Abstract
BackgroundNumerous diagnostic tests are available to detect Helicobactor pylori (H. pylori). There has been no single test available to detect H. pylori infection reliably. We evaluated the accuracy of a new fluorescence quantitative PCR (fqPCR) for H. pylori detection in children.MethodsGastric biopsy specimens from 138 children with gastritis were sent for routine histology exam, rapid urease test (RUT) and fqPCR. 13C-urea breath test (13C-UBT) was carried out prior to endoscopic procedure. Gastric fluids and dental plaques were also collected for fqPCR analysis.Results38 children (27.5%) were considered positive for H. pylori infection by gold standard (concordant positive results on 2 or more tests). The remaining 100 children (72.5%) were considered negative for H. pylori. Gastric mucosa fqPCR not only detected all 38 H. pylori positive patients but also detected 8 (8%) of the 100 gold standard-negative children or 11 (10.7%) of the 103 routine histology-negative samples. Therefore, gastric mucosa fqPCR identified 46 children (33.3%) with H. pylori infection, significantly higher than gold standard or routine histology (P<0.01). Both gastric fluid and dental plaque fqPCR only detected 32 (23.2%) and 30 (21.7%) children with H. pylori infection respectively and was significantly less sensitive than mucosa fqPCR (P<0.05) but was as sensitive as non-invasive UBT.ConclusionsGastric mucosa fqPCR was more sensitive than routine histology, RUT, 13C-UBT alone or in combination to detect H. pylori infection in children with chronic gastritis. Either gastric fluid or dental plaque PCR is as reliable as 13C-UBT for H. pylori detection.
Highlights
Numerous diagnostic tests are available to detect Helicobactor pylori (H. pylori)
H. pylori infection status according to reference standard and each individual test As shown in Table 1, 38 children (27.5%) were positive for H. pylori infection according to the gold standard
We found that gastric mucosa fluorescence quantitative PCR (fqPCR) is more sensitive than routine histology, rapid urease test (RUT), 13C-urea breath test (13C-UBT) or the commonly used gold standard for detecting H. pylori infection in children with gastritis
Summary
Numerous diagnostic tests are available to detect Helicobactor pylori (H. pylori). It is well known that a successful eradication of H. pylori dramatically reduces the rate of Numerous diagnostic tests are available to detect H. pylori infection and are divided into either invasive (histology, rapid urease test (RUT) and bacterial culture) or noninvasive tests (serology, 13C-urea breath test (13C-UBT), and stool antigen test) [3]. There has been no single test available that can be used as a gold standard to detect H. pylori infection reliably and accurately [4,5]. Histological exam and RUT provided excellent diagnostic sensitivity and specificity of approximately 90–95% but the detection rate for H. pylori decreased in the presence of bleeding peptic ulcers or gastric atrophy [6,7]. It is recommended that concordant results of at least two tests are needed to define the H. pylori infection status in children [5]
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