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PEDIATRICS Vol. 104 No. 2 August 1999, p. e22

ELECTRONIC ARTICLE:
Long-term Follow-up Study of Serum Immunoglobulin G and Immunoglobulin A Antibodies After Helicobacter pylori Eradication

Received Nov 24, 1998; accepted Mar 12, 1999.

Seiichi Kato*, Noriko FuruyamaDagger , Kyoko Ozawa*, Kenji Ohnuma*, and Kazuie Iinuma*

From the * Department of Pediatrics, Tohoku University School of Medicine; and Dagger  Department of Pediatrics, Sendai City Hospital, Sendai, Japan.

Objective.  There have been few studies concerning serum titers of anti-Helicobacter pylori immunoglobulin G (IgG) antibody >12 months after eradication of the original infection. Moreover, clinical usefulness of immunoglobulin A (IgA) antibody levels remains to be established. The purpose of this study was to investigate long-term responses of serum IgG-specific and IgA-specific antibodies to H pylori in children after eradication therapy.

Study Design.  A total of 34 children, 2 to 17 years of age (mean: 11.7 years) with H pylori-associated gastroduodenal disease received eradication therapy (proton pump inhibitor-based dual or triple regimens). Diagnoses included nodular gastritis (n = 8), gastric ulcer (n = 7), and duodenal ulcer (n = 19). Upper gastrointestinal endoscopy and biopsy were performed before the therapy and at 1 to 2 months' posttreatment. H pylori infection and eradication were defined by biopsy-based tests; eradication was successful in 28 patients and unsuccessful in 6. Pretreatment IgG was positive in 30 patients (88.2%), and the IgA was positive in 31 (91.2%), who were entered into this study (duration <= 24 months). Serum samples were obtained before treatment and at 1, 3, 6, 12, 18, and 24 months' posttreatment. IgG and IgA antibodies were measured using commercial enzyme immunoassay kits (HM-CAP and PP-CAP; Enteric Products, Inc, New York, NY).

Results.  Compared with pretreatment values, IgG and IgA antibodies significantly and steadily decreased at 1 through 24 months' posttreatment in successfully treated patients. A decrease in titer of the IgA class was significantly greater than that of the IgG class at 1 to 12 months' follow-up. There was no significant decrease in titer of either antibody in all but 2 patients with eradication failure. A >= 30% decrease in titer of the IgA antibody at 6 months indicated eradication with sensitivity of 90.5% and specificity of 100%. For the IgG antibody, a 30% decrease at 12 months showed equal sensitivity and specificity. Seroreversion rates of IgG and IgA antibodies were 53% and 48% at 12 months and were 86% and 81% at 24 months, respectively. The mean periods from the completion of eradication therapy to seroreversion of IgG and IgA antibodies were 11.2 ± 7.0 and 11.6 ± 7.8 months, respectively (not significantly different). A higher pretreatment titer of IgG antibody was related to a longer period of seroreversion (r = 0.44). In one patient, 13C-urea breath test-confirmed reinfection was accompanied by reappearance of significant titers of the IgG and IgA antibodies.

Conclusions.  A serology test is useful for evaluating eradication in children. Approximately half of patients with successful eradication remained to be IgG-seropositive and IgA-seropositive at 12 months' posttreatment. When a decrease titer in antibody is used for assessing eradication, an endpoint of >= 6 months is required. The IgA antibody may be a more convenient indicator of H pylori status than is the IgG antibody.  Key words:  Helicobacter pylori, serum antibody, eradication, IgG, IgA.




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 Arch Pediatr Adolesc MedHome page
S. Kato and P. M. Sherman
What Is New Related to Helicobacter pylori Infection in Children and Teenagers?
Arch Pediatr Adolesc Med, May 1, 2005; 159(5): 415 - 421.
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