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13C-urea breath test, referral patterns, and results in children
Yaron Niv1, Galia Abuksis, Rivka Koren
1Department of Gastroenterology, Beilinson Campus, Rabin Medical Center, Petach Tiqwa, 49100, Israel. yniv@clalit.org.il
Insights
Helicobacter pylori (Hp) infection is common in children, increasing with age and linked to Asian-African origin. The 13C-urea breath test (13C-UBT) is effective for diagnosing Hp in children, with omeprazole, amoxicillin, and clarithromycin being a common treatment.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Diagnostic Testing
Background:
- Helicobacter pylori (Hp) infection is prevalent globally, often acquired in childhood, and can lead to gastritis and peptic ulcers.
- Recurrent abdominal pain in children may be linked to Hp-induced gastritis, with eradication potentially improving symptoms.
Purpose of the Study:
- To characterize pediatric patients undergoing 13C-urea breath test (13C-UBT) based on referral patterns and test results.
- To investigate the efficacy of different treatment combinations for Hp eradication in children.
Main Methods:
- 13C-urea breath test (13C-UBT) using 75 mg of 13C-labeled urea in orange juice, with breath samples collected at 0 and 30 minutes.
- Data collection via physician questionnaires including demographics, indication for testing (proton pump inhibitor use), and eradication therapy type.
Main Results:
- The study included 1655 children (aged 1-18 years); 46.1% tested positive for Hp.
- Positive 13C-UBT results correlated with age, with peptic disease history being the primary indication for testing (81.4%).
- Children of Asian-African origin showed higher 13C-UBT positivity rates and referral reasons for Hp eradication validation.
Conclusions:
- 13C-urea breath test (13C-UBT) is suitable for all pediatric age groups, mainly indicated for suspected peptic ulcer disease.
- Hp infection prevalence increases with age; Asian-African origin was the only associated factor for increased infection.
- The most common eradication therapy involved a combination of omeprazole, amoxicillin, and clarithromycin.
Background:
The family is the core unit for Helicobacter pylori (Hp) infection. In most instances, Hp colonization occurs in early childhood, and correlates with socioeconomic parameters. Helicobacter pylori infection is highly prevalent in many countries, and may cause chronic gastritis and peptic ulcer in adults and in children. Gastritis induced by Hp may be associated with recurrent abdominal pain in children, and eradication of the bacterium may improve the clinical symptoms. AIM The primary aim of this study is to characterize the group of pediatric patients according to the referral patterns and results of 13C-urea breath test (13C -UBT) in our laboratory. The secondary aim is to investigate the result of different treatment combinations for Hp eradication.
Methods:
The 13C-UBT was performed with 75 mg urea labeled with 13C in 200 mL orange juice. Breath samples were collected at 0 and 30 minutes, and the results expressed as the change in the 13C/12C ratio at T30' minus T0' The cutoff for Hp eradication was 3.5. The physicians who ordered the test completed a questionnaire covering demographic data (age, gender, and origin), indication for the test was use of a proton pump inhibitor (PPI), and type of combination eradication therapy.
Results:
The study sample consisted of 1655 children, aged 1 to 18 years, 992 (59.9%) boys and 663 (40.1%) girls, from all parts of the country. The 13C-UBT was positive in 763 (46.1%). The prevalence of positive results was directly correlated with age. History of peptic disease was the main indication for the test, in 1346 (81.4%) cases. Details on eradication therapy were available for 435 children of whom 42.5% had a positive 13C-UBT, indicating a successful eradication rate of 57.5%. Compared with Israeli and American-European origin, children of Asian-African origin had a higher rate of referrals for reason of validation of successful Hp eradication, greater long-term PPI use, and a higher rate of 13C-UBT positivity. No significant difference was demonstrated between the triple therapy regimens used.
Conclusion:
13C-UBT may be performed in children of all age groups. The main indication is a history of peptic ulcer disease. The prevalence of Hp infection increased with age and the only factor associated with increased Hp infection was Asian-African origin. The most frequent eradication therapy used in children is a combination of omeprazole, amoxicillin, and clarithromycin.