Antibody-Based Detection Tests for the Diagnosis of Helicobacter pylori Infection in Children: A Meta-Analysis

Abstract

BackgroundNumerous serologic tests are available for the diagnosis of H. pylori infection in children. Common designs of antibody-based detection tests are ELISA and Western Blot (WB). For developing countries with limited laboratory resources and access, ELISA would be the preferred method because of its simplicity, lower cost and speed. Although in adults ELISA has proven to be highly accurate in diagnosing H. pylori infection; in children, it has shown variable accuracy.Methods/FindingsWe conducted a systematic review and meta-analysis to assess the accuracy of antibody-based detection tests for the diagnosis of H. pylori infection in children. Selection criteria included participation of at least 30 children and the use of a gold standard for H. pylori diagnosis. In a comprehensive search we identified 68 studies. Subgroup analyses were carried out by technique, immunoglobulin class, and source of test (commercial and in-house). The results demonstrated: 1) WB tests showed high overall performance, sensitivity 91.3% (95% CI, 88.9–93.3), specificity 89% (95% CI, 85.7–91.9), LR+ 8.2 (95% CI, 5.1–13.3), LR− 0.06 (95% CI, 0.02–0.16), DOR 158.8 (95% CI, 57.8–435.8); 2) ELISA-IgG assays showed low sensitivity 79.2% (95% CI, 77.3–81.0) and high specificity (92.4%, 95% CI, 91.6–93.3); 3) ELISA commercial tests varied widely in performance (test for heterogeneity p<0.0001); and 4) In-house ELISA with whole-cell antigen tests showed the highest overall performance: sensitivity 94% (95% CI, 90.2–96.7), specificity 96.4% (95% CI, 94.2–97.9), LR+ 19.9 (95% CI, 7.9–49.8), LR− 0.08 (95% CI, 0.04–0.15) DOR 292.8 (95% CI, 101.8–841.7).Conclusions/SignificanceWB test and in-house ELISA with whole-cell antigen tests are the most reliable tests for the diagnosis of H. pylori infection in children. Antigens obtained from local strains of the community could partially explain the good overall accuracy of the in-house ELISA. Because of its cost and technical demands, in-house ELISA might be more suitable for use in developing countries.

Helicobacter pylori and recurrent abdominal pain in children: Is there any relation?

“…3,5 However, marked differences in H. pylori seroprevalence have been observed and reported among various ethnic and racial groups from other studies. 17 In this study it was confirmed that HP prevalence in children was significantly higher if family members were also HP infected regardless of other socioeconomic and environmental factors.…”

“…2 HP infection is one of the most common bacterial infections in humans affecting nearly 50% of the world's population. 3 It is usually acquired in childhood and is associated with sociodemographic factors such as low socio-economic status, poor hygiene, and overcrowding. 4 The prevalence of HP infection is markedly high in developing countries, Acute infection is often silent, with symptoms and disease manifesting later in life, as does an increased risk of gastritis, peptic ulcer and HP related malignancy.…”

“…4 The prevalence of HP infection is markedly high in developing countries, Acute infection is often silent, with symptoms and disease manifesting later in life, as does an increased risk of gastritis, peptic ulcer and HP related malignancy. 3 Controversial results have been found in assessing the role of HP infections as the etiology of specific symptoms in children like RAP. 7 Guidelines on screening for HP in children are often contradictory.…”

<i>HELICOBACTER</i> INFECTION AND ALLERGY IN MAJORITY AND ROMA POPULATION IN THE CZECH REPUBLIC

“…Among suggested associations is exposure to tobacco smoke (Arnold et al, 2011;Hancox et al, 2004;Laszewicz et al, 2014;Moayyedi et al, 2002;Roesler et al, 2014;Wang et al, 2012), quality of indoor conditions (Laszewicz et al, 2014), quality of environment (Hancox et al, 2004;Krumbiegel et al, 2000;Roesler et al, 2014;Rothenbacher et al, 1998;Vasar et al, 2011;Wang et al, 2012;Wex et al, 2010), genetic and race influences (10,17,22,26,29,32), social-economic effects and education (Amedei et al, 2010;Bode et al, 2002;Chen and Blaser, 2008;Hancox et al, 2004;Laszewicz et al, 2014;Leal et al, 2008), exposure to allergens from domestic animals (Amedei et al, 2010) and lately the exposure to nanoparticles from car exhausts, mainly with diesel engines (Amedei et al, 2010). Another theory speculates about the possibility that the use of antibiotics given either therapeutically or in small amounts in food influences composition of the microbiome and triggers the allergies (Arnold et al, 2011, Blaser 2012Fu 2014;Holster et al, 2012).…”

IgG Subclasses Against Helicobacter pylori Isolates: An important Tool for Disease Characterization

“…In vivo experiments in humans have shown elevated levels of interleukin-1b (IL-1b) and interleukin-8 (CXCL8), among others, and have demonstrated that monocytes and polymorphonuclear cells are recruited early during infection, followed by lymphocyte infiltration after 4 weeks [7]. In the clinic, the determination of total immunoglobulin G (IgG) titres against whole extracts or particular antigens has been in use for several years, greatly improving the understanding of infection dynamics [8].…”