The importance of stool antigen testing and serology in diagnosis and treatment of helicobacter pylori infection in children with upper gastrointestinal complaints

6. NG L ZCE ÖZETThe importance of stool antigen testing and serology in diagnosis andtreatment of Helicobacter pylori infection in children with uppergastrointestinal complaintsIntroduction and Aim: The aim of this study; to determine theimportance of HpSA (Helicobacter pylori stool antigen) ve HpIgG(Helicobacter pylori immunoglobulin G) tests in diagnosis and treatment ofHelicobacter pylori (Hp) infection in children with upper gastrointestinal (GI)complaints, to find the rate of eradication of Hp infection after treatment, toestablish whether Hp infection influences the characteristics of complaints inchildren with upper GI complaints and whether the socioeconomic conditionshave an effect on appearance of complaints in children with Hp infection.Material and Methods: Between January 2003 and December 2005,87 children with upper GI complaints and 95 children without upper GIcomplaints aged between 5-18 years were included. Hp infection wasdetected by Urea Breath Test (UBT) (Helicobacter Test Infai) in children withupper GI complaints. HpSA (Diagnostic Bioprobes Srl, Milano, Italy) andHpIgG (Radim, Roma, Italy) tests were applied to all the children. Two weekstreatment regimen of amoxicillin, clarithromycin and lansoprozole were givento the 34 Hp positive children with upper GI complaints. These children werere-evaluated 4-6 weeks after treatment with UBT, HpSA and HpIgG tests.Children with upper GI complaints were questioned about the characteristicsof their of complaints and family history. All children were evaluated aboutsocioeconomic characteristics.Results: In children with upper GI complaints sensitivity, specificity,PPV, NPV, false positivity and false negativity of HpSA test were found to be86%, 84.1%, 84%, 86%, 15.9% and 14% respectively. In children with upper67GI complaints sensitivity, specificity, PPV, NPV, false positivity and falsenegativity of HpIgG test were detected to be 76.7%, 90.9%, 89%, 80%, 9.1%and 23.3% respectively. In Hp positive children with upper GI complaintssensitivity, specificity, PPV, NPV, false positivity and false negativity of HpSAtest in determination of eradication after treatment were found to be 88.9%,84%, 66%, 95%, 16% and 11.1% respectively. In Hp positive children withupper GI complaints sensitivity, specificity, PPV, NPV, false positivity andfalse negativity of HpIgG test in determination of eradication after treatmentwere found to be 77.8%, 36%, 30%, 81%, 64% and 22.2% respectively.There was no significant difference in sensitivity, specificity, PPV, NPV, falsepositivity and false negativity of HpSA test in children with upper GIcomplaints 10 years age and >10 years age. The sensitivity of HpIgG test inchildren with upper GI complaints was lower in 10 years age group thoughinsignificantly. With the HpSA test, Hp positivity in children with upper GIcomplaints was found to be 50.5% and Hp positivity in children without upperGI complaints was found to be 18.9%. Among children with upper GIcomplaints, sleep pattern, eating habits and school life was found to beaffected at a higher rate in the ones who are Hp positive (p=0.01). Hpinfection was positive in 50.57% of children with upper GI complaints and in18.9% of children without upper GI complaints. Educational level of mothersand fathers were significantly lower in children with upper GI complaints(p=0.01 and p=0.00 respectively). There was no significant difference offamily history of peptic ulcer and gastritis in Hp positive children with upperGI complaints and Hp negative children without upper GI complaints. In Hppositive children with upper GI complaints eradication was achieved in 73.5%and compliance to treatment was 85.3%. Non-compliance to treatment wasobserved in 55.5% of children in whom Hp eradication could not be achieved.The rate of eradication failure after treatment in Hp positive children withupper GI complaints who were compliant to treatment were %11.7.Discussion and Conclusion: HpSA test can be used as anoninvasive method in diagnosis and treatment of Hp infection in different68age groups of children with upper GI complaints. Use of the HpIgG test as asingle noninvasive method in diagnosis of Hp infection may be problematicespecially in younger age groups because of the low sensitivity compared tothe HpSA test. It was detected that in our region, Hp infection is needed to beremembered as a potential etiology in differential diagnosis of children withupper GI complaints and that especially the educational level of the family isan important factor in appearance of the complaints. It was seen that, inorder to achieve success in Hp eradication, it is important to take precautionsthat will prevent non-compliance.Key words: Helicobacter pylori, child, Helicobacter stool antigen test, Ureabreath test.69