ABSTRACT
BACKGROUND AND OBJECTIVE: The monoclonal stool antigen test for diagnosing Helicobacter pylori infection in children has been tested in developed countries, showing sensitivity and specificity higher than 90%. However, its accuracy in young children from developing countries is not well established. The aim of the study was to determine the accuracy of the monoclonal stool antigen test for diagnosing H pylori infection in children up to 7 years old. PATIENTS AND METHODS: Two hundred seventy-six patients (53.6% female; ages 0.35-6.99 years) were evaluated. Gold standard positive culture or positive histology and rapid urease tests were performed. The test (Amplified IDEIATM Hp StAR) was done according to the manufacturer's instructions. Results were expressed as optical density (OD) and an OD more than or equal to 0.190 was considered positive. Additionally, a receiver operating characteristic curve was used to find the best cutoff. RESULTS: The monoclonal stool antigen test for diagnosing H pylori infection showed 100% sensitivity (95% confidence interval [CI] 92.7%-100%) and 76.2% specificity (95% CI 70.1%-81.4%), considering the manufacturer's cutoff. After setting a new cutoff with the receiver operating characteristic curve (OD = 0.400), sensitivity remained 100% (95% CI 92.7%-100%), but the specificity improved to 97.7% (95% CI 94.7%-99%). At ages up to 2 years, sensitivity was 100% (95% CI 43.8%-100%) and specificity was 100% (95% CI 92.4%-100%); at ages 2 to 4 years, 100% (95% CI 80.6%-100%) and 97.6% (95% CI 96%-99.2%); at ages older than 4 years, 100% (95% CI 88.6%-100%) and 96.6% (95% CI 94.7%-98%), respectively. CONCLUSIONS: The monoclonal stool antigen test is accurate for diagnosing H pylori in children younger than 7 years old, but it must be locally validated in order to find the best cutoff for each population.
Subject(s)
Antibodies, Monoclonal , Antigens, Bacterial/analysis , Feces/chemistry , Helicobacter Infections/diagnosis , Helicobacter pylori/immunology , Immunoenzyme Techniques/methods , Child , Child, Preschool , Female , Helicobacter Infections/immunology , Helicobacter Infections/microbiology , Humans , Infant , Male , ROC Curve , Reference Values , Sensitivity and SpecificityABSTRACT
BACKGROUND AND OBJECTIVE: Studies support the accuracy of 13C-urea breath test for diagnosing and confirming cure of Helicobacter pylori infection in children. Three methods are used to assess 13CO2 increment in expired air: mass spectrometry, infrared spectroscopy, and laser-assisted ratio analysis. In this study, the 13C-urea breath test performed with infrared spectroscopy in children and adolescents was evaluated. METHODS: Seventy-five patients (6 months to 18 years old) were included. The gold standard for diagnosis was a positive culture or positive histology and a positive rapid urease test. Tests were performed with 50 mg of 13C-urea diluted in 100 mL orange juice in subjects weighing up to 30 kg, or with 75 mg of 13C-urea diluted in 200 mL commercial orange juice for subjects weighing more than 30 kg. Breath samples were collected just before and at 30 minutes after tracer ingestion. The 13C-urea breath test was considered positive when delta over baseline (DOB) was greater than 4.0%. RESULTS: Tests were positive for H. pylori in 31 of 75 patients. Sensitivity was 96.8%, specificity was 93.2%, positive predictive value was 90.9%, negative predictive value was 97.6%, and accuracy was 94.7%. CONCLUSIONS: 13C-urea breath test performed with infrared spectroscopy is a reliable, accurate, and noninvasive diagnostic tool for detecting H. pylori infection.
Subject(s)
Breath Tests , Helicobacter Infections/diagnosis , Helicobacter pylori , Spectrophotometry, Infrared , Urea , Adolescent , Carbon Isotopes , Child , Child, Preschool , Female , Gastritis/microbiology , Gastroscopy , Humans , Infant , Male , Peptic Ulcer/microbiology , Sensitivity and Specificity , Urea/administration & dosage , Urease/analysisABSTRACT
A Síndrome de Budd-Chiaru caracteriza-se por obstruçäo do fluxo sangüíneo hepático levando a hipertensäo portal, manifestada clinicamente por ascite, hepatomegalia e dor abdominal. Säo apresentados dois casos de meninos com Síndrome de Budd-Chiari, diagnosticada através de parâmetros clínicos, laboratoriais, radiológicos e histológicos. O esclarecimento diagnóstico foi obtido através do estudo radiológico contrastado; no caso 1 a cavografia inferior demonstrou obstruçäo da veia cava inferior ao nível das veias supra-hepáticas com presença de circulaçäo colateral reno-ázigos. No 2 o estudo angiográfico revelou trombose das tributárias da veia supra-hepatica direita sem a presença de circulacäo colateral