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Immune responses to Helicobacter pylori in children with recurrent abdominal pain
J E Crabtree1, M J Mahony, J D Taylor
1Department of Medicine, St James's Hospital, Leeds.
Insights
Serological detection of Helicobacter pylori IgG antibodies is valuable for diagnosing children with recurrent abdominal pain. Assays require validation in pediatric populations for accurate H. pylori infection assessment.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Microbiology
Background:
- Recurrent abdominal pain and upper gastrointestinal symptoms are common in children.
- Helicobacter pylori infection is a potential cause of these symptoms.
- Accurate diagnostic methods for H. pylori in children are crucial.
Purpose of the Study:
- To evaluate the systemic immune response to H. pylori in children.
- To assess the utility of serological assays for H. pylori IgG antibodies in pediatric patients.
- To compare diagnostic performance between enzyme-linked immunosorbent assay (ELISA) and immunoblotting.
Main Methods:
- Enzyme-linked immunosorbent assay (ELISA) and immunoblotting were used to detect H. pylori IgG, IgA, and IgM antibodies in sera from 69 children.
- Histological examination confirmed H. pylori status.
- Assays were compared between pediatric and adult populations.
Main Results:
- H. pylori infection was confirmed histologically in 30% of children.
- H. pylori IgG antibodies detected by ELISA showed 86% sensitivity and 98% specificity.
- Immunoblotting demonstrated 95% sensitivity for IgG antibodies.
- IgA and IgM antibody detection showed poor discriminatory value.
- A positive correlation was observed between IgG antibody titers and age in children with H. pylori gastritis.
- ELISA cutoff for adults was higher than for children.
Conclusions:
- Serological detection of H. pylori IgG antibodies is a valuable tool for assessing children with gastrointestinal symptoms.
- ELISA and immunoblotting show promise for H. pylori diagnosis in pediatric populations.
- Further validation of serological assays in pediatric populations is recommended before widespread clinical use.
Abstract:
The systemic immune response to Helicobacter pylori was examined in 69 children with recurrent abdominal pain and upper gastrointestinal symptoms. Twenty one (30%) children were histologically positive for H pylori. Eighteen of the 21 positive subjects and two H pylori negative subjects (one with normal mucosa, one with lymphocytic gastritis) were positive for H pylori IgG antibodies by enzyme linked immunosorbent assay (ELISA) (86% sensitivity, 98% specificity). In children with H pylori associated gastritis, there was a significant positive correlation (p less than 0.05) between IgG antibody titres and patient age. Intra-assay comparison of sera from histologically negative adults with those of histologically negative children showed that the cut off for positivity in the ELISA for adults was greater than that for children. Immunoblotting showed IgG positivity in 20 of the 21 patients with H pylori infection (95% sensitivity). Both ELISA and immunoblotting for IgA and IgM H pylori antibodies had poor discriminatory value for determining infection. Serological detection of H pylori IgG antibodies seems to be valuable in the assessment of children presenting with recurrent abdominal pain and other gastrointestinal symptoms, but assays must first be validated in paediatric populations.