To culture on not to culture? That is the question for the primary care physician

Abstract

In spite of the increase in number of non-invasive diagnostic tools for Helicobacter pylori in children, the ultimate solution (gold standard) has not yet been discovered. This reality is not unexpected, considering the various factors that may affect the accuracy rate of any diagnostic tool. Those factors include the prevalence of the disease in the tested community, the number of infected children included in the study, the demographic data of the children involved (young vs. older age, race and ethnicity), the commercial availability of the tested tool, its reliable cut-off value for the pediatric age group, and more. It is thus understandable, why different expert committees from Europe and North America are “chasing” the published data every so often, and revising their recommendations accordingly [1–3]. In this issue of Journal of Pediatric Infectious Diseases, Argentieri et al. [4] reported the accuracy of various invasive and non-invasive diagnostic tools for detection of H. pylori infection in Italian children. In this presumed retrospective study, 215 children were evaluated for H. pylori infection by invasive [tissue biopsy, rapid urease test (RUT), and culture], and noninvasive (stool antigen) methods. The authors chose