Orit Elkayam

The seroprevalence of Helicobacter pylori in a referral population of children in the United States

OBJECTIVES:The purpose of this study was to determine the prevalence of serum antibodies directed against Helicobacter pylori (H. pylori) in children referred to childrens hospitals or medical centers throughout the United States.METHODS:This multisite cross-sectional prospective study involved 992 children from 12 states using a validated anti–H. pylori IgG enzyme immunoassay. The children were recruited into two groups: those without any GI complaints (non–GI referral, n = 619) and those who were referred for endoscopy because of abdominal pain (GI referral, n = 373).RESULTS:GI referral children had a higher rate of seropositivity (22.5%) than non–GI referral children (14.1%) from the same geographic regions. In both groups, older children were more likely to be seropositive for H. pylori, as were nonwhite children and those with lower socioeconomic status. H. pylori seropositivity rates were higher in GI referral children with four or more household members (relative risk [RR] = 1.47; CI 1.01–2.14). Multivariate analysis controlling for age, ethnicity, and household income, showed that presence of GI symptoms were associated with a nearly 2-fold risk for H. pylori seropositivity (odds ratio = 1.77, CI 1.27–2.47). Epigastric pain (RR = 2.21; CI = 1.33–3.66) and having three or more episodes of abdominal pain in the last 3 months (RR = 0.59, CI = 0.35–0.99) were the only specific symptoms significantly associated with H. pylori seropositivity.CONCLUSIONS:The H. pylori seropositivity rate of GI referral children with symptoms of abdominal pain was significantly higher. H. pylori infection in early childhood was found to be associated primarily with the childs household size and socioeconomic status.

The Use of an Oral Fluid Immunoglobulin G ELISA for the Detection of Helicobacter pylori Infection in Children

Background. Enzyme linked immunosorbent assay (ELISA) evaluation of oral fluid immunoglobulin G (IgG) antibodies to Helicobacter pylori is a unique approach for both epidemiological studies and the diagnosis of infection, especially in children. The use of oral fluid sampling to evaluate specific H. pylori IgG antibodies has advantages over serum, including reduced biohazard risk and noninvasive collection. Oral fluid sampling is fast and involves minimal patient discomfort. Since children facilitate transmission of H. pylori infection, a simple, accurate, noninvasive diagnostic test is necessary for large epidemiologic studies. The aim of our study was to evaluate a new oral fluid ELISA for detection of IgG antibodies to H. pylori in children.

GB Virus C (GBV-C/HGV) and E2 Antibodies in Children Preliver and Postliver Transplant

The association of GB virus type C (GBV-C) virus and clinical disease is uncertain. The role of GBV-C and (Envelope) E2 antibody in children with liver transplants has not been determined. This studys aim is to examine the prevalence of GBV-C in children with liver transplants, to assess the relationship of GBV-C to posttransplant hepatitis, and to determine the role of E2 antibodies. Sera from 34 children, preliver and postliver transplant, between 1989-1996 were tested for GBV-C (Ribonucleic acid) RNA by the automated Abbott LCx PCR assay. Anti-E2 antibodies were detected by an Abbott immunoassay. Recent posttransplant liver biopsies were examined for hepatitis. The results of the study determined that pretransplant, four children (12%) were GBV-C RNA positive. Posttransplant, 14 (42%) children were GBV-C RNA positive. The GBV-C RNA positive conversion rate was 33% (CI 17.2-55.7%). Patients received blood products from a mean of 68 ± 34 donors, which correlated with GBV-C acquisition. There was no difference in the incidence (32% versus 36%; p = 0.726) or severity (grade 2.00 versus 0.68; p = 0.126) of posttransplant hepatitis in the liver biopsies of GBV-C RNA negative and/or positive children, respectively. Pretransplant, nine of 32 children were anti-E2 positive. Posttransplant, eight of 32 children were anti-E2 positive, including five children who were anti-E2 positive pretransplant. Of nine children who were anti-E2 positive and GBV-C RNA negative pretransplant, three became GBV-C RNA positive posttransplant. The results of this study conclude that the prevalence of GBV-C infection in children postliver transplantation is high and that blood product transfusions correlate with GBV-C acquisition. Also, no correlation was found between GBV-C RNA and the incidence or severity of posttransplant hepatitis. Finally, E2 antibody presence before transplantation failed to provide complete protection from GBV-C acquisition.

Incidence and Risk Factors for Cholestasis in Neonates Receiving Total Parenteral Nutrition: 1995-98

Incidence and Risk Factors for Cholestasis in Neonates Receiving Total Parenteral Nutrition: 1995-98