Evaluation of invasive and non-invasive methods for the diagnosis of Helicobacter pylori infection in symptomatic children and adolescents
Keywords:
Children and adolescents, Helicobacter pylori, Diagnostic methodsAbstract
CONTEXT: Multiple diagnostic methods are available for the detection of Helicobacter pylori infection, but at present no single one can be used as the gold standard. OBJECTIVE: The aim of this study was to evaluate the diagnostic accuracy of 3 invasive and 2 non-invasive methods for detection of Helicobacter pylori infection in symptomatic children and adolescents. DESIGN: Prospective cohort study SETTING: Peptic Disease outpatients service, Discipline of Pediatric Gastroenterology, Universidade Federal de São Paulo / Escola Paulista de Medicina. PATIENTS: Forty-seven patients who underwent endoscopy because of dyspeptic symptoms. DIAGNOSTIC METHODS: Endoscopy with gastric biopsies for 3 invasive (rapid urease test, histology and culture) and 2 non-invasive methods (a commercial ELISA serology and 13carbon urea breath test - isotope ratio mass spectrometry) for detection of Helicobacter pylori infection. MAIN MEASUREMENTS: Sensitivity, specificity, positive and negative predictive values of each method and agreement and disagreement rates between the methods. RESULTS: Forty-seven patients [mean age, 11y9mo (SD 2y10mo), 27 female and 20 male]; 62% of them were Helicobacter pylori-positive. All methods agreed in 61%, and were negative in 21% and positive in 40%. The greatest concordance between 2 methods occurred between the invasive methods: histology and rapid urease test (89.6%) and histology and culture (87.5%). The greatest sensitivity, considering Helicobacter pylori-positive cases, for any combination of 3 or more tests, was achieved by the rapid urease test (S=100%), followed by histology, serology and 13carbon-urea breath test (S=93.1%) and lastly by culture (S=79.3%). The highest specificity was obtained by histology (100%) and culture (100%), followed by the rapid urease test (84.2%), serology (78.9%) and 13carbon-urea breath test (78.9%). CONCLUSIONS: Our results suggest that among invasive methods, an association between the rapid urease test and histology constituted the best choice for the detection of Helicobacter pylori infection. If results of histology and the rapid urease test are different, serology may be recommended.
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References
Lindkvist P, Asrat D, Nilsson I, et al. Age at acquisition of
Helicobacter pylori infection: comparison of a high and a low preva- lence country. Scand J Infect Dis 1996;28:181-4.
Graham DY, Adam E, Reddy GT, et al. Seroepidemiology of Helicobacter pylori infection in India: comparison of developing and developed countries. Dig Dis Sci 1991;36:1084-8.
Oliveira AMR, Queiroz DMM, Rocha GA, Mendes EN. Seroprevalence of Helicobacter pylori infection in children of low socioeconomic level in Belo Horizonte, Brazil. Am J Gastroenterol 1994;89:2201-4.
Simán JH, Forsgren A, Berglund G, Florén CH. Association be- tween Helicobacter pylori and gastric carcinoma in the city of Malmö, Sweden. Scand J Gastroenterol 1997;32:1215-21.
Carvalho AST, Queiroz DMM, Mendes EN, Rocha GA, Penna FJ. Diagnosis and distribution of Helicobacter pylori in the gastric mucosa of symptomatic children. Braz J Med Biol Res 1991;24:163-6.
Drumm B, O’Brien A, Cutz E, Sherman P. Campylobacter pyloridis associated primary gastritis in children. Pediatrics 1987;80:192-5.
Oderda G, Dell’olio D, Morra I, Ansaldi N. Campylobacter py- lori gastritis: long term results of treatment with amoxicillin. Arch Dis Child 1989;64:326-9.
Hsu PI, Lai KH, Tseng HH, et al. Correlation of serum immu- noglobulin G Helicobacter pylori antibody titers with histologic and endoscopic findings in patients with dyspepsia. J Clin Gastroenterol 1997;25:587-91.
Blecker, U. Helicobacter pylori disease in childhood. Eur J Pediatr 1996;155:753-5.
Prieto G, Polanco I, Larrauri J, Rota L, Lama R, Carrasco S. Helicobacter pylori infection in children: clinical, endoscopic, and his- tologic correlations. J Pediatr Gastroenterol Nutr 1992;14:420-5.
Blaser MJ. Epidemiology of Campylobacter pylori infections. Rev Infect Dis 1990;12:99-106.
Dooley CP, Cohen H. The clinical significance of Campylobacter pylori. Ann Intern Med 1988;108:70-9.
Peterson WL. Helicobacter pylori and peptic ulcer disease. N Engl
J Med 1991;324:1043.
Killbridge PM, Dahms BB, Czinn SJ. Campylobacter pylori as- sociated gastritis and peptic ulcer disease in children. Am J Dis Child 1988;142:1149-52.
Lin JT, Wang LY, Wang JT, Wang TH, Chen CJ. Ecological study of association between Helicobacter pylori infection and gastric cancer in Taiwan. Dig Dis Sci 1995;40:385-8.
Wotherspoon AC, Ortiz-Hidalgo C, Falzon MR, Isaacson PG. Helicobacter pylori-associated gastritis and primary B-cell gastric lymphoma. Lancet 1991;338:1175-6.
Horstmann M, Erttmann R, Winkler H. Relapse of MALT lym- phoma associated with Helicobacter pylori after antibiotic treat- ment. Lancet 1994;343:1098-99.
Barabino A, Dufour C, Marino CE, Claudiani F, De Alessandri A. Unexplained refractory iron-deficiency anemia associated with Helicobacter pylori gastric infection in children: Further clinical evidence. J Pediatr Gastroenterol Nutr 1999;28:116-9.
Marignani M, Angeletti S, Bordi C, et al. Reversal of long-stand- ing iron deficiency anemia after eradication of Helicobacter pylori infection. Scand J Gastroenterol 1997;32:617-22.
Mégraud F. Advantages and disadvantages of current diagnostic tests for the detection of Helicobacter pylori. Scand J Gastroenterol 1996;31:57-62.
Morris A, Ali MR, Brown P, Lane M, Patton K. Campylobacter pylori infection in biopsy specimens of gastric antrum: labora- tory diagnosis and estimation of sampling error. J Clin Pathol 1989;42:727-32.
Fennerty MB. Helicobacter pylori. Arch Intern Med 1994;154:721-7.
Cutler AF, Haustad S, Ma CK, Blaser MJ, Perez-Perez GI, Schubert TT. Accuracy of invasive and non-invasive tests to diagnose Helicobacter pylori infection. Gastroenterology 1995;109:136-41.
Hodgson MI, Pantoja H, Latorre JJ, et al. Helicobacter pylori- associated gastroduodenal disease in symptomatic Chilean chil- dren: diagnostic value of serological assay. J Pediatr Gastroenterol Nutr 1995;21:263-8.
Heldenberg D, Wagner Y, Heldenberg E, et al. The role of Helicobacter pylori in children with recurrent abdominal pain. Am J Gastroenterol 1995;90:906-9.
Vandenplas Y, Blecker U, Devreker T, et al. Contribution of the 13 C-urea breath test to the detection of Helicobacter pylori gastri- tis in children. Pediatrics 1992;90:608-11.
Thijs JC, Van Zwet AA, Thijs WJ, et al. Diagnostic tests for Helicobacter pylori: a prospective evaluation of their accuracy, with- out selecting a single test as the gold standard. Am J Gastroenterol 1996;91:2125-9.
Feldman RA, Evans SJW. Accuracy of diagnostic methods used for epidemiological studies of Helicobacter pylori. Aliment Pharmacol Ther 1995;9:21-31.
Bodhidatta L, Hoge CW, Churnratanakul S, et al. Diagnosis of Helicobacter pylori infection in a developing country: comparison of two ELISAs and a seroprevalence study. J Infect Dis 1993;168:1549-53.
Gallen RS, Gambino SR. Beyond normality: the predictive value and efficiency of medical diagnoses. N. York: John Willey & Sons; 1975.
Siegel S, Casttelan Jr NJ. Non-parametric statistics. Second edi- tion. New York: McGraw-Hill; 1988:399.
Remington RD, Schork MA. Statistics with applications to bio- logical and health sciences. Englewood Cliffs, NJ: Prentice-Hall; 1970.
Chong SKF, Lou Q, Asnicar MA, et al. Helicobacter pylori infec- tion in recurrent abdominal pain in childhood: Comparison of diagnostic tests and therapy. Pediatrics 1995;96:211-5.
Elitsur Y, Hill I, Lichtman SN, Rosenberg AJ. Prospective com- parison of rapid urease tests (Pyloritek, CLOTest) for the diagno- sis of Helicobacter pylori infection in symptomatic children: a pediatric multicenter study. Am J Gastroenterol 1998;93:217-9.
Zaitoun AM. Histology compared with chemical testing for ure- ase for rapid detection of Helicobacter pylori in gastric biopsy speci- mens. J Clin Pathol 1993;46:684-5.
Veldhuyzen SJO, Tytgat K, deGara CJ, et al. A prospective comparison of symptoms and five diagnostic tests in patients with Helicobacter pylori positive and negative dyspepsia. Eur J Gastroenterol Hepatol 1991;3:463-8.
Marshall BJ, Guerrant RL, Plankey MW, et al. Comparison of 13C-urea breath test, microbiology and histology for the diagno- sis of Campylobacter pylori. (abstract) Gastroenterology 1988;94:A284.
Van Zwet AA, Thijs JC, Kooistra-Smid AMD, Schirm J, Snijder JAM. Sensitivity of culture compared with that of polymerase chain reaction for detection of Helicobacter pylori from antral bi- opsy samples. J Clin Microbiol 1993;31:1918-20.
Rowland M, Lambert I, Gormally S, et al. Carbon 13-labeled urea breath test for the diagnosis of Helicobacter pylori infection in children. J Pediatr 1997;131:815-20.
Raju GS, Smith MJ, Morton D, Bardhan KD. Mini-dose (1- µCi) 14C-urea breath test for detection of Helicobacter pylori. Am J Gastroenterol 1994;89:1027-31.
Hamlet AK, Erlandsson KIM, Olbe L, Svennerholm AM, Backman VEM, Pettersson AB. A simple, rapid, and highly reli- able capsule-based 14C urea breath test for diagnosis of Helicobacter pylori infection. Scand J Gastroenterol 1995;30:1058-63.
Blecker U, Lanciers S, Hauser B, Vandenplas Y. Diagnosis of Helicobacter pylori infection in adults and children using the Malakit Helicobacter pylori, a commercially available enzyme-linked immunosorbent assay. J Clin Microbiol 1993;31:1770-3.
Raymond J, Kalach N, Bergeret M, Barbet JP, Benhamou PH, Gendrel D. Evaluation of a serological test for diagnosis of Helicobacter pylori infection in children. Eur J Clin Microbiol In- fect Dis 1996;15:415-7.
Westblom TU, Madan E, Gudipati S, Midkiff BR, Czinn SJ. Diagnosis of Helicobacter pylori infection in adult and pediatric patients by using Pyloriset, a rapid latex agglutination test. J Clin Microbiol 1992;30:96-8.
Goossens H, Glupczynski Y, Burette A, Van Den Boore C, Butzler JP. Evaluation of a commercially available second-generation immunoglobulin G enzyme immunoassay for detection of Helicobacter pylori infection. J Clin Microbiol 1992;30:176-80.
Russell RG, Wassermann SS, O’Donnohue JM, et al. Serologic response to Helicobacter pylori among children and teenagers in northern Chile. Am J Trop Med Hyg 1993;49:189-91.
Carmolinga-Ponce M, Torres J, Perez-Perez G, et al. Validation of a serologic test for the diagnosis of Helicobacter pylori infection and the immune response to urease and CagA in children. Am J Gastroenterol 1998;93:1264-70.
Khanna B, Cutler A, Israel NE, et al. Use caution with serologic testing for Helicobacter pylori infection in children. J Infect Dis 1998;178:460-5.
Hoek FJ, Noach LA, Raws EAJ, Tytgat GNJ. Evaluation of the performance of commercial test kits for detection of Helicobacter pylori antibodies in serum. J Clin Microbiol 1992;30:1525-8.
Perez-Perez GI, Taylor DN, Bodhidatta L, et al. Seroprevalence of Helicobacter pylori infections in Thailand. J Infect Dis 1990;161:1237-41.
