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Commercial serologic assays accurately detect adult Helicobacter pylori infection. Their use in children remains controversial. An ELISA to detect H. pylori IgG in children was developed and compared with three commercial assays. ELISA standardization was done with sera from all ages and validation was done with another cohort of sera with known H. pylori status. Three commercial serologic assays were subsequently compared against this pediatric ELISA at independent sites, at which 142 pediatric serum samples from different countries were evaluated. The pediatric ELISA was 91.4% sensitive. Assay 3 demonstrated a sensitivity of 78%. Less sensitivity was observed for assay 1 (70%) and assay 2 (63%). Accuracy of commercial assays was greatly reduced when sera from developing countries and younger ages were evaluated. Results of serologic tests used to diagnose H. pylori should be interpreted with caution when evaluating children with abdominal pain. Accurate serologic assays in children may be more important for epidemiologic research than for clinical decision making.

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The systemic humoral response to Helicobacter pylori was studied in 86 infected adult patients before antimicrobial therapy and at intervals following therapy. Endoscopy with collection of biopsy specimens was performed immediately before treatment; a 13C-labeled urea breath test was performed, and blood specimens were collected before treatment and at 1, 3, 6, 9, and 12 months after treatment. Serum samples from three patient groups (eradication success [n = 50], eradication failure [n = 16], and no treatment [n = 20]) were assayed for IgA and IgG antibodies to H. pylori by enzyme-linked immunosorbent assay. Levels of antibody to H. pylori before treatment were similar in all three groups. As expected, the no treatment and eradication failure groups had no significant changes in antibody levels during the study period. In contrast, for the eradication success group, the specific IgA and IgG antibody levels decreased progressively and significantly. We conclude that serology is a potentially useful way to monitor the success of treatment of H. pylori infection without using invasive or more expensive methods.

Duodenal ulcer recurrence and gastritis are reduced with successful Helicobacter pylori treatment. Serology is accurate in the diagnosis of H. pylori, but its value in determining eradication is unproved. To evaluate the usefulness of serology in monitoring treatment, we measured serial serum antibodies in three patient groups: eradication success (N = 57), eradication failure (N = 19), and untreated patients (N = 24). Eradication was determined by Warthin Starry staining of antral biopsies and repeat 13C breath tests at six weeks. Subsequent 13C breath tests were then performed at three-month intervals to monitor eradication. IgG antibody concentrations to H. pylori were determined by a commercially available ELISA kit. Serology concentrations remained constant throughout the study period in the untreated patients. IgG concentrations decreased slightly in the treatment failure group at six weeks but thereafter remained at baseline values. In the eradicated group, serum IgG concentrations decreased 26% by three months, 43% by six months and 55% at nine and 12 months (P < 0.001). A 20% reduction in IgG concentrations by six months was associated with successful treatment (sensitivity 86% and specificity 88%). We conclude that serology is a potentially useful way to monitor H. pylori treatment success.

Combination therapy with clarithromycin and omeprazole resulted in significantly fewer uses of ulcer-related health care resources than conventional antisecretory therapy during a 1-year follow-up and significant savings in associated costs during the same period. Patients who received clarithromycin plus omeprazole also showed a significantly improved clinical outcome compared with patients who received only omeprazole or ranitidine.

SUMMARY BackgroundHelicobacter pylori infection is a major cause of peptic ulcer disease, but the prevalence of this infection has been decreasing steadily. Additionally, eradication of H. pylori decreases ulcer recurrence and prevents ulcer complications such as bleeding.