13C-Urea breath test threshold calculation and evaluation for the detection of Helicobacter pylori infection in children

Abstract

Background: The 13 C-urea breath test (UBT) is performed in adults and children with epigastric pain for non-invasively diagnosing a suspected H. pylori infection. Criteria for UBT interpretation have not been generally agreed on and test reliability has not been established in children of different ages. This study aimed at identifying reliable UBT thresholds in children by using 251 UBTs in conjunction with reference histology and by analyzing 1232 UBTs.

13C‐urea breath test for Helicobacter pylori in young children: cut‐off point determination by finite mixture model

“…The cut-o value obtained by using the maximum of sensitivity plus speciÿcity as criteria are smaller than the cut-o values using the maximum of positive predictive plus negative predictive values and the minimum probability of misclassiÿcation as the criteria. This agrees with the results from a recent study of German children [20].…”

“…Nevertheless, a recent study of 3 months-5 years of age found a cut-o point of 9:1D used a similar analytic method though with a rather large error [20].…”

“…In another recent study of 1232 German children with chronic abdominal pain (1 month to 18 years of age), a cut-o of 5:8 ± 0:4D was reported for H. pylori infection using UBT taken at 30 min intervals, by analysing the UBT alone. However, the cut-o point for children (138 cases) aged from 3 months to 5 years was 9:1D, with a standard deviation of 4:5D [20]. Therefore, ÿnding an appropriate model for calculating the UBT cut-o point for young children could improve the accuracy of diagnosis of H. pylori infection.…”

Long-term recurrence rate after treatment of Helicobacter pylori infection in children and adolescents in Estonia

“…Both histology (37) and [ 13 C]-UBT (38)(39)(40) have served as excellent methods for diagnosing H. pylori infection in children, although for the age group younger than 6 years the specificity of [ 13 C]-UBT can be lower (41). In our study, none of the patients was younger than 7 years of age.…”

Helicobacter pylori infection: Detection, investigation, and management

“…Although the 13 C-labeled UBT has been used in children and appears promising, reliability and determination of threshold values have not been adequately validated in multiple, large multicenter, randomized, controlled trials. 23 Serology with immunoglobulin G (IgG) is widely used and is considered the first line of noninvasive diagnostic tests in adults, particularly in Europe, with suspected H pylori infection. Unfortunately, serology does not provide any data as to whether there is active or past infection.…”