On the other hand, H. pylori prevalence among HIV-infected children from Uganda was surprisingly low, only 22.5% compared to the prevalence in healthy African children which is much higher . The explanation for significantly lower prevalence in HIV-infected children is accidental eradication with frequent antibiotic therapy used for the treatment of infectious comorbidity. Muhsen et al. studied the prevalence of H. pylori infection in different ethnic groups within the same geographic area and found
22.9% seropositivity among Jewish children and significantly higher 45.6% in Arab children in Israel. selleck screening library This difference was explained by different socioeconomic status, cultural habits and family size . In an another study, risk factors for the acquisition and maintenance of the H. pylori infection were more than three siblings in the family, the use of well water for drinking, and male gender . Conditions and clinical presentations anti-PD-1 antibody indicating or precluding search for H. pylori infection have been extensively reviewed in the recently published guidelines  and are summarized in the Table 1. Testing for H. pylori in children should be performed in properly
selected patients (Table 1) and with an adequate diagnostic procedure. Current recommendations do not approve a “test and treat” approach, but to select a patient in whom organic disease is expected based on detailed medical history and physical examination . Therefore, diagnostic procedures should aim to determine underlying disease and not to detect H. pylori . Although noninvasive tests yield high sensitivity and specificity, endoscopy with histopathology remains the only method that can detect
lesions associated with the infection, but also other possible causes of the patient’s symptoms . As no single test is accurate enough for detection of H. pylori, current guidelines recommend 上海皓元 endoscopy with gastric biopsies and confirmation of infection with two different tests: either histopathology and rapid urease test or a culture . Regarding noninvasive tests, recently published meta-analysis on the performance of the 13C-urea breath test (13C-UBT) showed relatively good accuracy especially in children older than 6 years of age (sensitivity 96.6%, specificity 97.7%) . However, stool antigen-detection test do not depend on the age and has similar accuracy; meta-analysis on stool antigen-detection tests revealed that enzyme-linked immunosorbent assay (ELISA) monoclonal antibodies have the best performance, with sensitivity and specificity of 97% compared to ELISA polyclonal antibodies (sensitivity of 92%, specificity of 93%), and to one-step monoclonal antibody tests (sensitivity of 88%, specificity of 93%) . Therefore, both of noninvasive tests, 13C-UBT and the accurate stool antigen-detection test, are recommended as reliable methods for evaluation of eradication rate in children .