Helicobacter pylori Serology at Diagnosis and Follow-up of Biopsy-verified Infection in Children

Abstract

Data on the use of Helicobacter pylori serology in children are limited. We studied the serum antibodies of 105 H. pylori-infected children (median age 9.1 y, range 1.5-17.5 y) using an in-house enzyme immunoassay. At diagnosis of the biopsy-verified infection, IgG antibodies to H. pylori were elevated in 98/105 children (93%) but were at a normal level in 7 children, 5 of whom were < 5 y of age. Serum IgA antibodies to H. pylori were elevated in 40/105 children (38%). The levels of IgG and IgA antibody titers to H. pylori correlated with age (p < 0.001 and p < 0.02, respectively). IgG titers were reduced by > or = 50% in 85% (83/98; median follow-up 0.6 y) of children after therapy. In 56 such children eradication was verified by negative histology or urea breath test but I such child showed Helicobacters on histologic examination. Of the 15 children whose IgG titers dropped by < 50%, 7 were considered positive and 4 negative on the basis of histology or urea breath test. In 3 children, IgG titers returned to pretreatment levels 1 y after a 50% drop was seen. Serology is 1 alternative for monitoring H. pylori infection in children, although its sensitivity is lower in very young children. The length of follow-up needed after eradication, however, is unclear.

Antibody-Based Detection Tests for the Diagnosis of Helicobacter pylori Infection in Children: A Meta-Analysis

“…Of the 38 articles, 18 [52], [53], [56], [58], [59], [61], [62], [67], [69], [71], [73], [74], [76], [78], [79], [82], [85], [89] (47.5%) used culture and histological examination as the gold standard; ten [54], [60], [64], [70], [72], [80], [81], [83], [84], [87] (26.3%) used histology in combination with RUT and UBT; two articles [63], [68] (5.2%) used histology alone and seven articles [55], [57], [66], [75], [77], [86], [88] (18.4%) used UBT; and finally one article [65] (2.6%) used culture + UBT as gold-standard. For all articles the ELISA and WB tests did not form part of the reference standard.…”

“…Thirty-one (81.5%) articles reported using a case-control design and the remaining seven [53], [57], [65], [66], [68], [69], [75] (18.5%) a cross-sectional design. Thirty-two of the 38 (84.2%) articles collected samples prospectively and six [53], [65], [66], [69], [74], [85] (15.8%) retrospectively; two [65], [75] (5.2%) articles reported the use of a randomly selected subset of the sample for validation with the reference standard. Eleven [52], [61], [63], [64], [67], [68], [78]–[81], [83] (28.9%) articles reported at least single-blinded interpretation of the ELISA and WB tests and reference standard results, while 27 (71.1%) articles did not mention the blinding status.…”

Helicobacter pylori and idiopathic thrombocytopenic purpura in children

“…Median age at the time of diagnosis was 3.8 years (range, 0.3-14.3 years), and median duration of thrombocytopenia at the time of the study was 3.9 years (range, 0.6-14.5 years). During a routine outpatient visit of the 17 consecutive patients, after informed consent, serum H pylori IgA and IgG class antibodies were measured by a locally validated enzyme immunoassay, 7 and in patients older than 5 years (n ϭ 12), a 13 C urea breath test (Diabact UBT) also was performed. The 13 C enrichment in the expired breath was measured by automated breath 13 C analysis by means of continuous flow-isotope ratio mass spectrometry.…”

Helicobacter pylori infection in Finland

“…Most of the childhood infections are acquired before the age of 7 years, and spontaneous disappearance is rare (53). Many H. pylori positive children remain asymptomatic (54), and PUD is rare in Finnish children (55), even in those CagA-positive (56). According to the Finnish guidelines, the diagnosis of H. pylori in children should always be based on invasive methods, although 13 C-urea breath test and quantitative serology can be used for screening (10).…”

“…Although the role of H. pylori in recurrent abdominal pain in children is not clear, it is recommended that H. pylori infection detected at gastroscopy should be eradicated (10). In addition to urea breath test, serology is one alternative in the follow-up of eradication therapy (55). H. pylori positive children may have iron de®ciency anemia and these patients may need eradication of the infection to normalize the iron stores (57).…”