Helicobacter pylori infection rate decreases in symptomatic children: a retrospective analysis of 13 years (1993-2005) from a gastroenterology clinic in West Virginia.

BACKGROUND: The rate of Helicobacter pylori is decreasing in the developed countries, but few long-term studies are available from the United States. We retrospectively assessed the annual H. pylori infection rate in symptomatic children seen in our clinic over a 13-year study period. STUDY: A retrospective analysis of all children who had histologic diagnosis of H. pylori infection between January 1993 and December 2005 in our pediatric gastroenterology clinic was performed. The annual infection rate and the overall infection rate were calculated. RESULTS: A total of 1743 upper endoscopy reports were reviewed, of which 212 (12.1%) were diagnosed with H. pylori infection. A significant decrease in mean annual H. pylori infection rate was noted in the last 6 years of the study period (2000 to 2005), compared with the first 7 years (1993 to 1999) (18.2% vs. 7.3%, respectively; P=0.001). CONCLUSIONS: The incidence of H. pylori infection in symptomatic children in our clinic is decreasing. A national multicenter study will be needed to assess whether this drop is a local phenomenon or a national trend.

The diagnostic accuracy of serologic markers in children with IBD: the West Virginia experience.

GOAL: To assess the sensitivity/specificity of the serologic markers: perinuclear antineutrophil cytoplasmic antibody (pANCA) and anti-saccharomyces cerevisiae antibody (ASCA) in children diagnosed with inflammatory bowel disease (IBD), living in West Virginia. BACKGROUND: In recent years, serologic markers have been used to differentiate between CD and UC diseases in children. The clinical usefulness of these markers in children was restricted by their low sensitivity and specificity. Racial and ethnic diversity may alter the accuracy of these markers in children. The demographic homogeneity of the West Virginia population may offer a better clinical setup to reassess the utility of those markers in children with IBD. STUDY: A retrospective analysis of all the charts of children diagnosed with IBD was performed at the gastroenterology clinics of Marshall University, Huntington, WV; and West Virginia University, Charleston Division, Charleston, WV. The diagnosis of IBD was established according to clinical, radiologic, and endoscopic data. Laboratory data and serum markers were recorded, and their accuracy to diagnose UC or CD was assessed. RESULTS: A total of 101 charts were reviewed, of which only 90 (89%) included serologic markers and were considered for further analysis. Disease distribution included: UC-41, CD-44, and indeterminate colitis (IC)-7 (2 patients changed diagnosis after colectomy). Serum antibody pANCA had a sensitivity of 73% and specificity of 84% for UC, but only 16% and 35% for CD, respectively. Serum antibody ASCA had a sensitivity of 58% and specificity of 92% for CD, but only 7% and 49% for UC, respectively. The outer membrane porin to Escherichia coli antibody (anti-OmpC) was available in 54 (59%) children and demonstrated a very poor sensitivity for both diseases (sensitivity<11%). CONCLUSION: Despite our homogeneous patient population, pANCA and ASCA antibodies had an inadequate sensitivity/specificity for children with UC or CD. Those antibodies were not useful for our small number of patients with IC.

The prevalance of celiac disease in West Virginia.

Celiac disease (CD) has been long considered as a "European disease" that is rarely seen in the North America. Recent data has refuted this notion and suggested that celiac disease in the United States is as common as in Europe. The atypical clinical presentation of celiac disease was one of the major reasons implicated for the under-diagnosis of this disease in American children. In this report, we describe several case presentations of children with celiac disease in order to update primary care physicians on the pathophysiology, diagnosis, treatment, and prognosis of this increasingly prevalent disease.

The prevalence of obesity and elevated liver enzymes in children at a university gastroenterology clinic.

Obesity has been recognized as a risk factor for liver disease. We evaluated the prevalence of obesity and elevated liver transaminases in children referred to the Pediatric Gastroenterology Clinic at the Marshall University Joan C. Edwards School of Medicine in Huntington. In a retrospective chart analysis the following data were collected: demographic, anthropometric, Body Mass Index, liver enzymes, medications, and final diagnosis. Of the 2550 charts reviewed, 540 children (21%) were obese, 399 (16%) were overweight, and 1,611 (63%) had normal weight. Liver enzymes were recorded in 902 children (35%). Elevated enzymes were found in 79 of the children (8.7%), but only 31 were appropriate for final calculation. Elevated liver enzymes were significantly higher in obese children compared to overweight or normal weight children. Over 30% of our children were obese or overweight. Obesity is a risk factor for elevated liver enzymes and early assessment is recommended.

Stool antigen test for diagnosis of Helicobacter pylori infection in children with symptomatic disease: a prospective study.

OBJECTIVE: Noninvasive tests for the diagnosis of Helicobacter pylori (Hp) infection in children are limited by low accuracy rates and lack of validation. Existing studies indicate that the stool antigen test (HpSA) has an acceptable level of accuracy for the diagnosis of Hp infection in adults but not children. The aim of this study was to evaluate the accuracy of the HpSA test for the detection of Hp infection in U.S. children. METHODS: Children requiring upper endoscopic procedures were prospectively recruited from two pediatric gastroenterology clinics. Stool samples were collected from each participant before endoscopy. The presence of Hp infection was determined by positive histologic findings and positive rapid urease test (RUT). The presence of Hp organisms in stool was determined by an enzyme-linked immunosorbent assay using a commercially available polyclonal antibody kit (Meridian Diagnostics, Cincinnati, OH, U.S.A.). Results of the stool antigen test were compared with histology findings and RUT results. RESULTS: One hundred twenty-one children (mean age, 10.1 +/- 3.7 years) participated, of whom 9 (7.4%) had Hp infection. Histologic findings and RUT results were concordant in 95% of the children. Per study protocol, HpSA had a sensitivity, specificity, positive and negative predictive value, and accuracy rate of 67%, 99%, 86%, 97%, and 96.5%, respectively. CONCLUSION: HpSA, a polyclonal antibody test, had a low sensitivity for infection in children in the United States and at present cannot replace histologic findings as the gold standard for the diagnosis of Hp infection in the pediatric population.

Distribution of Helicobacter pylori organisms in the stomachs of children with H. pylori infection.

Histology has been recognized as the gold standard for the diagnosis of Helicobacter pylori (Hp) infection in children. For ethical reasons, the number of mucosal biopsies obtained during endoscopic procedures is limited in the pediatric population. The aim of this study was to identify the optimal location where Hp organisms are colonized. Children who were scheduled for upper endoscopic procedures were prospectively recruited for the study. At least 2 mucosal biopsy samples were obtained from the following anatomic locations: greater curvature (mid-fundus [B3], mid-body [B1], and mid-antrum [A1] and lesser curvature mid-body [B2], incisura angularis [A3], and mid-antrum [A2]). In addition, a biopsy sample for a rapid urease test was obtained. The biopsy samples were stained with hematoxylin and eosin and Giemsa for the detection of inflammation and Hp colonization. The degree of mucosal inflammation and Hp colonization was assessed. The study group comprised 206 children, of whom 16 (8%) were positive for Hp infection. Hp colonization was significantly greater in the antral locations (A1, A2, and A3) than the body locations (B1, B2, and B3) (P <.001). The degree of mucosal inflammation correlated with the presence of Hp organisms, Hp density, and antral location. The mid-antrum location (A2) was superior for the detection of Hp organisms. The antrum, especially mid-antrum, at the lesser curvature is the best location in which to detect Hp organisms in children who have not recently used antibiotics or proton pump inhibitor medications.