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Helicobacter pylori (Hp) infects approximately 50% on the global population. 1 It remains the leading cause of peptic ulcer disease and chronic gastritis and also has associations with gastric cancer.2 ESPGHAN/NASPGHAN guidelines recommend targeted testing, eradication therapy, and mandatory post-treatment re-testing.3 Compliance to these recommendations, particularly with respect to targeted testing and re-testing, varies across centres. South-West London (SWL) has a heterogenous population, in this audit we explored factors associated with infection and concordance of management to guidelines.We aimed to:Assess the demographic of patients presenting with positive Hp in SWLEvaluate adherence to ESPGHAN/NASPGHAN guidelinesIdentify areas for improvement in managementAn audit was conduct on paediatrics patients (<18years at the time of testing), with a confirmed diagnosis of Hp. Data was collected from electronic patient care records and laboratory databases, from the last 2 years. Extracted variables included age, gender, ethnicity, weight percentile, diagnostic modality, treatment regimen and re-testing rates. Management was compared against ESPGHAN/NASPGHAN guidelines.3 Associations between categorical variables and Hp prevalence were assessed using Chi-square goodness of fit test, with p < 0.05 considered statistically significant.A total of 113 patients were identified with confirmed Hp infection. Ethnic distribution, where documented, revealed 66% Black/ Black British, 10% Asian, and 9% White. Statistical analysis revealed that the affected ethnic proportions were statistically significant (χ2 = 115.63, df =4, p< 0.001). Weight percentiles also varied, 30% of those with documented weight were obese, 12% were overweight and 56% were in the healthy range. Statistical analysis revealed this as a statistically significant result (χ2 = 57.73, df= 3, p< 0.001).Regarding management, 65% of patients received correct treatment as per ESPGHAN/NASPGHAN guidelines (omeprazole, amoxicillin, clarithromycin/ metronidazole). However, 56% of patients had no documented re-testing after treatment, and only 18% achieved confirmed eradication. Among those who underwent an oesophago-gastro-duodenoscopy (OGD), none had the recommended 6 or more biopsies retrieved.The collected data highlights notable ethnic disparities in Hp prevalence in SWL, despite the recent 2021 census illustrating an ethnic distribution of 51% White and 25% Black/ Black British in this area as shown in figure 1. This demonstrates an over-representation of Black ethnicity with Hp, calculated as statistically significant (χ2 = 86.81, df= 4, p< 0.001), aligning with existing literature.4 It also demonstrated that 40% of paediatric cases with confirmed Hp are overweight, in accordance with prior studies.5 While initial management largely aligned with ESPHGAN/NASPGHAN guidelines, we identified a lack of appropriate follow up and re-testing in the 6-8 weeks period post treatment.2 This increases the risk of missed treatment failure and persistent infections, which contributes to a rise in antibiotic resistance and long-term gastric complications.This audit highlighted the need for improved awareness of the ESPGHAN/NASPGHAN guidelines in both primary and tertiary care. Ethnic disparities for infections were also noted and may suggest a higher index of suspicion of infection in these groups.References Hassan MN. Global prevalence of helicobacter pylori and its effect on human health. Pure and Applied Biology 2020 Mar 10;9(1).Hsieh H, Yang HB, Sheu BS, Yang YJ. Atrophic gastritis in helicobacter pylori-infected children. Helicobacter 2022 Jun;27(3):e12885.Homan M, Jones NL, Bontems P, Carroll MW, Czinn SJ, Gold BD, et al. Updated joint ESPGHAN/NASPGHAN guidelines for management of Helicobacter pylori infection in children and adolescents (2023). J Pediatr Gastroenterol Nutr. 2024 Sep 15;79(3):758–85.Brown HT, Epplein M, Tang H, Garman K. Abstract PO-183: racial disparities in Helicobacter pylori infection: a systematic review and retrospective study. Cancer Epidemiology, Biomarkers & Prevention 2022 Jan 1;31(1_Supplement):PO-183-PO-183.Suki M, Leibovici Weissman Y, Boltin D, Itskoviz D, Tsadok Perets T, Comaneshter D, et al. Helicobacter pylori infection is positively associated with an increased BMI, irrespective of socioeconomic status and other confounders: a cohort study. Eur J Gastroenterol Hepatol. 2018 Feb;30(2):143–8.Abstract OC89 Figure 1