Although Helicobacter pylori (H. pylori) is considered by many to be the major cause of primary antral gastritis (PAG), several important questions concerning its pathogenetic role remain unanswered. The most basic unresolved issue relates to the low prevalence of H. pylori in children in developed countries. If H. pylori is the cause of PAG, the prevalence of PAG should also be low, but previous studies have not provided data on this issue. To answer this question, we prospectively studied 408 children who underwent esophagogastroduodenoscopy and biopsy from January 1, 1988, to December 31, 1990, for symptoms consistent with peptic disease or immunocompromise. Although the prevalence of PAG was similar (about 20%) in the four age groups of patients studied (< 5, 5-9, 10-14, and 15-20 years), the prevalence of H. pylori infections was significantly greater in the oldest age group (67%, P < 0.0001). Only four of 39 children < 10 years old with PAG had evidence of H. pylori. H. pylori is an uncommon finding in our population of young American children with PAG, indicating that it does not play an important role in the pathogenesis of this disorder in this age group.

Helicobacter pylori is one of the most common bacterial infections in humans, and has been found in differing rates in persons of all age groups, nationalities and socioeconomic classes (1). Because the role of H pylori in human disease continues to be explored, there is an increased need for rapid, reliable and inexpensive diagnostic tests (2,3). The most commonly used standard tests are listed in Table 1. To date, the only test that can detect infection and disease activity is endoscopy with biopsy, which is invasive and expensive.Five recently developed tests that offer potential advantages because they are less invasive or permit easier acquisition of samples are assessed. These tests are whole blood, saliva and urine assays that measure systemic antibody response to H pylori, stool tests that measure H pylori antigens and string tests that use methodology less invasive than upper gastrointestinal endoscopy to recover H pylori organisms.The tests are compared with current standard tests and criteria for optimal tests. The criteria are non-or minimally invasive nature; high sensitivity, specificity, and positive and negative predictive values in diagnosing infection and assessing disease activity and effectiveness of therapy; convenience, including ease of acquisition of samples and rapid determination of results; and low cost. WHOLE BLOOD ANTIBODY TESTS Background:Whole blood antibody tests are based on the fact that systemic antibodies to H pylori are found in whole blood, making testing possible in a primary care setting (2-9). Whole blood tests have several important potential advantages compared with standard serological tests; the samples are easier to obtain, testing can be done in an office setting and the results can be available within 10 mins. In addition, the cost is projected to be less than that for the standard serological tests. CANADIAN HELICOBACTER CONSENSUS CONFERENCE ON PEDIATRIC ISSUES