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Detecting H. pylori in the Stools of Children

The accuracy of a new stool antigen test for Helicobacter pylori (HpSA) appears comparable with that of the ¹³C-urea breath test (UBT) in adult populations (see JW Jun 1 2000, p. 87, accession number 000509004, Lancet 1999; 354:30, and Am J Gastroenterol 2000; 95:925). German investigators compared the 2 tests in children with abdominal pain; Japanese researchers compared 7 different H. pylori tests in symptomatic children.

In the first study, 24 of 162 children (age range, 8 months through 15 years) tested positive for H pylori by UBT; of these, 22 also had positive results by HpSA (sensitivity, 91.6 percent). Of the 138 children with negative UBT screens, 136 also had negative HpSA results (specificity, 98.6 percent). Sensitivity of HpSA was lower in the 56 children aged 6 years or younger than in the 106 older children (83.3 percent vs. 94.4 percent); specificity was similar in the 2 age groups (97.7 percent vs. 100 percent).

In the second study, 53 children (age range, 10 through 14 years) underwent endoscopy; biopsy specimens were obtained for urease testing, culture, histologic examination, and PCR testing. In addition, UBTs, serology tests, and HpSA tests were performed. Among the 27 children with positive results on at least 2 invasive tests, 25 had positive HpSA results (sensitivity, 92 percent; specificity, 100 percent).

Comment: The detection of HP infection in children is becoming increasingly important, although its significance in children with nonspecific abdominal pain is unclear. It appears that HpSA is an accurate diagnostic test in a referral population; whether it will be as accurate in the primary care setting is unknown.

— H Bauchner

Published in Journal Watch General Medicine July 18, 2000

Citation(s):

Braden B et al. New immunoassay in stool provides an accurate noninvasive diagnostic method for Helicobacter pylori screening in children. Pediatrics 2000 Jul 106 115-117.

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• Medline abstract (Free)

Ni Y-H et al. Accurate diagnosis of Helicobacter pylori infection by stool antigen test and 6 other currently available tests in children. J Pediatr 2000 Jun 136 823-827.

• Medline abstract (Free)