Detection of Helicobacter pylori infection in children with a standardized and simplified 13C-urea breath test.
BACKGROUND
The 13C-urea breath test, a reliable noninvasive method of detection of Helicobacter pylori in adults, needs validation in children.


METHODS
In order to evaluate the diagnostic accuracy of 13C-urea breath test in children, the results of this test performed in 144 children were correlated with the histology and culture of contemporaneous gastric (antral and fundic) biopsy specimens. The test was performed with 2 mg/kg body weight 13C-Urea (maximum, 100 mg) ingested after a fat-rich test meal. Samples of expired breath taken at 0, 5, 10, 20, and 30 minutes were assayed with mass spectrometry. Results were considered positive when the curve of excretion of labeled carbon dioxide in the expired breath increased by 5%O or more above the baseline.


RESULTS
Discrepancies in H. pylori status were observed in 14 children. To improve and simplify the test, the results were reanalyzed using different cutoff values for each sampling time. The best results, with sensitivity of 95.7% and specificity of 95.2%, were obtained with a cutoff of 3.5%O at 20 minutes.


CONCLUSIONS
The 13C-urea breath test is a reliable method for the noninvasive detection of H. pylori infection in children. The test can be simplified and its accuracy improved using only the 0- and 20-minute breath samples and a cutoff of 3.5%O instead of the classical 5%O used in adults. The need for modification of the cutoff value may reflect the higher production of endogenous CO2 in children.
Cadranel
S
S
Department of Paediatric Gastroenterology-Hepatology, Queen Fabiola Children's Hospital, Free University of Brussels, Belgium.
Corvaglia
L
L
Bontems
P
P
Deprez
C
C
Glupczynski
Y
Y
Van Riet
A
A
Keppens
E
E
D000293:Adolescent; D001944:Breath Tests; D002247:Carbon Isotopes; D002648:Child; D002675:Child, Preschool; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D012680:Sensitivity and Specificity; D014508:Urea / Q000032:analysis*
D002247:Carbon Isotopes; D014508:Urea