Screening: ijzergebreksanemie

1

Huang X. et al.

Asia

Postgrad Med J feb 2010

Iron deficiency anaemia can be improved after eradication of Helicobacter pylori

Therapy

SR

4 studies with children aged 2-18 years with HP and iron deficiency anaemia

Eradication therapy combined with iron administration

Iron administration alone

Changes in serum Hb concentrations

Changes in serum ferritine concentrations

WMD=7.3 mmol/l (1.5-13.2 mmol/l), p<0.00001

WMD=5.93 (4.53-7.32), p=0.91

PICO 2

All studies from Asia.

Level: A2 (inconsequence regadering cut-off Jadad-score)

2

Qu XH, et al.

Asia

World J Gastroenterol. 2010 Feb 21;16(7):886

Does HelIco

bacter pylori infection play a

role in iron

deficiency

anemia? A

meta-analysis.

Etiologie and therapy

Meta-analyse

Children aged <18 years with HP and iron deficiency (anaemia)

Eradication therapy combined with iron administration

Iron administration alone

Association HP and IDA

<11 years of age:

10-18 years of age:

Hb changes,

 <11 years of age

SF changes, <11 years of age

OR=4.76 (1,73-13.08)

OR=2.85 (1.68-4.31)

0.65 g/L (-1.52-2.82)

0.70 g/L (-1.01-2.41)

PICO 2

Adolescents: 10-18 years of age, children <11 years of age

5 observational studies (to asses the association between HP and IDA) and 3 RCTs (to asses changes in Hb and SF)

Studies from Asia, except one.

Level: A2

Screening: gastrointestinale klachten

3

Spee LA et al.

The Netherlands

Pediatrics. 2010 Mar;125(3):e651-69. Epub 2010 Feb 1

Association

between

helicobacter pylori  and gastrointestinal symptoms in

children.

Etiologie

SR

Children aged 0-18 years with GI symptoms

RAP and HP

12 Case-control studies

7 Cross-sectional studies

UAP and HP

6 Case-control studies (hospital –based):

5 Cross-sectional studies (population-based)

Pooled OR=1,21 (0,82-1,78)

Pooled OR=1,00 (0,76-1,31)

Pooled OR=2,87 (1,62-5,09)

Pooled OR=0,99 (0,46-2,11)

PICO 2

Studies concerning exclusively

children with relevant comorbidity

such as mental disabilities, immunodeficient

disorders, and diabetes

were excluded.

Level: A1

Therapie: sequentieel

4

Gatta L et al.

Italy

Am J Gastroenterol. 2009 Dec;104(12):3069-79

Sequential

therapy or triple therapy for Helicobacter pylori infection: systematic review and meta-analysis of randomized controlled trials in adults and children.

Therapy

SR and meta-analysis

3 RCTs with 260 children ≤18 years of age with HP.

1 study: patients with nonulcer dyspepsia and peptic ulcer disease.

Sequential therapy ST

Triple therapy TT

Eradication

7-day eradication

14-day eradication

Adverse events

OR (pooled): 1.98 (0.96-4.07)

OR (pooled, fixed)=2.53 (1.21-5.29) favoring ST

Difference 6.6%, Not significant

Difference: 2,7% niet sign. (iets meer bij ST)

PICO 3

HP was diagnosed by 13 C-UBT (2 studies) and RUT+histo (1 study)

Level A1

Diagnostiek

6

Leal YA et al.

J Pediatr Gastroenterol Nutr. 2011 Apr

Utility of Stool Sample-based Tests for the Diagnosis of Helicobacter pylori

Infection in Children.

1.      

Diagnosis

SR and meta-analysis

39 studies and 5799 children, 0-19 years of age, were included. Of these, 2323

were HP positive and 3476 were HP negative

Stool tests: antigen-detection tests and

DNA-detection tests

22 (56%) used both culture and histology, 5 (13%): only histology and either RUT or

UBT, 8 (21%): UBT alone, and 4 used UBT combined with ELISA.

Sensitivity and specificity

ELISA monoclonal antibody tests (6 test comparisons)

ELISA polyclonal antibody tests (29 test comparisons)

DNA, PCR-based tests (7 test comparisons)

SE: 97%, 95% CI 94–98

SP: 97%, 95% CI 95–98

Heterog: p<0.05

SE: 92%, 95% CI 90–93

SP 93%, 95% CI 91–94

Heterog: p<0.016

SE: 54%–100%

SP: 93%–100%

PICO 1

Level A1

Each test comparison was counted as a separate study. Thus, a total of 48

tests (and 29 studies) comparisons were included in

the meta-analysis.

PCR

1

Vécsei A,

Stool polymerase chain reaction for Helicobacter pylori detection and

clarithromycin susceptibility testing in children.

Clin Gastroenterol Hepatol. 2010

Austria

B

Retrospective

All children (n=143) who underwent gastroscopy  between March 2006 and February 2009 and also having been examined by stool PCR

(3e lijn)

Culture was positive in 71 (54.2%).

E-test

revealed resistance to clarithromycin in 32 of 71 isolates

(45.1%).

Mean age: 10.8 (2.8-17.9)

Males : females, 1:1.5

Real-time polymerase-chain reaction (PCR)

Rapid urease test, histology and culture.

E-test for clarithromycin susceptibility testing

83.8%

89.2%

98.4%

100%

PPV: 98.5%

NPV: 82.7%

Test accuracy: 90.2%

94.0% (test accuracy)

Unclear: Only posttreatment cases followed by EGD for clinical reasons were considered

Urease-sneltest

2

Roma-Giannikou E,

Endoscopic tests for the diagnosis of Helicobacter pylori infection in children:

Validation of rapid urease test.

Helicobacter 2010

Greece

B

Retrospective, patient control

530 children

proved to be infected with H. pylori by upper GI endoscopy  during the period January 1989 to April 2009.

HP+: 530 children, 254 males,

aged 0.5 to 15 years (mean 10.4 ± 3.0 SD years)

HP-: 1060 children, 526 males, aged 0.1 to 16.2 years

(mean 7.3 ± 4.4 SD years).

Rapid urease test (CLO test)

Culture

Histology

Culture or two other positive tests (histology and rapid urease test (CLO-test) or UMT als één van de twee positief was

83.4% (CLO)

84.6% (culture)

93.2% (histology)

99%

100%

100%

Inclusion

criteria were the performance of CLO-test together

with antral biopsy, and culture whenever was available (?).

Feces-antigeentest

3

Raguza D,

Validation of a monoclonal stool antigen test for diagnosing Helicobacter pylori

infection in young children. J Pediatr Gastroenterol Nutr. 2010

Brasil

A2

Cross sectional?

276 patients with digestive symptoms, referred for endoscopy

(3e lijn)

18.1% (50/276)

6% (3/51) in patients up to 2 years, 16.5% (17/103) in

patients with ages 2 to 4 years, and 22.6% (30/122) in patients with

ages 4 to 7 years.

53.6% female;

age 0.35–6.99 years (mean: 3.94 years).

Monoclonal stool antigen test

Culture or both, RUT and histology

100% or 100% (depending on the cut-offs)

76.2% / 97.8% (depending on the cut-offs)

PPV: 49,0%/90.9%, NPV:  100,0%/100% (depending on the cut-offs)

The test must be locally validated

in order to find the best cutoff for each population.

4

Prell C,

Improved performance of a rapid office-based stool test for detection of

Helicobacter pylori in children before and after therapy.

 J Clin Microbiol. 2009

Germany

B

2x cross sectional (pre- en posttreatment, 6-8 weken na therapy)

185 symptomatic children (not further described)

62 (34%) in the pre-treatment group

14 (24%) in the post-treatment group

Mean age, 10.2; range,

0.3 to 18.2 years

Rapid office-based stool test (Hpstar)

Compared to the monoclonal EIA

Pretreatment group: culture and at least two other tests (histology, rapid urease test, and UBT)

Post-treatment Group (6-8 weeks after therapy): 13C urea breath test

93.5% / 90.3% (observer 1 and 2)

93.5% (monoclonal EIA)

100%

89.4 / 91.9% (observer 1 and 2)

97.6% (monoclonal EIA)

97.7%

5

Kalach N,

Usefulness and influence of age of a novel Rapid HpStAR stool antigen for the

diagnosis of Helicobacter pylori infection in children.

Diagn Microbiol Infect Dis. 2009

A2/B

Prospective

For a 1-year period, from September 2007 to June 2008,

108 children undergoing

endoscopy were enrolled, in the course of diagnostic

evaluation of clinical gastritis, manifested by recurrent

abdominal pain (RAP) for at least 3 months, nausea, and

vomiting.

16/108 (15%)

40 girls and 68 boys

The 108 children undergoing an endoscopy had a mean age of 7.6 years (SD, 4.8 years; range, 10 months to 18 years): 38 patients were younger than 5 years (3 H. pylori

positive), and the remaining 70 were older than 10 years (13 H. pylori positive).

A novel rapid monoclonal enzyme immunoassay stool antigen Rapid HpStAR™

Histology combined with the rapid urease test or culture only

87.5%

97.8%

PPV: 87.5%

NPV: 97.8%

The test was validated in only 13 patients.

Iron deficiency

1

Duque X. et al.

Mexico

Arch Med Res. 2010 Jan

Effect of eradication of Helicobacter pylori and iron supplementation on the iron

status of children with iron deficiency.

A2/B

Therapy / screening

RCT

72 children 6- to 13-years

old from a low SES who attended any of

four public schools in Mexico City and had iron deficiency or anemia (in 2003)

Children with HP received eradication treatment and daily supplementation for 3 months with ferrous sulfate

plus folic acid (n=19)

Children without HP received ferrous sulfate plus folic acid (n=36):

both, as intervention group and control group

Children with HP received eradication treatment and daily supplementation for 3 months with placebo (n=17)

Hemoglobin mean concentration

Serum ferritin concentration

0.37 g/dL (95% CI: -0.02, 0.75)  increase in children in whom eradication was achieved compared to non-infected children

0.47 g/dL (95% CI 0.01-0.93) increase in children in whom eradication was achieved and ferrous sulfate compared to non-infected children who received iron supplementation

11.26 ng/mL (95% CI 1.86-20.65) increase in non-infected children with ferrous sulfate compared to placebo

A C13 urea breath test for the diagnosis of HP  was performed.

Follow-up: 12 weeks

PICO 2

2

Cardenas VM. et al.

Texas

J Pediatr Gastroenterol Nutr, 2011

Helicobacter pylori eradication and change in markers of iron stores among

non-iron-deficient children in El Paso, Texas: an etiologic intervention study.

A2

Therapy / screening

RCT

110 asymptomatic children aged 3 to 10 years old residents of El PasoCounty, with HP (recruited through household visits)

10-day course of sequential eradication therapy plus 6 weeks  of iron supplementation or eradication therapy plus placebo

Iron supplementation and placebo or placebo only

Hemoglobin,

Transferrin saturation

Serum ferritin

No differences in haemoglobin and transferrin saturation.

Those who had their infection eradicated (n=33, ≥45 days after treatment) had 3-fold increased average change from baseline serum ferritin compared with that of children who remained infected (n=57):  7.7 versus 1.9 ng/ml (p<0.05).

HP was defined as positive results on a urine-based rapid test detecting anti-H pylori IgG antibodies

(RAPIRUN, Otsuka Pharmaceutical Co, Ltd, Tokyo, Japan) and a 13C-urea breath test (UBT) (UBiT-IR300; Breath Tek, Meretek Diagnostics, Lafayette, CO).

Follow-up: ≥6 months

ITT: n=110

PP: n=90

PICO 2

Sequential therapy

3

Albrecht P. et al.

Poland

J Pediatr. 2011 Mar 2.

Sequential Therapy Compared with Standard Triple Therapy for Helicobacter Pylori

Eradication in Children: A Double-Blind, Randomized, Controlled Trial.

A2

Therapy

RCT

107 children, 3 to 18 years of age who were hospitalized at the Department

of Pediatric Gastroenterology and Nutrition with HP

(3e lijn)

Sequential treatment (amoxicillin andomeprazole for 5 days followed by clarithromycin, tinidazole, and omeprazole for 5 days).

7-day standard triple eradication (amoxicillin and clarithromycin plus omeprazole) followed by placebo for 3 days

Eradication rate at 6/8 weeks after completion therapy

Secondary outcomes: adverse events, the need for discontinuation of the HP therapy, compliance)

45/52 or 86.5% versus 35/51 or 68.6%; RR=1.26; 95% CI, 1.02-1.60).

No significant diferences

Diagnosis HP: 2 of 3 tests were positive:13C-urea breath test, histopathology and rapid urease test.

103 patients were included in final analysis.

Borderline statistical significance.

PICO 3

4

Prieto-Jimenez CA. et al.

Texas

J Pediatr Gastroenterol Nutr. 2011

Double-blind randomized trial of quadruple sequential Helicobacter pylori

eradication therapy in asymptomatic infected children in El Paso, Texas.

A2

Therapy

RCT

110 asymptomatic children aged 3 to 10 years old residents of El PasoCounty, with HP (recruited through household visits)

10-day course of sequential eradication therapy plus 6 weeks  of iron supplementation or eradication therapy plus placebo

Iron supplementation and placebo or placebo only

Proportion of subjects cured from HP

ITT analysis (n=110):

 44.3% vs 12.2% (p<0.001)

PP analysis (n=90):

52.9% vs 15.4% (p<0.001)

HP eradication was

defined as a negative UBT >=45 days after completing study

medications.

PICO 3