Stool Test Predicts H. pylori Infection in Children

Laurie Barclay, MD

June 27, 2003

June 27, 2003 -- A monoclonal antibody stool test is highly predictive of the presence or absence of Helicobacter pylori infection in children, according to the results of a study published in the June issue of Gut. Further study is needed to validate the test for children younger than six years.

"Reliable non-invasive methods for detection of [ H.] pylori infection are required to investigate the incidence, transmission, and clearance of infection in childhood," write S. Koletzko from Ludwig-Maximilians University in Munich, Germany, and colleagues. "An enzyme immunoassay (EIA) to detect H. pylori antigen in stool would circumvent...difficulties as stool samples can be obtained from children without their active collaboration."

Of 302 symptomatic previously untreated children recruited from three centers, 148 were girls, and age range was 0.5 to 18.7 years. Culture, histology, rapid urease test, and 13C urea breath test showed that 92 children were infected with H. pylori and that 210 were not. Stool samples were tested by EIA using two different production lots and an optical density (OD) of 0.150 as a cut-off value.

Median OD value was 2.729 (5th-95th percentile, 0.232 - >4.000) in the H. pylori infected children and 0.021 (0.009 - 0.075) in the noninfected children. There were two false-positives and two false-negatives, yielding a sensitivity of 98%, specificity of 99%, positive predictive value of 98%, and negative predictive value of 99%. Age and OD values were not significantly correlated in infected or in noninfected children.

Because only 18 of 116 children younger than six years were infected with H. pylori, the authors recommend further validation of this test in young infected children.

"The monoclonal EIA stool test is easy to perform and provides excellent differentiation between positive and negative test results," the authors write. "If further studies in children confirm our results, this test may become an excellent tool to study the incidence, spontaneous clearance of H. pylori infection, and effect of preventive measures such as vaccination."

The Child Health Foundation in Munich supported this study. Connex GmbH provided free test kits for determination of stool antigen.

Gut. 2003;52:804-806

Reviewed by Gary D. Vogin, MD



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