Clinical and Laboratory ObservationsLimitations to carbon 13–labeled urea breath testing for Helicobacter pylori in infants☆,☆☆
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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Cited by (72)
Evaluation of the diagnostic performance and the utility of Helicobacter pylori stool antigen lateral immunochromatography assay
2022, HeliyonCitation Excerpt :Moreover, certain studies accounted for the lower specificity of the UBT in young ages. False-positive results may be attributed to urease-producing bacteria from the oral cavity in non-infected children [14]. HpSA-LFIA could be used as an alternative to UBT to diagnose primary infection of H. pylori, especially in developing countries.
Long-term follow-up of the incidence of Helicobacter pylori
2018, Clinical Microbiology and InfectionCitation Excerpt :As with other long-term studies, we had an overall loss to follow-up of 21% since 1997. We have previously shown that there are technical difficulties in performing 13C-UBT in children under 2 years of age [28]. Consequently, it is not possible to provide a specific at-risk age profile for the incidence of H. pylori in children younger than 3 years old.
Helicobacter pylori infection, a classic but often unrecognized cause of iron deficiency anemia in teenagers
2013, Archives de PediatrieUsefulness and influence of age of a novel Rapid HpStAR™ stool antigen for the diagnosis of Helicobacter pylori infection in children
2009, Diagnostic Microbiology and Infectious DiseaseA rapid lateral flow stool antigen immunoassay and <sup>14</sup>C-urea breath test for the diagnosis and eradication of Helicobacter pylori infection in children
2008, Diagnostic Microbiology and Infectious DiseaseCitation Excerpt :The test can be performed by using 14C-urea or 13C urea (Graham et al., 1987; Ormand et al., 1990). It is reported that the 13C urea breath test (UBT) has excellent sensitivity and specificity in the diagnosis of H. pylori infection in children (Bazzoli et al., 2000; de Carvalho Costa Cardinali et al., 2003; Kato et al., 2002, 2004a; Ni et al., 2000; Vandenplas et al., 1992), but specificity decreases in very young children, and collection of exhaled air is difficult in this age group (Imrie et al., 2001; Kindermann et al., 2000). 13C-labeled urea is preferable to 14C because of nonradioactive isotope, but high cost of 13C and requirement for mass spectrometric analysis preclude its use in developing countries.
Breath tests in pediatrics
2008, Clinica Chimica Acta
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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.