Common experience in the diagnosis of helicobacter pylori infection in children with abdominal symptoms in Egypt and in the United Kingdom

ABSTRACT

Are 1] to determine the role of Helicobacter pylori [Hp] infection in children with RAP, 2] to compare between two types of Hp stool antigen tests [Meridian and IDEIA Hp Star] in screening and follows up of the cases after treatment, and 3] to compare the results of the stool antigen by the results of the endoscopy in Egypt and UK. Over a 2 year period [2005 -2007], H Pylori positive children were selected. An age match, sex and social group of children were selected as controls from the GI clinic of Queen Mary's Hospital for Children and Suez Canal University Hospital- Ismailia, Egypt. Forty-eight Egyptian child with abdominal pain and/or vomiting and 40 children from United Kingdom were enrolled in the study. The age ranged from 5-16 years. The children had been screened for Hp by two different kits of stool antigen detection. Upper GI endoscopy [OGD] was performed in all the children, and biopsies for histological examination and rapid urease test [CLO test] were done. The prevalence of H. pylori in our sample was high in both Egypt [41.7%] and UK [37.5%]. In the Hp positive Egyptian cases, 90% of patients were males, while 66.6% of the patients in the UK were males. The main presenting symptoms were similar in both populations, which were mainly RAP, nausea, and vomiting. However haematemesis was observed only in the Egyptian children [10%]. In both groups, endoscopic data showed that the majority of Hp infection was associated with antral nodularity, erosive gastritis, and rarely with peptic ulcer. Hp assay results using the Meridian HpSA method in Egypt, showed comparable accuracy with those of the IDEIA Hpstar used in England. There is a close similarity in diagnostic approach and treatment of Hp infection in the UK and the Egyptian children. The stool antigen kits used in Egypt and those used in UK had high specificity and sensitivity when compared with the results of the endoscopy and histologic evaluation. The disappearance of symptoms after treatment suggests a possible relation between Hp and RAP. We recommend the use of Hp stool antigen as a rapid, simple, accurate, non- invasive method for Hp detection. Long term follow up studies after treatment with a larger study sample is required to clearly establish the role of Hp in RAP