Bacteriology
Is GastroPanel serum assay useful in the diagnosis of Helicobacter pylori infection and associated gastritis in children?

https://doi.org/10.1016/j.diagmicrobio.2006.06.022Get rights and content

Abstract

GastroPanel (Biohit, Helsinki, Finland) is a serum test kit that measures Helicobacter pylori antibodies (HPABs) and pepsinogens I and II and gastrin 17, which reflect the degree of atrophic gastritis. We assessed whether GastroPanel can replace endoscopic biopsies in the diagnostics of H. pylori in children and whether the H. pylori-infected children show markers for atrophic gastritis. Eighty children (median age, 6.8 years; range, 0.6–18.7 years) underwent gastroscopy for H. pylori-related abdominal complaints (n = 40), surveillance after surgery for gastrointestinal tract malformations (n = 20), gastroesophageal reflux (GER) (n = 10), and miscellaneous diseases (n = 10). Gastric biopsies and a serum sample were obtained from all 80 children. HPAB levels of 38 and 15 IU were tested as cutoff values for H. pylori gastritis. The biopsies showed H. pylori-positive gastritis in 30 children, 9 had gastritis not associated with H. pylori, and 41 had normal biopsies. Atrophic gastritis was not found. The sensitivity and specificity of HPAB for H. pylori were 47% and 98% (cutoff, 38 IU), and 73% and 85% (cutoff, 15 IU), respectively. The assays of pepsinogens and gastrin did not improve sensitivity. None of the markers of pepsinogen (PG) I, PGII, and gastrin 17 (G17) indicated atrophic gastritis. GastroPanel is too insensitive for H. pylori screening and does not replace endoscopy. Markers indicative of atrophic gastritis were negative in all children with H. pylori gastritis.

Introduction

Histology obtained from endoscopic biopsies has remained the gold standard in the diagnosis of H. pylori-related gastritis. In children, however, endoscopy is an invasive procedure that requires general anesthesia, and other diagnostic means such as breath test and serum and stool samples have been adopted. In children, however, the sensitivity of the less invasive tests has been low, and a biopsy is still needed for the diagnosis of H. pylori (Bourke et al., 2005). In adults, the serum concentrations of pepsinogens I and II (PGI, PGII), gastrin (G17), and H. pylori antibodies of IgG class have been used to assess the risk of atrophic gastritis and to differentiate between H. pylori-related and non–H. pylori-related gastritis (Vaananen et al., 2003). In the present study, we assess the performance of PGI, PGII, G17, and H. pylori antibody determination by GastroPanel kit (Biohit, Helsinki, Finland) in sera by comparing the results with endoscopic biopsies of gastric mucosa. We test the following hypotheses: can endoscopy and biopsies be replaced with GastroPanel assay in children and do the H. pylori-infected children present with markers for atrophic gastritis?

Section snippets

Materials and methods

Eighty children (median age, 6.8 years; range, 0.6–18.7 years; male, n = 43; Caucasian n = 54, African n = 25, Asian n = 1) underwent endoscopy of the upper gastrointestinal tract with gastric biopsies. Indications for endoscopies are shown in Table 1. Twenty-eight (70%) of the 40 patients whose abdominal pains were suspected to relate with H. pylori had breath (n = 3), blood (n = 23), or stool (n = 14) tests indicative of H. pylori infection. Three patients with abdominal pains had been

Endoscopy and histology

Thirty children (median age, 6.7 years; range, 2.4–12.1 years) had H. pylori-related gastritis (H. pylori-positive) (biopsy- and culture-positive, n = 29; biopsy positive + culture negative, n = 1 ), and in 50 children, H. pylori was not found either in biopsy or culture (H. pylori-negative). Of the 30 H. pylori-positive children, 23 were of African origin (n = 25) and 7 of Caucasian origin (n = 54) (P < 0.05). Of the 50 H. pylori-negative children, 41 (median age, 5.9 years; range, 0.6–17.9)

Discussion

The present study attempted to find out whether GastroPanel assay can provide an accurate diagnosis for H. pylori infection and H. pylori-related gastritis in children by comparing the test results with endoscopic gastric biopsies. We found that in H. pylori-positive children, the mean serum concentrations of HPAB and PGII were significantly higher and PGI/II ratio lower than in those H. pylori-negative. However, HPAB and PGII serum concentrations overlapped between H. pylori-positive and H.

References (11)

  • G.B.J. Glass et al.

    Atrophic gastritis

    Hum Pathol

    (1975)
  • B. Bourke et al.

    Canadian Helicobacter Study Group Consensus Conference: update on the approach to Helicobacter pylori infection in children and adolescents-an evidence-based evaluation

    Can J Gastroenterol

    (2005)
  • B. Hino et al.

    Comparison of invasive and non-invasive tests diagnosis and monitoring of Helicobacter pylori infection in children

    J Pediatr Gastroenterol Nutr

    (2004)
  • N. Kalach et al.

    Serum levels of pepsinogen I, pepsinogen II, and gastrin-17 in the course of Helicobacter pylori gastritis in pediatrics

    J Pediatr Gastroenterol Nutr

    (2004)
  • M. Kato et al.

    Japanese paediatric Helicobacter study group. Comparison between the 13C-urea breath test and stool antigen test for the diagnosis of childhood Helicobacter pylori infection

    J Gastroenterol

    (2004)
There are more references available in the full text version of this article.

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