Commercial non-invasive immuno-assay versus upper gastrointestinal invasive endoscopy in diagnostic approach to helicobacter pylori infection in pediatric cases with recurrent abdominal pain. [immuno-assay versus histological and electron microscopic study]

ABSTRACT

Knowledge about Helicobacter pylori [H. pylori] infection is evolving, particularly in the pediatric age group for which there are still large gaps in knowledge. Some hope to find an explanation for a larger number of the pediatric recurrent abdominal pain [RAP] was raised with the discovery of H. pylori. Clinical trials are underway for the validation of non-invasive diagnostic tests for theH. pylori infections. The purpose of the present study was to find out the association between RAP and H. pylori infection as well as to evaluate the diagnostic accuracy of the stool antigen test [HpSA] versus the invasive endoscopic biopsy and other non-invasive serological methods for detection of H. pylori infection in Egyptian children Patients and methods: Seventy the children were classified into 2 groups Group I 50 children suffered from obscure RAP. Group II 25 children [control group] underwent endoscopy for indications other than RAP. Each patient was subjected to I] Upper gastrointestinal endoscopic examination and multiple gastric biopsies were taken for histological examinations. 2] Non-invasive tests [Serology] for H. pylori infections Sera and saliva were assayed for H. pylori IgG antibodies. Stool specific H.pylori antigen [HpSA] assay. Results: Endoscopic examination observed that 76% of children presented by obscure RAP had pathological findings in the form of antral gastritis [32%], esophagitis [20%], pangastritis [14%], duodenal ulcer [6%], duodenal erosions [2%] and esophageal varices [2%]. The prevalence of H. pylori organism among children presented by RAP was 38% versus 16% in control group. The most common findings among children colonized by H. pylori were non active and active chronic superficial antral gastritis. H. pylori stool antigen assay showed a diagnostic accuracy [92.5%; 95.5%], sensitivity [93.8%; 100%] and specificity [9 1.7%; 80%] in both RAP and control groups respectively. In conclusion: Prevalence of H. pylori among children presented by RAP was 38% but with no significant etiological relationship. The HpSA test is a very sensitive, specific, and easy to perform non-invasive diagnostic tool for the primary diagnosis of H. pylori infection in Egyptian children