High accuracy of noninvasive tests to diagnose Helicobacter pylori infection in very young children

Objective

To validate the ¹³C-urea-breath-test (UBT) and stool antigen test (HpSA) in children aged 5 years or younger, against invasive histologic study and rapid-urease-testing or culture.

Study design

On all consecutive children aged 5 years or younger undergoing endoscopy in 1 single center during the last 7.5 years, UBT and HpSA were performed.

Results

Of a total of 184 children (median age 2.2 years, range 0.2-5.5), 30 were Helicobacter pylori–positive (16.3%). Sensitivity and specificity of UBT were 93.3% (95%CI 77.9%-99.2%) and 95.5% (90.9-98.2), with a cutoff of 5‰, but specificity increased to 98.1% (94.4%-99.6%) with a cutoff of 8‰. Sensitivity and specificity of HpSA were 93.3% (77.9%-99.2%) and 98.7% (95.4%-99.8%).

Conclusion

Accuracy of noninvasive tests in our single-center study were satisfactory: specificity of UBT improved with a cutoff at 8%, and sensitivity of HpSA was high when determined locally without transportation after long or inadequate storage that could impair results.

Abbreviations: HpSA, Helicobacter pylori stool antigen, OD, Optical density, RUT, Rapid urease test, UBT, ¹³C-Urea breath test