Dual versus triple therapy of Helicobacter pylori infection: results of a multicentre trial.

OBJECTIVE: To compare dual therapy (omeprazole and amoxicillin) with triple therapy (omeprazole, amoxicillin, and clarithromycin) in the treatment of Helicobacter pylori infection. The efficacy of 1 mg/kg/day omeprazole was randomly compared with 2 mg/kg/day. STUDY DESIGN: 252 patients (median age, 11.0 years; range, 3-18) presenting with chronic abdominal pain underwent endoscopy and a 13C-urea breath test. Gastric biopsy specimens were taken for histological examination and for the rapid urease test. Patients were treated for two weeks: group A (n = 63) received amoxicillin (50 mg/kg; maximum, 2 g/day), group B (n = 73) received amoxicillin and clarithromycin (20 mg/kg; maximum, 1 g/day). Both groups were randomly treated with either 1 or 2 mg/kg omeprazole (maximum, 80 mg/day). Diagnostic procedures were repeated four weeks after the end of treatment. RESULTS: 11 patients were excluded; 136 patients were H pylori positive (56%), 105 of whom were re-examined after treatment. Helicobacter pylori was eradicated in 52% of group A and 83% of group B. The dose of omeprazole had no influence on the eradication rate. Specificity and sensitivity of the rapid urease test were 94% and 93%, respectively. Specificity and sensitivity of the 13C-urea breath test were 93% and 95%, respectively. CONCLUSIONS: Dual therapy can no longer be recommended. Triple therapy is more effective than dual therapy in the eradication of H pylori infection. The lower dose of 1 mg/kg omeprazole was as effective as 2 mg/kg.     

CagA seropositivity and the severity of Helicobacter pylori infection in dyspeptic children

AIM: To assess the incidence of cagA (cytotoxin-associated protein) and to evaluate its correlation with endoscopic-histologic findings and with eradication rate in a series of children affected by Helicobacter pylori (H. pylori) gastritis. METHODS: Fifty consecutive H. pylori gastritis children (27M; median age 10 y and 11 mo) were tested for IgG cagA protein (Western Blot technique). Pretreatment H. pylori infection was assessed on the grounds of endoscopic antral biopsy specimens by means of rapid urease test and histologic examination (Giemsa staining). All the children were treated with omeprazole (1 mg/kg/d), clarithromycin (15 mg/kg/d) and amoxycillin (50 mg/kg/d) for 2 wk. According to universally accepted clinical practice, outcome of treatment was assessed by 13C urea breath test at least 6 wk after the end of therapy. RESULTS: Thirty-five children (70%) were seropositive to cagA+ protein (median age 11 y and 1 mo). Endoscopic findings of cagA+ patients were similar to those of cagA- patients. In cagA seropositive patients the severity of histologic gastritis was higher (p < 0.05) and the granulocytic infiltration more marked (p < 0.01) than in seronegative ones. In cagA+ children, H. pylori eradication rate was significantly lower (p < 0.02). CONCLUSIONS: cagA testing may be of useful clinical interest because its positivity can imply a more severe gastritis and a lower susceptibility to eradication treatment.     

儿童幽门螺杆菌根除后复燃与再感染

为探讨儿童在幽门螺杆菌（H.pylori)根除后的复发情况，对90例H.pylori相关性胃十二指肠疾病，在抗H.pylori根除治疗后确定为H.pylori根除的患儿跟踪随访。结果90例儿童中复发23例，总复发率为25．56％。根除后1年内复发率为26．32％（10／38例）；根除后1年以上复发率为25．00％（13／52例），其中1年－11／2年为11．11％（2／18例）、11／2年－2年为20．22％（3／15例）、2年以上为40．11％（8／9例），P＜0．05。不同治疗方案与疗程的病例在1年内的复发率差异无显著性。H.pylori根除后1年以上，复发率呈逐步上升趋势。     

Helicobacter pylori and associated duodenal ulcer.

Twenty three children with coexistent duodenal ulcer and Helicobacter pylori infection were treated with either two weeks of amoxycillin (25 mg/kg/day) in addition to six weeks of cimetidine, or cimetidine alone. Endoscopy with antral and duodenal biopsies for urease test, microaerophilic culture, and histological studies were performed at entry, six weeks, 12 weeks, and at six months. Children with persistent H pylori infection at six weeks were given a further two weeks'' course of amoxycillin. H pylori persisted in all children not receiving amoxycillin treatment but cleared in six of the 13 children (46%) treated with amoxycillin. With failure of H pylori clearance at six months, only two out of six (33%) ulcers had healed and 50% of patients had experienced ulcer recurrence. In contrast, when H pylori remained cleared all ulcers healed and no ulcer recurred. Persistent H pylori infection was associated with persistent gastritis and duodenitis despite endoscopic evidence of ulcer healing. Detection and eradication of H pylori deserves particular attention in the routine management of duodenal ulceration in children.     

Interpreting the 13C-urea breath test among a large population of young children from a developing country.

The 13C-urea breath test is a noninvasive tool for the diagnosis of gastric Helicobacter pylori infection. However, it has not been validated in young children from the developing world, where infection is very common. 13C urea breath tests were performed on 1532 occasions on 247 Gambian infants and children aged from 3 to 48 mo. The means and variances of the separate sub-populations of 13C enrichment results contained within the overall dataset were estimated by a Genstat procedure using the EM algorithm, thereby identifying a cut-off value to discriminate positive from negative results. To illustrate the appropriateness of this calculated cut-off value, 13C urea breath tests were performed upon a small group of 14 patients aged 6 to 28 mo undergoing diagnostic upper endoscopy. Fixed gastric antral biopsies were examined to identify H. pylori. Two subpopulations were identified within the large dataset. A cut-off value of 5.47 delta per thousand relative to Pee Dee Belemnite limestone above baseline at 30 min identified 95% of the normally distributed negative sub-population and 99.4% of the log normal distributed positive sub-population. Comparison with endoscopic data confirmed that this cut-off value was appropriate for this population, as 7/7 children without H. pylori on their gastric biopsies had negative urea breath tests, and 6/7 children with gastric H. pylori colonization had positive urea breath tests. These findings confirm the value of the urea breath test as a diagnostic tool in young children from developing countries. They also offer a way to calculate the most appropriate cut-off value for use in different populations and the likelihood that it will correctly assign any value into the appropriate sub-population, without the need for endoscopy.     

缺铁性贫血伴幽门螺杆菌感染68例的治疗

目的：缺铁性贫血目前在我国仍是最常见的贫血类疾病,该研究旨在了解缺铁性贫血伴幽门螺杆菌感染的患儿抗幽门螺杆菌加铁剂治疗的疗效。方法：143例缺铁性贫血病例均做13C-呼气试验,其中阳性68例,将68例患者随机分为A,B二组。A组(35例):口服硫酸亚铁加2周治疗幽门螺杆菌的三联疗法;B组(33例):口服硫酸亚铁。结果：接受治疗的68例患者中,A,B二组在疗程结束后第8周复查血红蛋白、血清铁及血清铁蛋白均较治疗前有明显上升,且A组患者治疗后血红蛋白、血清铁及血清铁蛋白上升明显高于B组,差异有显著性,均P<0.01。结论：幽门螺杆菌感染与缺铁性贫血关系密切,与单独铁剂治疗相比较,加用抗幽门螺杆菌的治疗可加快提高血红蛋白的水平,二者配伍才是治疗缺铁性贫血伴幽门螺杆菌感染患者的最佳方案。     

Evaluation of stool antigen test for Helicobacter pylori infection in asymptomatic children from a developing country using 13C-urea breath test as a standard

OBJECTIVE: Prevalence of asymptomatic Helicobacter pylori infection is very high in infants and children in developing countries. C urea breath test (UBT) is a reliable non-invasive diagnostic test for H. pylori infection in children that avoids invasive endoscopy. We compared a newly introduced H. pylori stool antigen test (with a high sensitivity and specificity in symptomatic children) with UBT in asymptomatic children mostly 1-5 years old, from a population with a high prevalence of infection. METHOD: Eighty six asymptomatic children (42 boys and 44 girls) were tested for H. pylori infection using the UBT and a stool antigen test (HpSA) based on a sandwich enzyme immunoassay for antigen detection. RESULTS: Forty five of the eighty-six (52.3%) children tested positive for H. pylori using the breath test. In 34 of these forty-five children, H. pylori antigen was detected in stool (sensitivity = 75.6%, 95% CI = 63 to 88%). Of the 50 of 86 (58%) children positive by HpSA test, 34 were positive for breath test. Of the 41 children with negative UBT test 25 were negative for stool antigen test (specificity = 61%, 95% CI = 46 to 76%). CONCLUSION: The sensitivity and specificity of the new stool antigen test are lower in asymptomatic children with high H. pylori prevalence rate compared to those reported for children with gastrointestinal symptoms. Its usefulness is limited for diagnosis in an asymptomatic child with H. pylori infection.     

A prospective trial of lansoprazole triple therapy for pediatric Helicobacter pylori infection

BACKGROUND: Triple therapy with a proton-pump inhibitor and two antibiotics is widely used in the treatment of Helicobacter pylori infection in adults. Experience with such therapy in the pediatric population is limited. This was a prospective, nonrandomized, open-label trial to evaluate safety and efficacy of a combination of lansoprazole, clarithromycin, and amoxicillin in symptomatic children with H. pylori infection. METHODS: Children with H. pylori gastritis diagnosed by endoscopy performed for persistent nausea, vomiting, recurrent abdominal pain, and diarrhea with consistent histology were treated with the regimen of 0.45 mg/kg per day lansoprazole divided into two doses (maximum dose, 15 mg twice daily), amoxicillin 40 mg/kg per day in two doses (maximum dose, 1.0 g twice daily), and 250 mg clarithromycin twice daily (<10 years old) or 500 mg twice daily (>10 years old) for 2 weeks. Pre- and posttreatment endoscopic biopsy specimens were graded for the severity of gastritis and H. pylori density by a blinded pathologist. A questionnaire for assessing the severity of symptoms at the time of initial and second endoscopy were completed by patient and/or parent. RESULTS: Thirty-two children (age range, 1-25 years; mean age, 11 years; 19 females, 13 males) were treated with this regimen during an 18-month period. H. pylori organisms with varying grades of gastritis were present in tissue specimens of all patients. Only 28 children had follow-up endoscopy, which showed eradication of H. pylori in 15 (54%) children. Histologic symptoms of gastritis improved after therapy in the whole group. Overall, symptoms of vomiting, abdominal pain, diarrhea, anorexia, and halitosis significantly improved (P < 0.05). Minor adverse effects of therapy occurred in 25% of patients. CONCLUSIONS: Symptoms, histologic, and endoscopic findings improved after triple therapy in children with H. pylori gastritis; however, eradication of bacteria was achieved in only 56% of children.     

Comparison of an enzyme immunoassay for the detection of Helicobacter pylori antigens in the faeces with the urea breath test.

BACKGROUND: Current diagnostic tests for Helicobacter pylori are invasive (endoscopy) or indirect (urea breath test, serology). AIMS: To evaluate a new enzyme immunoassay (EIA) which detects H pylori antigens in faeces, by comparing its sensitivity and specificity in children with the (13)C urea breath test (UBT). METHODS: A total of 119 children underwent a UBT and provided a faecal sample for antigen testing within seven days. After an overnight fast each child provided a pretest breath sample, and samples at 30 and 40 minutes after ingestion of 100 mg (13)C labelled urea. (13)C enrichment of breath was measured by isotope ratio mass spectrometry. Faeces were stored at -70 degrees C until antigen testing, using the EIA. Samples were read spectrophotometrically at 450 nm and results were interpreted using recommended cut offs of optical density <0.14 as negative, >/=0.16 as positive, with >/=0.14 and <0. 16 representing equivocal results. Sensitivity and specificity were calculated using the manufacturer's cut off compared with UBT. RESULTS: Sensitivity and specificity were 88% and 82%, respectively. Negative and positive predictive values were 97% and 58%. CONCLUSIONS: The EIA is an alternative, non-invasive, and easy to use method for the detection of H pylori in children. Its high negative predictive value suggests a role in screening out uninfected children.     

儿童幽门螺杆菌感染的菌株类型及治疗

目的评估幽门螺杆菌(H.pylori)不同菌株对儿童胃粘膜炎症程度和治疗效果。方法对94例经胃镜和活检确诊H.pylori相关性胃炎的5～14岁儿童,用免疫印迹试验测血清细胞毒相关蛋白(CagA)、细胞空胞毒素(VacA)、尿素酶(urase)亚型抗体;抗H.pylori三联疗法10d,67例分A组(LAC组,用奥美拉唑 克拉霉素 阿莫仙治疗)和B组(BCF组,用果胶铋 克拉霉素 呋喃唑酮治疗),停药4周后用13C-UBT测定H.pylori根除率。结果①94例中检出CagA和/或VacA阳性86.2%,CagA和/或VacA阴性13.8%;慢性胃炎(CSG)27%,CSG 十二指肠球炎(DG)48%,CSG DG 十二指肠溃疡(DU)21%,胃溃疡(CU) DU4%,滤泡样改变56%,各种疾病检出菌株差异无显著性(χ2=2.551,P>0.05)。②94例H.pylori根除率76%,其中A组90.32%(28/31例),消化性溃疡(PU)根除率100%(12/12例)、CSG根除率84.21%(16/19例);B组H.pylori根除率为88.89%(32/36例),PU76.00%(6/8例),CSG92.86%(26/28例),两组差异无显著性(P>0.05)。各菌株根除率差异无显著性(P>0.05)。症状消退慢、难治及未能根除者大多为阳性菌。结论H.pylori蛋白印迹法简单、可靠,是流行病学筛选H.pylori细胞毒素的指标;阳性患儿必须予以根治。以下各组患儿推荐根治:①慢性活动性胃炎H.pylori阳性者;②胃十二指肠溃疡病患者;③产细胞毒素CagA阳性者。LAC三联根治H.pylori相关性胃炎疗程短、副作用小和根除率高,值得推广。     

儿童腹型过敏性紫癜与幽门螺杆菌感染的关系探讨

目的：探讨腹型过敏性紫癜(HSP)的发病及反复发作与幽门螺杆菌(HP)感染的关系。方法对36例腹型HSP及32例非腹型HSP中的16例进行胃、十二指肠内镜检查并行快速尿素酶试验,另设30例健康儿童作为对照组。3组均进行14C尿素呼气试验、血清抗HP抗体检测。结果36例腹型HSP患儿HP阳性21例（58.3%）, 其中反复发作16例,HP阳性13例（81.3%）,首次发作20例HP阳性9例（45.0%）。32例非腹型HSP患儿HP阳性9例（28.1%）;对照组HP阳性2例（6.7%）。三组比较差异具有非常显著性意义（χ2=14.7,P<0.01）,反复发作与首次发作比较差异具有显著性意义（χ2 =4.49,P<0.05）。结论 腹型HSP的发病及反复发作与HP感染有关。［中国当代儿科杂志,2007,9（4）：367-369］     

13 C-urea breath test with infrared spectroscopy for diagnosing helicobacter pylori infection in children and adolescents

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.     

Dual versus triple therapy of Helicobacter pylori infection: results of a multicentre trial

OBJECTIVE—To compare dual therapy (omeprazole and amoxicillin) with triple therapy (omeprazole, amoxicillin, and clarithromycin) in the treatment of Helicobacter pylori infection. The efficacy of 1 mg/kg/day omeprazole was randomly compared with 2 mg/kg/day.
STUDY DESIGN—252 patients (median age, 11.0 years; range, 3-18) presenting with chronic abdominal pain underwent endoscopy and a ¹³C-urea breath test. Gastric biopsy specimens were taken for histological examination and for the rapid urease test. Patients were treated for two weeks: group A (n = 63) received amoxicillin (50 mg/kg; maximum, 2 g/day), group B (n = 73) received amoxicillin and clarithromycin (20 mg/kg; maximum, 1 g/day). Both groups were randomly treated with either 1 or 2 mg/kg omeprazole (maximum, 80 mg/day). Diagnostic procedures were repeated four weeks after the end of treatment.
RESULTS—11 patients were excluded; 136 patients were H pylori positive (56%), 105 of whom were re-examined after treatment. Helicobacter pylori was eradicated in 52% of group A and 83% of group B. The dose of omeprazole had no influence on the eradication rate. Specificity and sensitivity of the rapid urease test were 94% and 93%, respectively. Specificity and sensitivity of the ¹³C-urea breath test were 93% and 95%, respectively.
CONCLUSIONS—Dual therapy can no longer be recommended. Triple therapy is more effective than dual therapy in the eradication of H pylori infection. The lower dose of 1 mg/kg omeprazole was as effective as 2 mg/kg.

     

Helicobacter pylori and nonulcer dyspepsia in childhood: clinical pattern, diagnostic techniques, and bacterial strains

BACKGROUND: This is a report of the results of a multicenter study performed in children with dyspepsia from five pediatric centers in Puglia, a region in southern Italy. In the study, clinical features of Helicobacter pylori infection, the reliability of diagnostic techniques, and the involvement of bacterial strains were examined. METHODS: Fifty-three outpatients with dyspepsia enrolled in our study and compiled a diary recording clinical symptoms in patients before they underwent the following diagnostic techniques: endoscopy, biopsy for histologic analysis, rapid urease test, 13C urea breath test, serology specific for immunoglobulin (Ig)G and anti-CagA and VacA. RESULTS: H. pylori showed a prevalence of 30.2% (n = 16). Histologic positivity was seen in all patients at the antral level (H. pylori-associated chronic gastritis). In the gastric body, bacterial chronic active gastritis was present only in six patients (H. pylori-associated chronic pangastritis). Clinical evaluation showed a significant difference in favor of subjects positive for H. pylori only for epigastric burning and/or pain (p < 0.001). The comparison of results of diagnostic tests, using histology as the gold standard, showed sensitivity and specificity of more than 93% for 13C urea breath test and more than 85% for rapid urease test and serology. Anti-CagA antibodies were found in 64.3% and anti-VacA antibodies in 42.8% of H. pylori-positive patients. CONCLUSIONS: H. pylori prevalence in children with dyspepsia from the geographic area studied is comparable with that found in other developed countries. Approximately 50% of the studied patients were infected by cytotoxic strains. The urea breath test was the most reliable noninvasive diagnostic tool and is suitable for routine use, although endoscopy with histologic assessment remains the definitive investigation and is particularly important in patients with positive serology for CagA and VacA. Finally, the frequency of aggressive strains in our region seems to affect the clinical pattern; this emphasizes the importance of definitive diagnosis in children and offers a new role for serology.     

Acquisition of secondary resistance after failure of a first treatment of Helicobacter pylori infection in children]

AIMS: To assess the frequency of acquisition of secondary Helicobacter pylori resistant-strains after a first course of antimicrobial treatment. PATIENTS AND METHODS: A retrospective study was performed during the 1994-2000 period, in 15 girls and eight boys, mean age 10.9 +/- 4.8 years (1.4-17 years), with Helicobacter pylori gastritis (culture and antimicrobial susceptibility) presenting a failure of first course treatment, with during one week a proton pump inhibitor and amoxicillin together with either clarithromycin (n = 14) or metronidazole (n = 9). Two endoscopies were performed, the first at the time of diagnosis and the second after the failure of bacterial eradication demonstrated by a positive 13C urea breath test six weeks after the end of treatment. Antimicrobial susceptibility of all Helicobacter pylori strains was tested after each endoscopy and before starting a second course of the treatment. RESULTS: Comparison of antimicrobial susceptibility before and after the first course of treatment showed that Helicobacter pylori strains were all sensitive to amoxicillin, clarithromycin-resistant in eight children (34.7%) before treatment vs 12 (52.1%) after treatment, p = 0.42, ns, metronidazole-resistant in 13 (56.5%) vs 12 (52.1%), p = 0.80, ns, and both clarithromycin and metronidazole-resistant in four (17.3%) vs seven (30.4%), p = 0.63, ns. Among the 14 children treated by a triple therapy including clarithromycin, three (21.4%) developed a secondary resistance to clarithromycin and in one metronidazole resistance was no more detected. Among the nine children treated with a triple therapy including metronidazole, none developed a secondary resistance to metronidazole and one developed a secondary resistance to clarithromycin. CONCLUSION: This study shows the absence of amoxicillin-resistant strains, a high initial clarithromycin-resistant strains level (primary resistance), increasing after a first course of treatment, and for metronidazole a high initial level of resistance not influenced by treatment. Secondary clarithromycin-resistance of Helicobacter pylori strains following the first course of treatment could account for failure of bacterial eradication and suggests the importance of antimicrobial susceptibility.     

Diagnostic value of stool antigen and antibody tests for Helicobacter pylori infection in Turkish children with upper gastrointestinal complaints before and after eradication

The aim of this study was to evaluate the diagnostic value of Helicobacter pylori stool antigen (HpSA) and serologic tests before and after eradication therapy for H. pylori in Turkish children in our region with upper gastrointestinal complaints. In this study, 87 children with upper gastrointestinal complaints and 95 children with various symptoms without gastrointestinal complaints were enrolled. H. pylori infection was detected by urea breath test (UBT). HpSA and H. pylori immunoglobulin G (HpIgG) tests were applied to all the children. Eradication treatment was given to the 34 H. pylori-positive children. The UBT was positive in 43 of 87 children (49.4%) with upper gastrointestinal complaints. The sensitivity and specificity of the HpSA in children with upper gastrointestinal complaints were 86% and 84.1%, respectively, and those for the HplgG were 76.7% and 90.9%, respectively. After eradication, the overall HpSA test sensitivity and specificity values were detected as 88.9% and 84%, respectively, and those for the HpIgG were 77.8% and 36%, respectively. The HpSA test is highly sensitive and specific for the diagnosis of H. pylori and for confirming eradication in Turkish children with upper gastrointestinal complaints. However, serology is not a reliable method for the diagnosis of H. pylori infection or for confirming eradication in children.     

Helicobacter pylori, anemia, and iron deficiency: relationships explored among Alaska native children

BACKGROUND: Attempts to understand determinants of anemia and iron deficiency have led researchers to examine the role of Helicobacter pylori infection. The current study assessed determinants of anemia and iron deficiency, including H. pylori, in Alaska Native children. METHODS: In 1999, a population-based survey was conducted among 86 children (67% response rate), mean age of 43.7 months (standard deviation = 16.8 months). Samples of breath, stool, and venous blood were obtained from children for measures of anemia, iron deficiency, H. pylori, fecal blood loss, and current inflammation. Standardized interviews with parents provided information on demographics, illness, and intake of dietary iron, iron-absorption inhibitors, and enhancers. RESULTS: Of the 86 children studied, 17.4% were anemic and 38.6% were iron deficient. Forty-one percent of the cohort had H. pylori-specific IgG antibodies, 86% tested positive by the urea breath test (UBT), and 80% tested positive by the stool antigen test. Presence of H. pylori antibodies emerged as a significant risk factor for anemia and iron deficiency in adjusted analyses controlling for demographic factors, current inflammation, and antibiotic use. In contrast, children with positive UBT or stool antigen results were significantly less likely to have anemia or iron deficiency than those with negative results. CONCLUSIONS: Results from different measures of H. pylori may reflect different stages of infection. Relationships between H. pylori and anemia/iron deficiency may depend on the phase of infection measured, with serologic tests reflecting established H. pylori infection associated with anemia/iron deficiency, and UBT and stool antigen results reflecting an earlier stage of infection.     

Accuracy of serology and 13C-urea breath test for detection of Helicobacter pylori in children

BACKGROUND: Indirect noninvasive methods, such as the 13C-urea breath test and serology, can be useful for the detection of Helicobacter pylori infection in children. We analyzed retrospectively the diagnostic accuracy of these two methods. PATIENTS AND METHODS: Between September, 1989, and October, 1996, H. pylori status was determined in 139 children by means of culture and histologic study of gastric biopsies. We performed 146 13C-urea breath tests and serologic assays (Cobas core; Roche). RESULTS: H. pylori infection was detected in 91 of 139 (65%) children. The 13C-urea breath test was discordant with H. pylori status in 4 of 146 tests; serology was discordant in 24 and indeterminate in 7 of 146. The 13C-urea breath test was more sensitive than serology (98% vs. 79%, P < 0.01) but comparable in specificity (96% vs. 92%). The serology yielded false negative results more often in children younger than 5 years of age (P < 0.05). CONCLUSIONS: The 13C-urea breath test is more reliable than serology for the detection of active H. pylori infection in children. Below 10 years of age serology is insufficiently sensitive for clinical purposes, whereas the 13C-urea breath test remains a reliable test.     

Helicobacter pylori infection in children with chronic idiopathic thrombocytopenic purpura

BACKGROUND: Recently a high prevalence of Helicobacter pylori infection has been reported in adult patients with chronic idiopathic thrombocytopenic purpura (cITP). Furthermore, after H. pylori eradication therapy in such patients, their platelet counts have been observed to increase, suggesting that H. pylori may be a causative agent of adult cITP. However, there have been only a few reports of children with cITP. The purpose of the present paper was to examine the association between H. pylori infection and cITP in Japanese children. METHODS: Helicobacter pylori stool antigens (HpSA) were measured and the prevalence of H. pylori infection was determined in 10 children with cITP. RESULTS: Helicobacter pylori infection was found in only two of the subjects. In a boy, the urea breath test (UBT) was also positive and the patient received eradication therapy using amoxicillin, clarithromycin, and lansoprazole for 1 week. The therapy was successful and the patient's platelet count increased. The response was maintained throughout more than 1 year of follow up. CONCLUSIONS: The prevalence of H. pylori infection in children with cITP is not high. However, the platelet count increased after eradication therapy in a boy with cITP. It is suggested that the eradication of H. pylori infection would be valuable in children, as well as in adults, with cITP.     

Treatment of pseudomonas aeruginosa colonisation in cystic fibrosis.

To test whether early treatment could postpone the chronic colonisation of the respiratory tract with mucoid strains of Pseudomonas aeruginosa in patients with cystic fibrosis, we performed a pilot study in 28 patients aged 2 to 18 years. A two week course of azlocillin (150 mg/kg/day) and tobramycin (10 to 15 mg/kg/day) was given after a mean duration of P aeruginosa colonisation of five months (range one to 11 months). Weight for height increased significantly by 3.5% (SEM 0.7%) of the predicted normal after chemotherapy. The eradication of P aeruginosa that was achieved in 18 children directly after hospital treatment was only temporary. Samples from only 10 and five patients remained negative three and six months after treatment, respectively. Five children remained free from P aeruginosa for a prolonged period of 14 to 32 months. We conclude that, apart from the clinical improvement in all patients, some children might benefit from early antipseudomonas treatment with respect to the bacteriological outcome. Most children, however, experience only a temporary reduction in colonisation. Further investigations in form of controlled clinical trials seem justified.