Helicobacter pylori (H. pylori) is causally associated with peptic ulcer disease and
gastric carcinoma. Typically, children get infected during the first decade of life, but
diseases associated with H. pylori are seen mainly in adults. Multiple diagnostic
methods are available for the detection of H. pylori infection. The aim of this study
was to evaluate the correlation and diagnostic accuracy of three invasive methods
[rapid urease test (RUT), histology and bacterial culture] and one non-invasive
method (IgG serology) for diagnosis of H. pylori infection in a prospective cohort
study conducted on 50 symptomatic children between two and eighteen years of
age. Endoscopies with gastric biopsies were performed for RUT, culture and histopathological
examination, respectively. IgG antibodies were measured in patient sera
using a commercially available enzyme-linked immunosorbent assay (ELISA). RUT
and positive H. pylori IgG antibodies were concordant in 88% (44/50) of patients.
Both tests were negative in 32% (16/50), and both were positive in 56% (28/50).
Disagreement occurred in 12% (6/50) of the patients: three of them (6%) had positive
RUT and negative H. pylori IgG, and another three (6%) had negative RUT
and positive H. pylori IgG. A combination of RUT with non-invasive serology constituted
the optimum approach to the diagnosis of H. pylori infection in symptomatic
children. The non-invasive serological test (ELISA) could not be used alone as
the gold standard because it cannot distinguish between active and recently treated
infection; and bacterial culture could not be used alone because of its low sensitivity