IntroductionThe prevalence of childhood infection with Helicobacter pylori is high, especially in developing countries. Non-invasive methods for detection of infection in children should be inexpensive, easy to perform, well tolerated and have a high diagnostic accuracy. We aimed to compare the reliability, specificity and sensitivity of the H. pylori stool antigen (HpSA) test with the 13C-urea breath test (13C-UBT) for the diagnosis of H. pylori infection in a limited resource setting.Material and methodsThe stool samples of 60 symptomatic and dyspeptic children with a mean age of 7.2 ±3.7 years (2–15 years) were evaluated using the rapid One step HpSA test by lateral flow immunoassay. The 13C-UBT was used as the gold standard method for the diagnosis of H. pylori infection.ResultsThe HpSA test detected H. pylori antigen in 34 out of 38 positive patients with 4 false-negatives (sensitivity 89.5%, 95% confidence interval (CI): 75.2–97.1%), while 21 patients had true-negative results and one false-positive (specificity 95.5%, 95% CI: 77.2–99.9%), with a strong measure of agreement between the HpSA test and the 13C-UBT (κ = 0.83, 95% CI: 68–97%, p < 0.001). It had a positive predictive value of 97.1% (95% CI: 85.1–99.9%), a negative predictive value of 84% (95% CI: 63.9–95.5%) and an accuracy of 91.7%.ConclusionsThe rapid lateral flow HpSA test is a reliable method for the primary diagnosis of H. pylori infections in children, though not as accurate as the 13C-UBT. It is more affordable, simpler to perform and more tolerable, representing a viable alternative, especially in developing countries.

Hepatitis C virus (HCV) is a major cause of chronic hepatitis and hepatic fibrosis. The overall sero-prevalence in Egyptian children in two cross sectional studies from Southern and Northern Egypt were 8.7% and 24.3% respectively. Finding the best method to evaluate and manage children infected with HCV continues to be a challenge. Liver biopsy, due to its limitations and risks, is an imperfect gold standard for assessing the severity of the most frequent chronic liver diseases. Noninvasive alternatives to liver biopsy in patients infected with HCV include 2 combinations of simple serum biochemical markers: FibroTest (FT) for the assessment of fibrosis, and ActiTest (AT) for the assessment of necro-inflammatory activity. Although, the uses of FT and AT have been validated in adults with chronic HCV infection and is probably of great benefit, yet, there is lack of relevant data concerning their role in pediatric patients. In this pilot study, we attempted to verify the possibility of implementation of FT and AT as non invasive markers in assessment of the degree of hepatic fibrosis and necro-inflammatory activity in pediatric patients with chronic HCV infection in comparison to liver biopsy. Fifty patients, aged 2.0-18.0 years (with a mean of 10.52 ±4.83 years), with chronic HCV infection were studied. Two assessments have been done, within 24-hour-duration, one of a liver biopsy specimen and the other with FT and AT measured in serum sample. A highly significant linear trend between FT related fibrosis and fibrosis stage by histopathological examination was found (p value<0.0005). A highly significant correlation was also found between both parameters (r=0.811). As well, a highly significant correlation was found between AT and necro-inflammatory histological activity index (HAI) with r=0.591 and p<0.0005. FT and AT are potential non-invasive methods for assessment of hepatic fibrosis and necro-inflammatory activity in pediatric patients with chronic HCV infection.