This pan-European survey evaluated current knowledge and clinical practice of 508 paediatric healthcare professionals from 32 countries regarding *Helicobacter pylori* diagnosis and management in children, benchmarked against ESPGHAN guidelines.
Only 7.5% of respondents fully complied with guidelines; 54% chose clarithromycin empirically (against resistance-aware recommendations), 43% considered test-and-treat, and 30% were unaware of local *H. pylori* prevalence.
Survey-based design limits causal inference; response bias likely since participants were ESPGHAN national society members (may overrepresent engaged specialists); full-text was inaccessible, so granular subgroup data could not be verified.
Guideline adherence for paediatric *H. pylori* is very low across Europe — particularly around empirical clarithromycin use and testing indications. Targeted education initiatives for European paediatric gastroenterologists are urgently needed.
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