Traditional and Modern Diagnostic Approaches in Diagnosing Pediatric Helicobacter pylori Infection

Abstract

Helicobacter pylori (H. pylori) is the most common bacterial infection worldwide, is usually acquired during childhood and is related to gastric carcinogenesis during adulthood. Therefore, its early proper diagnosis and subsequent successful eradication represent the cornerstones of gastric cancer prevention. The aim of this narrative review was to assess traditional and modern diagnostic methods in terms of H. pylori diagnosis. Several invasive and non-invasive methods were described, each with its pros and cons. The invasive diagnostic methods comprise endoscopy with biopsy, rapid urease tests, histopathological exams, cultures and biopsy-based molecular tests. Among these, probably the most available, accurate and cost-effective test remains histology, albeit molecular tests definitely remain the most accurate despite their high costs. The non-invasive tests consist of urea breath tests, serology, stool antigens and non-invasive molecular tests. Urea breath tests and stool antigens are the most useful in clinical practice both for the diagnosis of H. pylori infection and for monitoring the eradication of this infection after therapy. The challenges related to accurate diagnosis lead to a choice that must be based on H. pylori virulence, environmental factors and host peculiarities.

Helicobacter pylori-Related Extraintestinal Manifestations—Myth or Reality

“…Another potential mechanism for this deficiency might be related to the treatment with antacid drugs [ 19 ]. Furthermore, H. pylori might play the role of molecular mimicker since H. pylori expresses an antigen which is similar to H + /K + -adenosine triphosphate protein [ 199 ].…”

“…The first step for effective eradication is in fact represented by accurate diagnosis based on choosing the most appropriate diagnostic method depending on the geographic area, patient’s age, or other H. pylori -related peculiarities [ 19 ]. Additionally, the diagnosis is even more difficult in patients that present only extraintestinal manifestations triggered by this infection.…”

Worldwide Prevalence and Risk Factors of Helicobacter pylori Infection in Children

“…More recent studies also showed that out of more than 100 million individuals, 70% were tested using serology, and 4.2% turned out to be positive [ 54 ]. Although the current recommendations state that serology should be confirmed by a second test [ 15 , 55 ], in the previous study, only 16% were confirmed by a urea breath test and 11% by stool antigen immunoassay. Contrarywise, other studies reported gastric biopsy as the most commonly used diagnostic method in more than 50% of the individuals, followed by stool antigen in 20% [ 48 ].…”

“…It might also represent a reliable noninvasive method for detecting this bacterium [ 159 , 160 ]. Nevertheless, the choice of the diagnostic method should rely on several other criteria, such as the epidemiology of the geographical area, ethnicity, or previous treatments [ 15 ]. Finland implemented a ‘screen and treat’ projects which resulted in a considerable decrease in H. pylori prevalence [ 161 ].…”

“…One of the main challenges related to H. pylori eradication is to diagnose the infection as soon as possible with increased accuracy. Therefore, choosing the proper diagnostic method for this infection might seem simple, but the choice should be based on several criteria related to the patient’s age and geographical peculiarities [ 15 ]. Taking into account that all children should be treated regardless if they present symptoms or not [ 16 , 17 ], choosing the most effective and accurate diagnostic method might severely influence the success of eradication and might increase the frequency of H. pylori -related complications during adulthood.…”