Carbon-14 urea breath test in the diagnosis of Helicobacter pylori infection in children: Is it the best test?

Objectives H.pylori infects about 50% of children.It may cause chronic active gastritis, duodenal and gastric ulcers, gastric cancer and MALT lymphomas during their lives. This study was aimed to assess the efficacy of C-14 urea breath test (UBT) in children and to correlate UBT with endoscopic biopsy, urease test and PCR to find out the most sensitive test on the basis of gold standard culture test.

Methods Between 2008-2011 710 children who underwent UBT were retrospectively evaluated. Of these 104 patients who underwent at least 2 diagnostic tests in addition to UBT were included. None of them had any gastric surgery or medical treatment in the last 3 months. UBT results were correlated with endoscopy, biopsy, culture, PCR and urease test.

Results UBT was negative in 26/104(25%) and positive in 78/104 (75%) patients. Endoscopy, biopsy, PCR and culture tests were done in 100, 103, 91 and 79 patients respectively. Culture as the gold standard test was negative in 47/104 (45%), positive in 27/104 (25%), contaminated in 5/104 (4,8%) and not available in 25/104(24%) patients. For the patients without culture test, 2 positive tests of any kind were accepted as positivity criteria for H pylori, as such H.pylori was positive in 49/104(47%) and negative in 55/104(53%) patients. UBT was also positive in 46 out of these 49 patients which resulted with a sensitivity and specificity of 93% and 42% respectively. These 46 patients had biopsies which were negative for malignancy and displasia. Sensitivity and specificity of urease test, PCR and biopsy were 86%-46%, 88%-73% and 79%-41% respectively. Among all tests UBT was the most sensitive diagnostic test.

Conclusions C-14 UBT is the most sensitive diagnostic test for H. Pylori infection among other diagnostic tests, based on gold standard culture test. As being a non-invasive test, C-14 UBT is especially useful for the diagnostic work-up of H. Pylori infection in pediatric patients