title: Value of Antral Nodularity for the Diagnosis of Helicobacter pylori Infection in Children.
abstract: BACKGROUND
  The aim of this study was to confirm the role of antral nodularity in the diagnosis of Helicobacter pylori (H. pylori) infection in children.
  
  
  METHODS
  This prospective study included 107 children (58 male; 54.2%), between the ages of 3 and 18 years, infected with H. pylori, which was confirmed if the patient had at least 2 of 4 positive test results (urea breath test, urease test in gastric biopsy, histopathology - positive hematoxylin and eosin and Giemsa staining, and/or monoclonal stool ELISA test - Amplified IDEIA™ Hp StAR™). The control group consisted of 234 children with abdominal pain, of similar age, in whom urease test in gastric tissue and histopathology were negative. In both groups, photographs of the gastric antrum taken during endoscopy were evaluated for nodularity by 3 independent endoscopists, blinded to the results of other tests. Sensitivity, specificity, and negative and positive predictive value of nodularity were assessed. Indication for upper endoscopy was chronic abdominal pain not considered to be functional.
  
  
  RESULTS
  There were no statistical differences between groups regarding sex (chi-square test with Yates's correction: p=0.8763) or age (mean ±SD) 11.77±3.49 and 12.43±3.32, study and control groups, respectively (Mann-Whitney test: p=0.1352). The sensitivity of the presence of nodularity as an indication of H. pylori infection was 91.6% and specificity was 91%. PPV of gastric nodularity was 81% and NPV was 96%.
  
  
  CONCLUSIONS
  Antral nodularity is reliable test. Physicians could start treatment of H. pylori infection whenever gastric nodularity is observed and the urease test result is positive, without waiting for histopathology results.
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Izabella
authors.initials: I
authors.lastname: Łazowska-Przeorek
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Maria
authors.initials: M
authors.lastname: Kotowska
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Banasiuk
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Karolewska-Bochenek
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Banaszkiewicz
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Gawrońska
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Albrecht
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011706:Pyloric Antrum / Q000473:pathology*; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric