Diagnosis for Helicobacter pylori in a pediatric population

By: Youhanna S. Al-Tawil, MD,  GiforKids, PLLC

H. pylori can be found in a normal stomach and be asymptomatic. When there is a strong suspicion that H. pylori are causing clinical symptoms, testing can not only detect the presence of H. pylori but also confirm a diagnosis.

Upper gastrointestinal endoscopy and biopsy remains the “gold standard” in the diagnosis and identification of H. pylori infection and its consequences in childhood.  It allows visualization of the upper gastrointestinal tract.  Nodularity within the stomach is seen more frequently in children than adults.  The mucosa is irregular in appearance, resembling a cobblestone pavement.  Seen most often within the gastric antrum, it is frequently referred to an antral nodular gastritis.

Other tests that are not preformed thru endoscopy include the serologic (blood prick) test.  In children, this test detects only 20-50% of H. pylori infected patients.  The urea breath test can be done safely in the clinic and is used to detect H. pylori in young children; and can be repeated without risk to the child.  H. pylori antigen can also be detected in the stool.  Stool testing is a potentially inexpensive, non-invasive method for determining H. pylori infection.  Overall sensitivity and specificity of the stool test are comparable to the breath test.  The sensitivity to stool testing is negatively affected by PPLs, bismuth, and antibodies, which can decrease bacterial load.