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Utility of Stool Sample–based Tests for the Diagnosis of Helicobacter pylori Infection in Children

Leal, Yelda A*; Cedillo-Rivera, Roberto*; Simón, J Abraham; Velázquez, Juan R; Flores, Laura L§; Torres, Javier||

Journal of Pediatric Gastroenterology and Nutrition: June 2011 - Volume 52 - Issue 6 - p 718–728
doi: 10.1097/MPG.0b013e3182077d33
Original Articles: Gastroenterology

Objective: Helicobacter pylori antigen or DNA in stool are meant to detect the bacteria; however, in children the colonization of the gastric mucosa by H pylori is usually weak and fecal excretion of antigen or DNA varies considerably, challenging the utility of these tests in this age group. The aim of the present study was to carry out a systematic review and meta-analysis to evaluate the performance of stool H pylori DNA and antigen tests for the diagnosis of infection in children.

Methods: We conducted a systematic review and meta-analysis to assess the accuracy of stool tests for diagnosis of H pylori infection in children. We searched PubMed, EMBASE, and LILACS databases. Selection criteria included participation of at least 30 children and the use of a criterion standard for H pylori diagnosis. In a comprehensive search, we identified 48 studies.

Results: Regarding antigen-detection tests, enzyme-linked immunosorbent assay (ELISA) monoclonal antibodies showed the best performance, with sensitivity and specificity of 97%, positive likelihood ratio (LR+) of 29.9, and negative likelihood ratio (LR−) of 0.03. ELISA polyclonal antibodies had sensitivity of 92%, specificity of 93%, LR+ of 16.2, LR− of 0.09, and high heterogeneity (P < 0.0001). One-step monoclonal antibody tests demonstrated sensitivity of 88%, specificity of 93%, LR+ of 10.6, and LR− of 0.11. For DNA detection, polymerase chain reaction–based test showed sensitivity of 80.8%, specificity of 98%, LR+ of 17.1, and LR− of 0.18.

Conclusions: Detection of H pylori antigen in stools with ELISA monoclonal antibodies is a noninvasive efficient test for diagnosis of infection in children. One-step tests showed low accuracy and more studies are needed to obtain a useful office-based screening test. The available molecular tests are still unreliable.

*Unidad de Investigación Médica Yucatán (UIMY), Unidad Médica de Alta Especialidad de Mérida, Instituto Mexicano del Seguro Social, Mérida, Yucatan, México

BIOCEM/HRAEPY Mérida Yucatán

Departamento de Inmunogenética y Alergia, Instituto Nacional de Enfermedades Respiratorias, México, City

§Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital and the University of California, San Francisco, USA

||Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias (UIMEIP) Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, Mexico.

Received 30 December, 2009

Accepted 18 October, 2010

Address correspondence and reprint requests to Yelda A. Leal, Unidad de Investigación Médica Yucatán, Unidad Médica de Alta Especialidad del Centro Médico Nacional “Ignacio García Téllez” Mérida Yucatán, Instituto Mexicano del Seguro Social, Calle 34 #439 x 41 Colonia Industrial (Ex-terrenos del Fénix, Hospital T1), Mérida 97150, Yucatán, México (e-mail:

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN