family":"Stefanescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Smaranda","family":"Diaconescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cTitu Maiorescu\u201d University of Medicine, 67A Gheorghe Petrascu Str., 031592 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"17754","DOI":"10.1038\/s41598-022-21661-y","article-title":"Alarming Antibiotics Resistance of Helicobacter pylori from Children in Southeast China over 6 Years","volume":"12","author":"Shu","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/5584_2019_361","article-title":"Helicobacter Pylori Infection in Children and Adolescents","volume":"1149","author":"Okuda","year":"2019","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1053\/j.gastro.2017.04.022","article-title":"Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis","volume":"153","author":"Hooi","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00535-006-1990-z","article-title":"Helicobacter pylori: Present Status and Future Prospects in Japan","volume":"42","author":"Suzuki","year":"2007","journal-title":"J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"103824","DOI":"10.1016\/j.amsu.2022.103824","article-title":"Evaluation of Antibiotic Resistance of Helicobacter pylori Bacteria Obtained from Gastric Biopsy Samples: A Cohort Study","volume":"78","author":"Azadbakht","year":"2022","journal-title":"Ann. Med. Surg."},{"key":"ref_6","first-page":"809","article-title":"Evaluation of Helicobacter pylori Infection in Patients with Eso-Gastro-Duodenal Pathology","volume":"58","author":"Olar","year":"2017","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_7","first-page":"3488","article-title":"Prevalence of Helicobacter pylori Infection Among Dyspeptic Patients in Northwestern Romania: A Decreasing Epidemiological Trend in the Last 30 Years","volume":"20","author":"Corojan","year":"2020","journal-title":"Exp. Ther. Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Dom\u0219a, A.-M.T., Lupu\u0219oru, R., Gheban, D., \u0218erban, R., and Borzan, C.M. (2020). Helicobacter pylori Gastritis in Children\u2014The Link between Endoscopy and Histology. J. Clin. Med., 9.","DOI":"10.3390\/jcm9030784"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1097\/MPG.0000000000001594","article-title":"Joint ESPGHAN\/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016)","volume":"64","author":"Jones","year":"2017","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1111\/j.1440-1746.2010.06536.x","article-title":"The Sydney System for Classification of Gastritis 20 Years ago","volume":"26","author":"Sipponen","year":"2011","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_11","first-page":"3","article-title":"Facing Resistance of H. Pylori Infection","volume":"4","author":"Zali","year":"2011","journal-title":"Gastroenterol. Hepatol. Bed Bench."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1097\/MPG.0000000000002816","article-title":"Helicobacter pylori Infection in Pediatric Patients Living in Europe: Results of the EuroPedHP Registry 2013 to 2016","volume":"71","author":"Kori","year":"2020","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Bujanda, L., Nyssen, O.P., Vaira, D., Saracino, I.M., Fiorini, G., Lerang, F., Georgopoulos, S., Tepes, B., Heluwaert, F., and Gasbarrini, A. (2021). Antibiotic Resistance Prevalence and Trends in Patients Infected with Helicobacter pylori in the Period 2013\u20132020: Results of the European Registry on H. pylori Management (Hp-EuReg). Antibiotics, 10.","DOI":"10.3390\/antibiotics10091058"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/j.gastrohep.2016.05.003","article-title":"IV Spanish Consensus Conference on Helicobacter pylori Infection Treatment","volume":"39","author":"Gisbert","year":"2016","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_15","unstructured":"(2023, February 05). World Health Organization: List of Bacteria for Which New Antibiotics Are Urgently Needed. Available online: http:\/\/Who.Int\/Mediacentre\/News\/Releases\/2017\/Bacteria-Antibiotics-Needed\/En\/."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"516","DOI":"10.3855\/jidc.15420","article-title":"Dental Risk Factors Associated with Oral Helicobacter pylori Infection: A Cross-Sectional Study Based on Saliva Antigen Test","volume":"16","author":"Almashhadany","year":"2022","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.jcma.2014.11.004","article-title":"A Novel One-Step Helicobacter pylori Saliva Antigen Test","volume":"78","author":"Yang","year":"2015","journal-title":"J. Chin. Med. Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Gastli, N., Allain, M., Lamarque, D., Abitbol, V., Billo\u00ebt, A., Collobert, G., Coriat, R., Terris, B., Kalach, N., and Raymond, J. (2021). Diagnosis of Helicobacter pylori Infection in a Routine Testing Workflow: Effect of Bacterial Load and Virulence Factors. J. Clin. Med., 10.","DOI":"10.3390\/jcm10132755"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Milani, M., Moaddab, Y., and Sharifi, Y. (2019). One Piece Biopsy for Both Rapid Urease Test and Cultivation of Helicobacter pylori. J. Microbiol. Methods, 164.","DOI":"10.1016\/j.mimet.2019.105674"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"406","DOI":"10.4103\/ijmm.IJMM_17_246","article-title":"Detection of Clarithromycin-Resistant Helicobacter pylori by Polymerase Chain Reaction Using Residual Samples from Rapid Urease Test","volume":"35","author":"Jeon","year":"2017","journal-title":"Indian J. Med. Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Bogiel, T., Mikucka, A., Szaflarska-Pop\u0142awska, A., and Grzanka, D. (2023). Usefulness of Molecular Methods for Helicobacter pylori Detection in Pediatric Patients and Their Correlation with Histopathological Sydney Classification. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24010179"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Skrebinska, S., Megraud, F., Daugule, I., Santare, D., Isajevs, S., Liepniece-Karele, I., Bogdanova, I., Rudzite, D., Vangravs, R., and Kikuste, I. (2022). Who Could Be Blamed in the Case of Discrepant Histology and Serology Results for Helicobacter pylori Detection?. Diagnostics, 12.","DOI":"10.3390\/diagnostics12010133"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1159\/000497810","article-title":"Accuracy of Different Rapid Urease Tests in Comparison with Histopathology in Patients with Endoscopic Signs of Gastritis","volume":"101","author":"Dechant","year":"2020","journal-title":"Digestion"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1177\/2050640618787055","article-title":"Contribution of Genetic Amplification by PCR for the Diagnosis of Helicobacter Pylori Infection in Patients Receiving Proton Pump Inhibitors","volume":"6","author":"Bazin","year":"2018","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e651","DOI":"10.1542\/peds.2010-0941","article-title":"Association between Helicobacter pylori and Gastrointestinal Symptoms in Children","volume":"125","author":"Spee","year":"2010","journal-title":"Pediatrics"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Helmbold, L., Ghebremedhin, B., Bellm, A., Hopkins, M.A., Wirth, S., and Aydin, M. (2022). Increased Antibiotic Resistance in Children with Helicobacter pylori Infection: A Retrospective Study. Pathogens, 11.","DOI":"10.3390\/pathogens11020178"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1016\/j.gie.2014.09.010","article-title":"The Concordance of Endoscopic and Histologic Findings of 1000 Pediatric EGDs","volume":"81","author":"Sheiko","year":"2015","journal-title":"Gastrointest. Endosc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.anndiagpath.2018.12.002","article-title":"Hit or a miss: Concordance between Histopathologic-Endoscopic Findings in Gastric Mucosal Biopsies","volume":"38","author":"Chen","year":"2019","journal-title":"Ann. Diagn. Pathol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1097\/MPG.0b013e318298020a","article-title":"Endoscopic and Histologic Analysis of Gastric Mucosa-Associated Lymphoid Tissue in Children with Helicobacter pylori Infection","volume":"57","author":"Yang","year":"2013","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1111\/j.1443-1661.2010.00943.x","article-title":"Endoscopic Identification of Helicobacter pylori Gastritis in Children","volume":"22","author":"Hidaka","year":"2010","journal-title":"Dig. Endosc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1590\/S1517-838246220140234","article-title":"Prevalence of Helicobacter pylori in Children in Eastern Turkey and Molecular Typing of Isolates","volume":"46","author":"Ozbey","year":"2015","journal-title":"Braz. J. Microbiol."},{"key":"ref_32","first-page":"499","article-title":"Prevalence of Helicobacter pylori among Children in A Training and Research Hospital Clinic in Istanbul and Comparison with Uptdated Sydney Classification Criteria","volume":"7","author":"Inceman","year":"2020","journal-title":"North Clin. Istanb."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/MPG.0000000000003259","article-title":"Systematic Review and Meta-analysis of Histological Gastric Biopsy Aspects according to the Updated Sydney System in Children","volume":"74","author":"Kalach","year":"2022","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"31","DOI":"10.16899\/jcm.705046","article-title":"Pylori Infection and Antral Nodular Gastritid in Children","volume":"10","author":"Urganci","year":"2020","journal-title":"J. Contemp. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1067\/mge.2001.111043","article-title":"Antral Nodularity Identifies Children Infected with Helicobacter pylori with Higher Grades of Gastric Inflammation","volume":"53","author":"Luzza","year":"2001","journal-title":"Gastrointest. Endosc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1097\/00005176-200302000-00011","article-title":"Endoscopic Nodular Gastritis: An Endoscopic Indicator of High-Grade Bacterial Colonization and Severe Gastritis in Children with Helicobacter pylori","volume":"36","author":"Maguilnick","year":"2003","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1590\/S0004-28032009000400015","article-title":"Evaluation of Gastric Histology in Children and Adolescents with Helicobacter pylori Gastritis Using the Update Sydney System","volume":"46","author":"Langner","year":"2009","journal-title":"Arq. Gastroenterol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"240","DOI":"10.3349\/ymj.2007.48.2.240","article-title":"Nodular Gastritis and Pathologic Findings in Children and Young Adults with Helicobacter pylori Infection","volume":"48","author":"Koh","year":"2007","journal-title":"Yonsei Med. J."},{"key":"ref_39","first-page":"226","article-title":"Real-Time PCR Detection and Quantitation of Helicobacter pylori Clarithromycin-Resistant Strains in Archival Material and Correlation with Sydney Classification","volume":"26","author":"Gazi","year":"2013","journal-title":"Ann. Gastroenterol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1155\/2007\/462804","article-title":"Helicobacter pylori Infection in Ontario: Prevalence and Risk Factors","volume":"21","author":"Naja","year":"2007","journal-title":"Can. J. Gastroenterol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1080\/21556660.2020.1854560","article-title":"Prevalence of Helicobacter pylori Infection and the Incidence of the Associated Malignant and Peptic Ulcer Disease (PUD) at Nelson Mandela Academic Hospital: A Retrospective Analysis","volume":"10","author":"Molaoa","year":"2021","journal-title":"J. Drug Assess."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"173","DOI":"10.4167\/jbv.2008.38.4.173","article-title":"Patterns of Helicobacter pylori Resistance to Metronidazole, Clarithormycin and Amoxicillin in Saudi Arabia","volume":"38","author":"Marie","year":"2008","journal-title":"J. Bacteriol. Virol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/hel.12414","article-title":"Helicobacter pylori Infection in Children","volume":"22","author":"Kalach","year":"2017","journal-title":"Helicobacter"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Li, J., Deng, J., Wang, Z., Li, H., and Wan, C. (2021). Antibiotic Resistance of Helicobacter pylori Strains Isolated from Pediatric Patients in Southwest China. Front. Microbiol., 11.","DOI":"10.3389\/fmicb.2020.621791"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"9303072","DOI":"10.1155\/2019\/9303072","article-title":"Prevalence and Risk Factors of Helicobacter pylori Infection among Children Aged 1 to 15 Years at Holy Innocents Children\u2019s Hospital, Mbarara, South Western Uganda","volume":"2019","author":"Aitila","year":"2019","journal-title":"J. Trop. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"10348","DOI":"10.3748\/wjg.v20.i30.10348","article-title":"Prevention of Helicobacter pylori Infection in Childhood","volume":"20","author":"Yucel","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1046\/j.1440-1746.2000.02070.x","article-title":"Helicobacter pylori Infection Occurs via Close Contact Infected Individuals in Early Childhood","volume":"15","author":"Miyaji","year":"2000","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1111\/apt.13364","article-title":"Prevalence and Risk Factors of Helicobacter pylori infection in Asymptomatic Chinese Children: A Prospective, Cross-Sectional, Population-Based Study","volume":"42","author":"Ding","year":"2015","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Burayzat, S., Al-Tamimi, M., Barqawi, M., Massadi, M.S., Abu-Raideh, J., Albalawi, H., Khasawneh, A.I., Himsawi, N., and Barber, M. (2023). Antimicrobial Resistance Molecular Mechanisms of Helicobacter pylori in Jordanian Children: A Cross-Sectional Observational Study. Antibiotics, 12.","DOI":"10.3390\/antibiotics12030618"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Le, L.T.T., Nguyen, T.A., Nguyen, N.A., Nguyen, Y.T.H., Nguyen, H.T.B., Nguyen, L.T., Vi, M.T., and Nguyen, T. (2022). Antibiotic Resistance of Helicobacter pylori in Children with Gastritis and Peptic Ulcers in Mekong Delta, Vietnam. Healthcare, 10.","DOI":"10.3390\/healthcare10061121"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"96","DOI":"10.5223\/pghn.2016.19.2.96","article-title":"Updates on the Diagnosis of Helicobacter pylori Infection in Children: What Are the Differences between Adults and Children?","volume":"19","author":"Yang","year":"2016","journal-title":"Pediatr. Gastroenterol. Hepatol. Nutr."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1053\/adpa.2000.17871","article-title":"Helicobacter pylori Gastritis in Children and Adults: Comparative Histopathologic Study","volume":"4","author":"Whitney","year":"2000","journal-title":"Ann. Diagn. Pathol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1038\/mi.2012.133","article-title":"Downregulated Th17 Responses are Associated with Reduced Gastritis in Helicobacter pylori\u2013Infected Children","volume":"6","author":"Serrano","year":"2013","journal-title":"Mucosal Immunol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/11\/1752\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:13:30Z","timestamp":1760130810000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/11\/1752"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,28]]},"references-count":53,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["children10111752"],"URL":"https:\/\/doi.org\/10.3390\/children10111752","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2023,10,28]]}}}