The diagnostic value of non-invasive tests of the Helicobacter pylori in the childhood

Okužba s Helicobacter pylori poteka v otroštvu večinoma brez simptomov, vendar predstavlja pomemben dejavnik v nastanku metaplazije in karcinoma želodca v odrasli dobi. Želeli smo ugotoviti, ali predstavljajo neinvazivni testi za odkrivanje okužbe s Helicobacter pylori posamezno in v kombinaciji koristne neinvazivne metode v rutinski diagnostiki okužbe v pediatrični populaciji. Na skupnem vzorcu 62 otrok z anamnestično-kliničnim sumom na okužbo s Helicobacter pylori smo prospektivno opravili štiri neinvazivne teste za določanje okužbe: serološko preiskavo določanja specifičnih IgA in IgG proti Helicobacter pylori, pregled vzorca blata na antigen Helicobacter pylori in 13-C urea dihalni test. Pri 32 preiskovancih je bila okužba potrjena z invazivno metodo zlatega standarda. Izračunali smo specifičnost, občutljivost, pozitivno in negativno napovedno vrednost ter površino pod krivuljo ROC za posamezne neinvazivne teste. Diagnostično vrednost različnih kombinacij testov pa smo ugotavljali s testom ROC in klasično diskriminatorno analizo. Urea dihalni test ima v primerjavi z dokazom HpSA, IgG in IgA kot samostojen test najvišjo diagnostično vrednost. Kombinacija vseh štirih testov ima višjo diagnostično vrednost kot katerikoli samostojen test. Enako velja za kombinacijo urea dihalnega testa s testom za dokaz HpSA ali s serološkimi testi. Slabše rezultate sta pokazali kombinacija obeh seroloških testov in kombinacija seroloških testov z dokazom HpSA. Kot presejalni test je klinično uporaben urea dihalni test kot samostojen test ali kombinacija urea dihalnega testa z dokazom HpSA v blatu oziroma s serologijo (IgA, IgG) ali kombinacija vseh štirih neinvazivnih testov.The infection with Helicobacter pylori, mostly asymptomatic in children, is also an important factor in the development of intestinal metaplasia and gastric carcinoma in adulthood. In the present article we want to establish whether the noninvasive diagnostic rates of the Helicobacter pylori infection could individually and in different combinations be used in every-day paediatric clinical practice. A total 62 coincidentally chosen children with symptoms and signs suspicious of the HP infection were prospectively studied. They underwent for noninvasive diagnostic tests: serology - specific antibodies IgA and IgG against HP, stool antigen test and 13-C urea breath test. 32 of the patients had their infection confirmed with the invasive gold standard method. We calculated specificity, sensitivity, positive and negative predictive value and ROC urea under the curve for an individual test. We estimated the diagnostic values of test combinations with ROC testingand classic discriminative analysis. Urea breath test compared to HpSA, IgG and IgA has been shown to have the highest diagnostic value as an individual test. The combination of all four tests has the diagnostic value that is higher than of any of the individual tests. The same applies to combination urea breath test + HpSA or with serology. The results of combination of both serologic tests and combination serology + HpSA turned out to be worse. Urea breath test individually and its combinations with HpSA or serology (IgG, IgA) are clinically applicable as the screening methods for HP infection. The same goes to the combination of all four tests