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

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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.

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Acknowledgment

The chairs of the North American/European consensus conference that took place in Munich December 2007 to establish pediatric guidelines for diagnosis and treatment of H. pylori are aware of this manuscript and approved a separate publication. All coauthors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Drs. Guarner, Kalach, and Elitsur have not received financial support or have interests in any of the commercial entities named in the manuscript. Dr Koletzko has recently received a grant of 24,000 € from Oxoid (Ely) Ltd. Thermo Fisher Scientific.

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Emory University Hospital (rm C179A), 1364 Clifton Rd, Atlanta, GA, 30322, USA

    Jeannette Guarner

  2. Department of Neonatology–Pediatrics, Cochin-St Vincent de Paul Hospital, Paris, France

    Nicolas Kalach

  3. Department of Pediatrics, Saint Vincent de Paul Hospital, Catholic University of Lille, Lille, France

    Nicolas Kalach

  4. Department of Pediatrics, Marshall University, Huntington, WV, USA

    Yoram Elitsur

  5. Dr. v. Haunersches Kinderspital, Ludwig Maximillians University, Munich, Germany

    Sibylle Koletzko

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  1. Jeannette Guarner
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  2. Nicolas Kalach
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  3. Yoram Elitsur
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  4. Sibylle Koletzko
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Correspondence to Jeannette Guarner.

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Guarner, J., Kalach, N., Elitsur, Y. et al. Helicobacter pylori diagnostic tests in children: review of the literature from 1999 to 2009. Eur J Pediatr 169, 15–25 (2010). https://doi.org/10.1007/s00431-009-1033-x

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  • DOI: https://doi.org/10.1007/s00431-009-1033-x

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