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Quantitative ¹³C-urea breath test values predict peptic ulcer risk in Helicobacter pylori -infected children: a
Xiaoting Pan1,2, Youtao Chen1,2, Haibo Li2
1Fujian Children's Hospital, Fujian Branch of Shanghai Children's Medical Center, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
Insights
The quantitative ¹³C-urea breath test (¹³C-UBT) effectively diagnoses H. pylori infection in children. Optimal thresholds correlate with peptic ulcer risk, aiding diagnosis and prognosis.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Diagnostic Accuracy
Background:
- The ¹³C-urea breath test (¹³C-UBT) is a key tool for diagnosing H. pylori infections.
- Pediatric-specific diagnostic thresholds and their link to peptic ulcer (PU) disease require further definition.
- This study addresses the need for optimized pediatric ¹³C-UBT criteria and ulcer risk assessment.
Purpose of the Study:
- To establish optimal pediatric delta over baseline (DOB) thresholds for diagnosing H. pylori infection.
- To investigate the association between DOB values and the risk of peptic ulcers in children.
- To evaluate the diagnostic and prognostic utility of quantitative ¹³C-UBT in pediatric populations.
Main Methods:
- A retrospective analysis of 1,034 children (aged 3-18 years) who underwent ¹³C-UBT and endoscopy.
- ROC analysis was used to determine optimal DOB cutoff values.
- Logistic regression and restricted cubic spline analyses assessed the relationship between DOBs and ulcer risk.
Main Results:
- An optimal pediatric DOB cutoff of 5.285‰ demonstrated high diagnostic accuracy (Sensitivity 84%, Specificity 90%, AUC 0.879).
- Children with peptic ulcers exhibited significantly higher median DOBs compared to those without (3.1% vs. 1.9%, P < 0.001).
- A dose-response relationship was observed, with ulcer risk increasing with DOB up to approximately 36.39‰, after which it plateaued.
Conclusions:
- A DOB cutoff of 5.285‰ is highly accurate for diagnosing pediatric H. pylori infection.
- Elevated DOBs correlate with bacterial load, inflammation, and peptic ulcer risk, showing a saturation effect around 36.39‰.
- Quantitative DOB assessment provides valuable diagnostic and prognostic information, supporting its use in pediatric guidelines.
Background:
The quantitative ¹³C-urea breath test (¹³C-UBT) is valuable for diagnosing Helicobacter pylori (H. pylori) infection. However, pediatric-specific thresholds and their association with peptic ulcer (PU) disease remain inadequately defined. This study aimed to identify optimal pediatric delta over baseline (DOB) thresholds for diagnosing H. pylori infection and explore associations with ulcer risk in children.
Methods:
In this retrospective study, 1,034 consecutive children aged 3-18 years undergoing ¹³C-UBT with endoscopy and histopathological evaluation at Fujian Children's Hospital (May 2021-May 2025) were enrolled. DOB cutoff values were determined by ROC analysis. Logistic regression and restricted cubic spline (RCS) analyses evaluated associations between DOBs and ulcer risk.
Results:
The optimal pediatric-specific cutoff was 5.285% [Sensitivity 84%, Specificity 90%, area under the curve (AUC) 0.879]. Children with ulcers had significantly higher median DOBs than those without (3.1% vs. 1.9%; P < 0.001). A clear dose-response trend was observed across DOB quartiles (P < 0.001). Ulcer risk increased with DOB up to approximately 36.39‰, beyond which the risk plateaued.
Conclusions:
A DOB cutoff of 5.285‰ provides excellent diagnostic accuracy for pediatric H. pylori infection. Higher DOBs correlate strongly with increased bacterial load, mucosal inflammation, and peptic ulcer (PU) risk up to ∼36.39‰, indicating a saturation effect. Quantitative DOB thus offers diagnostic and prognostic utility, supporting its integration into regional pediatric guidelines.
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