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Helicobacter pylori Eradication Rates in Children Upon Susceptibility Testing Based on Noninvasive Stool Polymerase Chain Reaction Versus Gastric Tissue Culture

Vécsei, Andreas*; Innerhofer, Albina*; Graf, Ulrike*; Binder, Christa*; Giczi, Heidemarie*; Hammer, Karin*; Bruckdorfer, Andrea*; Hirschl, Alexander M; Makristathis, Athanasios

Journal of Pediatric Gastroenterology and Nutrition: July 2011 - Volume 53 - Issue 1 - p 65–70
doi: 10.1097/MPG.0b013e318210586d
Original Articles: Gastroenterology

Background and Objectives: In children with clarithromycin-resistant Helicobacter pylori, clarithromycin-containing therapies often fail. The present study aimed to assess the outcome of tailored therapy upon noninvasive versus invasive H pylori susceptibility testing.

Patients and Methods: A retrospective cohort study was conducted in a pediatric outpatient clinic located in a region where H pylori clarithromycin resistance is highly prevalent. Between June 2007 and September 2009, 96 infected children (mean age 10.8 years), naïve to H pylori eradication treatment, were prescribed triple eradication therapies. These therapies were individually tailored upon susceptibility testing performed either noninvasively using stool polymerase chain reaction (stool PCR group) or invasively using endoscopy, biopsy, and culturing of gastric biopsies (gastric biopsy group). Eradication was defined by negative results upon noninvasive testing including stool PCR at least 5 weeks after the end of treatment.

Results: H pylori was eradicated in 43 of 55 stool PCR group versus 30 of 41 gastric biopsy group children (78.2% vs 73.2%, P = 0.63). Of those H pylori strains with pretherapeutic clarithromycin susceptibility, 78.8% were eradicated in the stool PCR group and 69.2% in the gastric biopsy group (P = 0.41) following clarithromycin-containing therapy; clarithromycin resistance was acquired by 4.1% of strains in the former group versus 12% in the latter (P = 0.33).

Conclusions: Stool PCR is as effective as the invasive approach of H pylori susceptibility testing for targeting resistance-guided eradication treatments in children. Furthermore, stool PCR is a useful tool for tracking the emergence of clarithromycin resistance following eradication treatment.

*St. Anna Children's Hospital, Austria

Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria.

Received 11 November, 2010

Accepted 13 January, 2011

Address correspondence and reprint requests to Athanasios Makristathis, PhD, Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria (e-mail: athanasios.makristathis@meduniwien.ac.at).

Drs Vécsei, Innerhofer, Graf, Binder, Giczi, Hammer, and Bruckdorfer report no conflicts of interest. Drs Hirschl and Makristathis have received consultancy fees from Ingenetics.

Copyright 2011 by ESPGHAN and NASPGHAN