Silvana Bonilla, MD, Attending physician, Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA. 

Silvana Bonilla, MD

Multicenter data presented by Silvana Bonilla, MD, at NASPGHAN 2025 highlight regional variation in pediatric H. pylori prevalence and support selective biopsy practices guided by clinical suspicion.

H. pylori geographical prevalence and NASPGHAN/ESPGHAN guidelines, with Silvana Bonilla, MD

At NASPGHAN 2025, 9.3% of children with immune-mediated digestive diseases tested positive for H. pylori, with the highest rates in Colombia and the United States

EoE was more common among H. pylori–positive patients, while CeD was higher in those without infection, supporting targeted rather than routine biopsies.

Lead author Silvana Bonilla, MD, said follow-up studies will examine whether H. pylori may have a protective role in pediatric digestive diseases.

At the 2025 North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) Annual Meeting, held in Chicago, Illinois, from November 5–9, 2025, researchers presented findings from a multicenter prospective study evaluating the relationship between 

 infection (HPI) and immune-mediated digestive diseases (IMDD) in children. The study, led by Silvana Bonilla, MD, attending physician, Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, assessed the prevalence of HPI in children with newly diagnosed IMDD, for conditions such as inflammatory bowel disease (IBD), celiac disease (CeD), and eosinophilic esophagitis (EoE).

The study included 365 children ≤18 years (mean age, 11.6 ± 4.8 years; 53.4% male) enrolled between July 2024 and April 2025 across five countries: the United States (86.6%), Colombia (7.4%), Chile (3.8%), Peru (1.1%), and Cuba (1.1%). Overall, 31 patients (9.3%) tested positive for HPI, with significant geographic variation—Colombia accounted for more than half of positive cases (51.6%), followed by the United States (29%), Cuba (12.9%), and Chile (6.5%) (

Children with EoE were significantly more likely to be HPI-positive (48.4% vs 27.2%; 

 = 0.0131), while CeD was more frequent among those without HPI (52.1% vs 32.3%; 

 = 0.0346). There was no significant difference in overall IBD prevalence (

 = 0.6129). Although HPI prevalence was lower among children with IMDD compared with those with nonspecific gastrointestinal symptoms, none of the differences reached statistical significance (

 Silvana Bonilla, MD, Explores Geographic Patterns of H. Pylori in Pediatric Digestive Disease

“This is very important to mention because there’s a huge difference between adults and children in how we diagnose and treat 

 infection,” said Bonilla. “In adults, the standard of care is noninvasive test-and-treat, but in children, we proceed with endoscopy and biopsies based on clinical suspicion to confirm active infection before treatment.”

Bonilla explained that the current findings reinforce existing guideline recommendations. “Our data support the idea that biopsies and culture for 

 should be guided mainly by clinical suspicion,” she said. “If you are doing endoscopy and you see nodularity or a duodenal ulcer—anything that suggests 

—then proceed with biopsies for diagnosis, but otherwise not routinely at this point with what we have found.”

The results align with the 2023 joint NASPGHAN/ESPGHAN guidelines, which conditionally recommend against routine 

 biopsies in children being evaluated for IBD, CeD, or EoE due to limited evidence suggesting possible protective immune effects.

Looking ahead, Bonilla noted that her team plans to follow these patients longitudinally to better understand how infection status, eradication, and environmental shifts influence disease trajectories. “One key next step is to determine whether 

 has a protective effect in certain immune-mediated conditions,” she said. “If that’s the case, it raises important questions about timing—whether we should reconsider early eradication when complications from 

 are rare in childhood. We’re also very interested in what happens when children move from high- to low-prevalence regions, like Latin America to North America. Does the immune modulation persist, or does it change with new environmental exposures? So to address these questions, definitely, we plan to follow up these patients over time to better understand how the infection eradication, the shifting environments influence the trajectory of the immune-mediated digestive diseases."

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.

Fitch J. Silvana Bonilla, MD, Explores Geographic Patterns of H. Pylori in Pediatric Digestive Disease. HCPLive. Published November 4, 2025. Accessed November 5, 2025. https://www.hcplive.com/view/silvana-bonilla-md-explores-geographic-patterns-of-h-pylori-in-pediatric-digestive-disease

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H. pylori Geographical Prevalence and NASPGHAN/ESPGHAN Guidelines, With Silvana Bonilla, MD

A multicenter study from NASPGHAN 2025 highlights geographic and immune-driven variations in pediatric H. pylori infection across the Americas.

Silvana Bonilla, MD, explores geographic patterns of H. pylori in pediatric digestive disease

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 

 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 

 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%).”

 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 

’s complex immunologic role. “With EoE, the higher prevalence might suggest that 

 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.”

’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 (

Silvana Bonilla, MD

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