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World J Clin Pediatr. Nov 8, 2015; 4(4): 143-147
Published online Nov 8, 2015. doi: 10.5409/wjcp.v4.i4.143
Limitations of urease test in diagnosis of pediatric Helicobacter pylori infection
Ji-Hyun Seo, Ji Sook Park, Kwang Ho Rhee, Hee-Shang Youn
Ji-Hyun Seo, Ji Sook Park, Hee-Shang Youn, Department of Pediatrics, Gyeongsang National Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, South Korea
Kwang Ho Rhee, Department of Microbiology, Gyeongsang National Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, South Korea
Author contributions: Seo JH wrote the paper; Seo JH, Park JS, Rhee KH, and Youn HS designed and reviewed the paper; Rhee KH and Youn HS had been several researches that were the bases for this paper.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hee-Shang Youn, MD, PhD, Department of Pediatrics, Gyeongsang National Institute of Health Sciences, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju 52727, South Korea. hsyoun@gnu.ac.kr
Telephone: +82-55-7508158 Fax: +82-55-7529339
Received: April 18, 2015
Peer-review started: April 21, 2015
First decision: August 5, 2015
Revised: September 1, 2015
Accepted: September 10, 2015
Article in press: September 16, 2015
Published online: November 8, 2015
Processing time: 206 Days and 18.2 Hours
Abstract

The diagnosis of Helicobacter pylori (H. pylori) infection is usually based on the results of urease test and histology. The urease test known as a simple and cheap method does not need special skills to perform or to read the result. The time needed for the test to turn positive depends on the concentration of bacteria, and the accuracy is up to the density of H. pylori density in the biopsy sample, which is generally lower in children than adolescents and adults. Therefore, there are debates about the sensitivity of the urease test in children. The reason for lower sensitivity of the urease test in children was not identified, but might be related to the low density and patchy distribution of bacteria. In this review, we discuss the limitations of the urease test in children according to age, histology, number of biopsy samples, and biopsy site. In children under 5 years old, the differences in positivity rate when the urease test used one or three biopsy samples, and samples from the antrum or the gastric body, were larger than those in children aged 5-15 years. Thus, three or more biopsy samples from both the antrum and body would improve the sensitivity of H. pylori infection diagnosis in children under 5 years old.

Keywords: Helicobacter pylori infection; Urease test; Children

Core tip: The diagnosis of Helicobacter pylori (H. pylori) infection is usually based on the findings of histology and the results of the urease test. However, the sensitivity of urease test in children was lower compared to adults. The lower sensitivity of urease test of children might be related to the low density and patchy distribution of bacteria. In urease test, three or more biopsy samples from both the antrum and body would improve the sensitivity of H. pylori infection diagnosis in children under 5 years old.