Efficacy of noninvasive tests in the diagnosis of Helicobacter pylori infection in pediatric patients.
BACKGROUND
Helicobacter pylori infection is likely acquired in childhood. Helicobacter pylori is recognized as a cause of gastritis and peptic ulcer.


OBJECTIVE
To investigate some noninvasive tests, particularly H pylori fecal antigen, for the diagnosis of H pylori infection in comparison with the gold-standard invasive test, esophagogastroduodenoscopy with biopsy.


METHODS
We studied 250 patients (102 male; age range, 3-18 years) who underwent esophagogastroduodenoscopy with biopsy (histologic examination and rapid urease test) for a suspicious upper gastrointestinal disease; in all of them, fecal H pylori antigen, serum H pylori immunoglobulin G, and cytotoxin-associated gene product A immunoglobulin G were measured. Sensitivity and specificity of noninvasive tests were compared with those of the gold-standard esophagogastroduodenoscopy with biopsy.


RESULTS
Ninety-three patients (37%) had positive histopathologic (Giemsa staining) and rapid urease test results. The H pylori fecal antigen revealed a sensitivity of 97%, a specificity of 98%, a positive predictive value of 97%, and a negative predictive value of 98%; serum H pylori immunoglobulin G had a sensitivity of 86%, a specificity of 80%, a positive predictive value of 72%, and a negative predictive value of 90%; and serum cytotoxin-associated gene product A immunoglobulin G had a sensitivity of 83%, a specificity of 80%, a positive predictive value of 71%, and a negative predictive value of 89%.


CONCLUSIONS
Our study demonstrates that among noninvasive and easily applicable tests, particularly in small children, H pylori fecal test is simple, suitable, and has high accuracy for the screening of H pylori-positive patients.
Sabbi
Tamara
T
Pediatric Unit, Belcolle Hospital, Viterbo, Italy. sabbi.t@libero.it
De Angelis
Paola
P
Colistro
Franco
F
Dall'Oglio
Luigi
L
di Abriola
Giovanni Federici
GF
Castro
Massimo
M
D000293:Adolescent; D000942:Antigens, Bacterial / Q000032:analysis; D001426:Bacterial Proteins / Q000097:blood; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D016145:Endoscopy, Digestive System; D005243:Feces / Q000382:microbiology; D005260:Female; D005756:Gastritis / Q000473:pathology; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000276:immunology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D006940:Hyperemia / Q000473:pathology; D007124:Immunoenzyme Techniques; D007074:Immunoglobulin G / Q000032:analysis; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011706:Pyloric Antrum / Q000473:pathology; D012463:Saliva / Q000276:immunology; D012680:Sensitivity and Specificity; D014510:Urease
D000942:Antigens, Bacterial; D001426:Bacterial Proteins; D007074:Immunoglobulin G; D014510:Urease