title: 13C-urea breath test, referral patterns, and results in children.
abstract: BACKGROUND
  The family is the core unit for Helicobacter pylori (Hp) infection. In most instances, Hp colonization occurs in early childhood, and correlates with socioeconomic parameters. Helicobacter pylori infection is highly prevalent in many countries, and may cause chronic gastritis and peptic ulcer in adults and in children. Gastritis induced by Hp may be associated with recurrent abdominal pain in children, and eradication of the bacterium may improve the clinical symptoms. AIM The primary aim of this study is to characterize the group of pediatric patients according to the referral patterns and results of 13C-urea breath test (13C -UBT) in our laboratory. The secondary aim is to investigate the result of different treatment combinations for Hp eradication.
  
  
  METHODS
  The 13C-UBT was performed with 75 mg urea labeled with 13C in 200 mL orange juice. Breath samples were collected at 0 and 30 minutes, and the results expressed as the change in the 13C/12C ratio at T30' minus T0' The cutoff for Hp eradication was 3.5. The physicians who ordered the test completed a questionnaire covering demographic data (age, gender, and origin), indication for the test was use of a proton pump inhibitor (PPI), and type of combination eradication therapy.
  
  
  RESULTS
  The study sample consisted of 1655 children, aged 1 to 18 years, 992 (59.9%) boys and 663 (40.1%) girls, from all parts of the country. The 13C-UBT was positive in 763 (46.1%). The prevalence of positive results was directly correlated with age. History of peptic disease was the main indication for the test, in 1346 (81.4%) cases. Details on eradication therapy were available for 435 children of whom 42.5% had a positive 13C-UBT, indicating a successful eradication rate of 57.5%. Compared with Israeli and American-European origin, children of Asian-African origin had a higher rate of referrals for reason of validation of successful Hp eradication, greater long-term PPI use, and a higher rate of 13C-UBT positivity. No significant difference was demonstrated between the triple therapy regimens used.
  
  
  CONCLUSIONS
  13C-UBT may be performed in children of all age groups. The main indication is a history of peptic ulcer disease. The prevalence of Hp infection increased with age and the only factor associated with increased Hp infection was Asian-African origin. The most frequent eradication therapy used in children is a combination of omeprazole, amoxicillin, and clarithromycin.
authors.affiliation: Department of Gastroenterology, Beilinson Campus, Rabin Medical Center, Petach Tiqwa, 49100, Israel. yniv@clalit.org.il
authors.forename: Yaron
authors.initials: Y
authors.lastname: Niv
authors.forename: Galia
authors.initials: G
authors.lastname: Abuksis
authors.forename: Rivka
authors.initials: R
authors.lastname: Koren
mesh_terms: D000293:Adolescent; D002247:Carbon Isotopes; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D016480:Helicobacter pylori; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data
chemical_list: D002247:Carbon Isotopes; D004338:Drug Combinations