Elsevier

The Journal of Pediatrics

Volume 139, Issue 5, November 2001, Pages 734-737
The Journal of Pediatrics

Clinical and Laboratory Observations
Limitations to carbon 13–labeled urea breath testing for Helicobacter pylori in infants☆,☆☆

https://doi.org/10.1067/mpd.2001.118398Get rights and content

Abstract

We determined the validity of the carbon 13–labeled urea breath test in young children. We found that although the 13C-labeled urea breath test had a specificity greater than 90%, borderline or false positive results occurred more frequently in children younger than 2 years compared with older children. False positive results may be caused by oral-urease-producing organisms because direct intragastric administration of 13C urea reduced the excess δ 13CO2. Care is urged in interpreting one positive 13C-labeled urea breath test in children younger than 2 years. (J Pediatr 2001;139:734–7)

Section snippets

Methods

Consecutive children younger than 4 years undergoing upper gastrointestinal endoscopy over a 3-year period were eligible for inclusion in the study if they had not received antibiotics or gastric acid inhibition therapy in the month before endoscopy (group A). Indications for endoscopy included investigation of failure to thrive, reflux oesophagitis, or vomiting. At endoscopy, 3 antral biopsies were taken for culture, rapid urease test (Clo, Delta West, Australia), and histologic examination

Results

Among the 55 children in group A (mean age 25.7 months, standard deviation [SD] 13.1 months; male/female ratio 1.4:1), 6 were infected with Helicobacter pylori. All 6 infected children, including 2 who were younger than 2 years, were correctly diagnosed by the UBT with a 30-minute breath sample (Table) (mean excess δ 13CO2 18.1/mL, SD 10.4, range 5.2 to 28.9).Three of the 49 noninfected children had false positive tests (Table) (specificity 93.8%, positive predictive value 66.6%, mean excess δ

Discussion

Our initial aim was to evaluate the sensitivity and specificity of the UBT in children younger than 2 years. The sensitivity of the test could not be fully evaluated because of the small number of infected children. However, a significant and unexpected finding of this study is the increased number of borderline or false positive results (2.5/mL to 5.0/mL) of the 30-minute breath sample in children younger than 2 years. In children between 2 and 4 years of age, false positive results occur

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Supported by a Wellcome Trust Project Grant 051393.

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Reprint requests: Marion Rowland, The Children’s Research Centre, Crumlin, Dublin 12,Ireland.

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