TITLE:
A Retrospective Analysis of Three Non-Invasive Tests for Initial Diagnosis of Helicobacter pylori Infection in Children
AUTHORS:
Tamaki Ikuse, Takahiro Kudo, Naho Obayashi, Keisuke Jimbo, Yo Aoyagi, Yoshikazu Ohtsuka, Thomas G. Blanchard, Steven J. Czinn, Toshiaki Shimizu
KEYWORDS:
Accuracy, Non-Invasive Tests, Urea Breath Test, Stool Antigen Test, Serum Antibody Test
JOURNAL NAME:
Advances in Microbiology,
Vol.7 No.4,
April
19,
2017
ABSTRACT: Proper diagnosis in the pediatric population is required to eradicate Helicobacter pylori (H.
pylori) and
prevent gastric cancer. Our aim was to assess the performance of non-invasive
tests to diagnose H.
pylori infection in pediatric patients. A retrospective analysis
was performed on 141 pediatric patients requiring endoscopic evaluation and
diagnostic tests for H.
pylori infection to define the cause of abdominal symptoms.
Non-invasive tests included the 13C-urea breath test (UBT), a
monoclonal stool antigen test using enzyme-linked immuno-sorbent assay (mSAT),
and a serum immunoglobulin G antibody test using antigens derived from Japanese
individuals (S-Ab). This study investigated sensitivity, specificity,
likelihood ratios for a positive and a negative test (LR+ and LR-), and
accuracy of non-invasive tests, in comparison with invasive tests. Eighty two
of 141 patients (58%) were recognized as H.
pylori positive by invasive methods. When UBT, mSAT or S-Ab were
analyzed, all were found to be effective over 94% accurate. Specificity ranged
between 86.7% and 95.8%, and sensitivity ranged between 93.8% and 97.1%. When
subjects were stratified into three distinct age groups, the best performance
was achieved for 1-6
years old with mSAT at 100% for sensitivity, specificity, and accuracy. S-Ab
yielded the best results for children 7-12 years old and the UBT test performed
best for 13-18
years old. These results demonstrate the utility of UBT, mSAT, and S-Ab
non-invasive tests in diagnosing H.
pylori but suggest that certain tests may be optimal for children
of distinct ages. Three non-invasive tests, UBT, mSAT and S-Ab showed
sufficient sensitivity, specificity and accuracy for the initial diagnosis of H. pylori infection
among pediatric patients. Non-invasive tests may contribute to achieving minimum invasive diagnosis with combining
with a histological test and a culture test in children.