# Concordance of Helicobacter pylori Detection Methods in Symptomatic Children and Adolescents

## TL;DR

This study compares different methods for detecting Helicobacter pylori in children and finds that combining Giemsa staining with RT-PCR gives the best results.

## Contribution

The study provides new evidence on the best diagnostic method combination for H. pylori in symptomatic children.

## Key findings

- RT-PCR for ureA showed the highest performance with 94.7% PPA and 98.6% NPA.
- RUT had lower performance with 65.9% PPA and 97.5% NPA.
- Serology had the lowest performance with 53.7% PPA and 96.1% NPA.

## Abstract

Background: Helicobacter pylori is the most prevalent chronic bacterial infection globally, acquired mostly during childhood. It is associated with chronic gastritis, peptic ulcer disease, and gastric cancer. Due to challenges in culturing H. pylori, diagnostic reference standards often rely on combining ≥2 non-culture, biopsy-based methods. Histology with Giemsa staining is widely used in clinical settings due to its low cost and reliable performance. Methods: This study evaluated the concordance between histology with Giemsa staining as the reference standard and other diagnostic methods, including the rapid urease test (RUT), ureA RT-PCR, 16S sequencing, and anti-H. pylori serum IgG. Positive percent of agreement (PPA), negative percent of agreement (NPA) and concordance kappa index were calculated. Results: A total of 120 patients (41 positive and 79 negative by Giemsa staining) were analyzed. Among the methods tested, RT-PCR for ureA showed the best performance (PPA = 94.7%, NPA = 98.6%, kappa = 0.939), while RUT underperformed compared with expectations (PPA = 65.9%, NPA = 97.5%, kappa = 0.681). Serology had the lowest performance (PPA = 53.7%, NPA = 96.1%, kappa = 0.548). Conclusions: The combination of histology with Giemsa staining and ureA RT-PCR achieved the highest detection rate and strongest agreement.