Helicobacter pylori and iron-deficiency anemia in adolescents in Brazil.

AIM: The aim of the study was to evaluate the association between Helicobacter pylori infection and iron deficiency (ID) in adolescents attending a public school. PATIENTS AND METHODS: From March to June 2001, a cross-sectional study was conducted among adolescents (10-16 years) enrolled in a single public school in São Paulo, Brazil. Of 400 eligible students, 195 agreed to participate, but 1 was excluded due to sickle cell disease. A blood sample was collected from each subject to measure hemoglobin and ferritin. H pylori status was investigated with the C-urea breath test. All of the subjects with either anemia or ID were given iron therapy. RESULTS: H pylori prevalence was 40.7% (79/194), being higher in male subjects (45/90 vs 34/104, P = 0.014). There was no relation between infection and nutritional status. Abnormally low serum ferritin was observed in 12 subjects, half of whom were positive for H pylori (odds ratio [OR] 1.49, 95% confidence interval [CI] 0.38-5.81). The median serum ferritin was 33.6 ng/mL (interquartile range 23.9-50.9) in infected subjects and 35.1 ng/mL (interquartile range 23.7-53.9) in uninfected subjects. Anemia was detected in 2% (4/194) of the students, half of whom were infected (OR 1.47, 95% CI 0.1-20.6). The mean hemoglobin value in infected subjects was 13.83 g/dL ± 1.02 versus 14 g/dL ± 1.06 in uninfected subjects. CONCLUSIONS: The study was not able to find a relation between H pylori infection and ID or anemia.

Validation of a monoclonal stool antigen test for diagnosing Helicobacter pylori infection in young children.

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.

Evaluation of the stool antigen test for Helicobacter pylori in children and adolescents.

The stool antigen test for Helicobacter pylori is a noninvasive immunoassay to diagnose active infection with Helicobacter pylori in human fecal samples. Its performance in children and teenagers has been tested in some developed countries, showing a sensitivity and specificity above 90%, however, its accuracy in developing countries and in children under 6 years is not well established. To determine the accuracy of the test for diagnosing Helicobacter pylori infection in children and teenagers, we evaluated 133 patients (4 months to 17 years old). The gold standard was a positive culture or positive histology and rapid urease test. The test was done according to the manufacturer's instructions. However, modifications were introduced for better reproducibility. Samples were analyzed twice and results are expressed as optical density (OD) determined spectrophotometrically at 450 nm. HpSA was considered positive at OD > or =0.160 and negative at OD <0.140. One hundred twenty-seven of the 133 (95.5%) patients were included. There were no infected infants. The test showed a 94.6% sensitivity (95% CI: 90.6-98.5) and a 96.5% specificity (95% CI: 93.3-99.7). At ages 2 to 6 years the specificity was 96.4% (95% CI: 85.1-99.2) and the sensitivity was 80.0% (95% CI: 64.8-89.7), at ages 6 to 10 years the sensitivity was 100.0% and the specificity 95.7%, and above 10 years the sensitivity and specificity were 100.0%. We conclude that the test is efficient in adolescents and children, however there is a need for further studies with a greater number of patients for evaluation of its accuracy in infants.

[Bowel preparation for colonoscopy with sodium picosulphate and magnesium citrate in children and adolescents]. / Preparo intestinal para colonoscopia com picossulfato sódico e citrato de magnésio em crianças e adolescentes.

BACKGROUND: The efficacy of colonoscopic examination depends directly on bowel cleansing preparation. There are few studies in the medical literature about bowel preparation in children. AIM: To determinate the efficacy of picosulphate sodium with magnesium citrate as a bowel preparation in children and adolescents. PATIENTS AND METHODS: In an open prospective and consecutive trial, we included all children above 1 year of age submitted to colonoscopy for different indications. All patients received the drug the day before the procedure and was allowed no solid food but a liberal intake of clear fluids. The adequacy of the preparation was graded as follows: gI--excellent, gII--good, gIII--fair and gIV--poor. RESULTS: Forty-six patients were included. The age ranged from 12 months to 16.1 years (median = 6.6y), 54.3% were males. Bowel preparation was made according to instructions in 37/46 (80.4%) of patients, 9 patients did not adhere to diet of clear liquids and 22/46 (47.8%) had side effects. The adequacy of the bowel preparation was: gI in 41.3%, gII in 52.2%, gIII in 6.5% and none in gIV. CONCLUSION: Bowel preparation with picosulphate sodium and clear fluids provides an effective, practical method of preparing the bowel for colonoscopy in children and adolescents and could be recommended.

Preparo intestinal para colonoscopia com picossulfato sódico e citrato de magnésio em crianças e adolescentes / Bowel preparation for colonoscopy with sodium picosulphate and magnesium citrate in children and adolescents

RACIONAL: A eficácia do exame colonoscópico depende diretamente da limpeza colônica. Ao contrário do paciente adulto, há poucos relatos na literatura sobre preparo colônico em crianças. OBJETIVO: Avaliar a eficácia do preparo colônico à base de picossulfato sódico e citrato de magnésio em crianças e adolescentes. PACIENTES E MÉTODOS: Realizou-se estudo aberto, prospectivo e consecutivo em crianças maiores de 1 ano, de ambos os sexos, que realizaram colonoscopia por diferentes indicações. Os pacientes receberam a medicação associada à dieta líquida e pastosa sem resíduos no dia anterior ao exame. A eficácia do preparo foi classificada em: Grau I: ótimo; Grau II: bom; Grau III: regular; Grau IV: ruim. RESULTADOS: A idade variou de 12 meses a 16 anos e 1 mês (mediana: 6 anos e 6 meses), sendo 54,3 por cento do sexo masculino. O preparo foi feito conforme a orientação em 37/46 (80,4 por cento) dos pacientes, sendo que 9 não fizeram a dieta adequadamente e 22/46 (47,8 por cento) referiram efeitos colaterais. A eficácia do preparo foi: GI em 41,3 por cento, GII em 52,2 por cento, GIII em 6,5 por cento e GIV em 0 por cento. CONCLUSAO: Preparo intestinal com picossulfato sódico e citrato de magnésio é eficiente e prático, podendo ser recomendado de rotina nos exames de colonoscopia em crianças e adolescentes.