Helicobacter pylori diagnostic tests in children: review of the literature from 1999 to 2009

Abstract

The array of tests that can be used for diagnosis of Helicobacter pylori infection is large, and it can be confusing to define which test to use particularly in children where results may not be comparable to those obtained in adult patients. Using PubMed, we reviewed the English literature from January 1999 to May 2009 to identify articles that determined sensitivity and specificity of H. pylori invasive and non-invasive diagnostic tests in children. We excluded articles that presented a review of the literature, abstracts, case reports, or series where children's results could not be separated from adult populations. Of the tissue based methods, rapid urease tests have better sensitivity than histology to detect presence of H. pylori; however, histology can detect the pathology associated with disease including gastritis, intestinal metaplasia, and other conditions that could be the cause of the child's symptoms. Culture of gastric tissues or stool has 100% specificity but sensitivity is low. Of the serologic tests, immunoblot has the best sensitivity. The urea breath tests have >75% sensitivity for detection of H. pylori before and after treatment. Immunoassays in stool using monoclonal antibodies have >95% sensitivity for detection of H. pylori before and after treatment. PCR testing can be performed in tissue and stool samples and can detect genes associated to antibiotic resistance. In summary, the current commercial non-invasive tests have adequate sensitivity and specificity for detecting the presence of H. pylori; however, endoscopy with histopathology is the only method that can detect H. pylori and lesions associated with the infection.

Clinical differences of Helicobacter pylori infection in children

“…The effectiveness of treatment regimens depends on the sensitivity of H. pylori strains to drugs used, the duration of the treatment and patients' compliance in taking medication. 51,53,54 It is recommended that drugs are tailored to the antibiotic susceptibility of H. pylori strains in a given region. 51,[55][56][57] The best results of H. pylori eradication are achieved after the first treatment; subsequent treatments with the same antibiotic may be less effective due to the increasing secondary antibioticresistance of H. pylori strains.…”

“…13,[51][52][53][54] Diagnostic testing should be carried out at least 2 weeks after the completion of proton pump inhibitors (PPI) therapy, and 4 weeks after antibiotic treatment. The effectiveness of H. pylori eradication treatment is most commonly assessed with a non-invasive test, i.e., the urea breath test, or with H. pylori antigen stool test 4-8 weeks after eradication therapy.…”

Specific Conditions: Children

“…Many serologic tests to detect IgA and IgG antibodies against H. pylori are commercially available and have been applied in children for epidemiological studies and in clinical practice [ 19 ]. The serologic test may be useful in screening H. pylori infection, but its application has been limited in young children owing to low sensitivity.…”

Helicobacter pylori Detection Using Machine Learning Algorithm

“…Non-invasive tests include detection of H. pylori antigens in stool, detection of antibodies against H. Pylori in serum, and urea breath test. The best test for detection of H. pylori is one which is available, minimally invasive, greatly accurate and inexpensive [4].…”