Prevalence, Management, and Outcomes of Non-Invasive Helicobacter pylori Testing in Children at a Tertiary Paediatric Hospital in Singapore
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Purpose: Helicobacter pylori infections differ between children and adults. The Pediatric society practice guidelines recommend against a test-and-treat approach, characterized by the use of non-invasive tests for diagnosis (e.g. urea breath test [UBT] or stool antigen test). However, significant variations exist in clinical practice. This study examined the use of non-invasive testing for the screening and diagnosis of H. pylori infection in children at a tertiary pediatric hospital in Singapore, reviewing both management decisions and patient outcomes. Methods: A retrospective review was conducted on children between the ages of 0 and 18 years who were tested for H. pylori infection using either a stool antigen test or UBT between January 2018 and June 2020. Results: Among the 1,397 children tested, 117 (8.4%) had a positive stool H. pylori antigen result, and 5 out of 85 tested (5.9%) had a positive UBT. Abdominal pain was the predominant symptom (n=98; 80.3%). Only 7 treatment-naïve children had biopsy-proven disease. Tissue biopsies for H. pylori culture were sent to 2 children, with 1 negative result. A total of 111 children (91.0%) received treatment, wherein proton pump inhibitor, amoxicillin, and clarithromycin for 14 days was the most common therapeutic regimen. Symptom resolution was observed in 62 children (50.8%). Conclusion: A test-and-treat strategy was more widely utilized than endoscopy-based testing, showing a low compliance to existing guidelines for the management of H. pylori infections in children at our center and significant false-positive rates.
Abstract
Purpose: Helicobacter pylori infections differ between children and adults. The Pediatric society practice guidelines recommend against a test-and-treat approach, characterized by the use of non-invasive tests for diagnosis (e.g. urea breath test [UBT] or stool antigen test). However, significant variations exist in clinical practice. This study examined the use of non-invasive testing for the screening and diagnosis of H. pylori infection in children at a tertiary pediatric hospital in Singapore, reviewing both management decisions and patient outcomes. Methods: A retrospective review was conducted on children between the ages of 0 and 18 years who were tested for H. pylori infection using either a stool antigen test or UBT between January 2018 and June 2020. Results: Among the 1,397 children tested, 117 (8.4%) had a positive stool H. pylori antigen result, and 5 out of 85 tested (5.9%) had a positive UBT. Abdominal pain was the predominant symptom (n=98; 80.3%). Only 7 treatment-naïve children had biopsy-proven disease. Tissue biopsies for H. pylori culture were sent to 2 children, with 1 negative result. A total of 111 children (91.0%) received treatment, wherein proton pump inhibitor, amoxicillin, and clarithromycin for 14 days was the most common therapeutic regimen. Symptom resolution was observed in 62 children (50.8%). Conclusion: A test-and-treat strategy was more widely utilized than endoscopy-based testing, showing a low compliance to existing guidelines for the management of H. pylori infections in children at our center and significant false-positive rates.
참고문헌 (31)
- Hooi JKY, "Global prevalence of Helicobacter pylori infection : systematic review and meta-analysis", Gastroenterology, 153, pp.420~429 (2017)
- Amieva M, "Pathobiology of Helicobacter pylori-induced gastric cancer", Gastroenterology, 150, pp.64~78 (2016)
- Ang TL, "The changing profile of Helicobacter pylori antibiotic resistance in Singapore : a 15-year study", Helicobacter, 21, pp.261~265 (2016)
- Ernst PB, "The translation of Helicobacter pylori basic research to patient care", Gastroenterology, 130, pp.188~206 (2006)
- Whitney AE, "Helicobacter pylori gastritis in children and adults : comparative histopathologic study", Ann Diagn Pathol, 4, pp.279~285 (2000)
- Freire de Melo F, "A regulatory instead of an IL-17 T response predominates in Helicobacter pylori-associated gastritis in children", Microbes Infect, 14, pp.341~347 (2012)
- Jones NL, "Joint ESPGHAN", NASPGHAN guidelines for the management of Helicobacter pylori in children and adolescents (update 2016), 2017, pp.64, 991~1003
- Spee LA, "Association between Helicobacter pylori and gastrointestinal symptoms in children", Pediatrics, 125, pp.e651~69 (2010)
- Bonilla S, "Low adherence to society guidelines for the management of Helicobacter pylori among pediatric gastroenterologists", J Pediatr Gastroenterol Nutr, 73, pp.178~183 (2021)
- Yang HR, "Updates on the diagnosis of Helicobacter pylori infection in children : what are the differences between adults and children?", Pediatr Gastroenterol Hepatol Nutr, 19, pp.96~103 (2016)
- Oderda G, "Detection of Helicobacter pylori in stool specimens by non-invasive antigen enzyme immunoassay in children : multicentre Italian study", BMJ, 320, pp.347~348 (2000)
- Ni YH, "Accurate diagnosis of Helicobacter pylori infection by stool antigen test and 6 other currently available tests in children", J Pediatr, 136, pp.823~827 (2000)
- Leal YA, "Utility of stool sample-based tests for the diagnosis of Helicobacter pylori infection in children", J Pediatr Gastroenterol Nutr, 52, pp.718~728 (2011)
- Zhou X, "Accuracy of stool antigen test for the diagnosis of Helicobacter pylori infection in children : a meta-analysis", Clin Res Hepatol Gastroenterol, 38, pp.629~638 (2014)
- Leal YA, "13C-urea breath test for the diagnosis of Helicobacter pylori infection in children : a systematic review and meta-analysis", Helicobacter, 16, pp.327~337 (2011)
- Guarner J, "Helicobacter pylori diagnostic tests in children : review of the literature from 1999 to 2009", Eur J Pediatr, 169, pp.15~25 (2010)
- Pacheco SL, "Diagnosis of Helicobacter pylori infection by means of reduced-dose ¹³C-urea breath test and early sampling of exhaled breath", J Pediatr Gastroenterol Nutr, 57, pp.607~611 (2013)
- Yang HR, "Diagnostic accuracy of the 13C-urea breath test in children : adjustment of the cut-off value according to age", J Gastroenterol Hepatol, 20, pp.264~269 (2005)
- Jaime F, "Functional gastrointestinal disorders in children from low socio-economic status and Helicobacter pylori infection", Child Care Health Dev, 44, pp.319~325 (2018)
- Farrell S, "Nonulcer dyspepsia and Helicobacter pylori eradication in children", J Pediatr Surg, 40, pp.1547~1550 (2005)
- Bektas M, "The effect of Helicobacter pylori eradication on dyspeptic symptoms, acid reflux and quality of life in patients with functional dyspepsia", Eur J Intern Med, 20, pp.419~423 (2009)
- Sugano K, "Kyoto global consensus report on Helicobacter pylori gastritis", Gut, 64, pp.1353~1367 (2015)
- Fallone CA, "The Toronto consensus for the treatment of Helicobacter pylori infection in adults", Gastroenterology, 151, pp.51~69 (2016)
- Chey WD, "ACG clinical guideline : treatment of Helicobacter pylori infection", Am J Gastroenterol, 112, pp.212~239 (2017)
- Chew CA, "The diagnosis and management of H. pylori infection in Singapore", Singapore Med J, 58, pp.234~240 (2017)
- Ford AC, "Helicobacter pylori"test and treat"or endoscopy for managing dyspepsia : an individual patient data meta-analysis", Gastroenterology, 128, pp.1838~1844 (2005)
- Kato S, "The updated JSPGHAN guidelines for the management of Helicobacter pylori infection in childhood", Pediatr Int, 62, pp.1315~1331 (2020)
- Ang TL, "Helicobacter pylori treatment strategies in Singapore", Gut Liver, 15, pp.13~18 (2021)
- Huang JG, "Antibiotic resistance patterns and therapeutic outcomes of pediatric Helicobacter pylori infection in a high-migrant Singaporean cohort", Helicobacter, 27, pp.e12868~ (2022)
- Graham DY, "Rational Helicobacter pylori therapy : evidence-based medicine rather than medicine-based evidence", Clin Gastroenterol Hepatol, 12, pp.177~186 (2014)
- Xiong LJ, "Detection of clarithromycin-resistant Helicobacter pylori by stool PCR in children : a comprehensive review of literature", Helicobacter, 18, pp.89~101 (2013)