Comparison of non-invasive tests to detect Helicobacter pylori infection in children and adolescents: results of a multicenter European study.

OBJECTIVE To compare the current non-invasive tests for Helicobacter pylori infection in children and adolescents. STUDY DESIGN This multicenter, multinational study investigated the sensitivity, specificity, and positive and negative predictive values of four non-invasive tests: urea breath test (UBT), stool antigen test, and antibody detection in serum and urine, in comparison with biopsy-based tests. RESULTS Of 503 patients included pre-treatment, 473 fulfilled the definition of H pylori status and among those 316 had results available for the four non-invasive tests (including 133 H pylori -positive patients). The specificity was excellent for all tests. The UBT had the best sensitivity in all age groups, followed by serology, stool test, and antibody detection in urine. A trend for better sensitivity with an increase in age was observed except for the stool test. The receiver operating characteristics (ROC) curves showed that sensitivity of serology, stool test, and urinelisa could be improved by changing the cutoff value. An inadequate storage of the specimens may explain the poor results of the stool test. CONCLUSION The UBT appears to be an excellent test for diagnosis of H pylori infection for children and adolescents.