What is the role of upper endoscopy (EGD) in the diagnosis of pediatric Helicobacter pylori (Hp) infection?

Updated: Nov 16, 2018
  • Author: Mutaz I Sultan, MBChB, MD; Chief Editor: Carmen Cuffari, MD  more...
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  • Upper endoscopy (EGD) is the procedure of choice for detecting gastritis, duodenitis, and PUD in the pediatric population.

    • EGD allows for direct visualization of the mucosa; for localization of the source of bleeding; for the detection of H pylori by means of biopsy, culture, and cytology analysis; and for DNA testing by using PCR.

    • In addition, a quick test based on detection of urease activity (a highly specific marker of H pylori) can be performed. The test, termed the Campylobacter -like organism (CLO) test allows for a diagnosis of H pylori infection within 24 hours.

    • Two modified, rapid urease test kits are now commercially available and are reported to have better accuracy, a shorter reaction time, and better cost-effectiveness than those of the CLO test.

    • In children, endoscopy may reveal a nodular appearance in the gastric antrum resulting from lymphoid hyperplasia. [32] However, only approximately 50% of affected children have endoscopic evidence of changes of H pylori gastritis.

    • The gross appearance of an active ulcer is a round or oval, punched-out lesion with a smooth, white base and with surrounding mucosa that is red and edematous. In H pylori infection, the most common location for ulceration is the duodenal bulb.

    • Biopsy specimens obtained in the prepyloric antrum have the highest yield in H pylori infection. Tissue specimens are often also obtained from the body and the transition zones of the stomach, particularly if the patient has recently taken acid-suppressing medication.

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