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Journal of Clinical Microbiology, October 2003, p. 4700-4704, Vol. 41, No. 10
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.10.4700-4704.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Diagnosis of Helicobacter pylori Infection in Adults with Intellectual Disability

Robyn A. Wallace,1,2,3* Philip J. Schluter,2 Ross Forgan-Smith,4 Robyn Wood,4 and Penelope M. Webb2,5

Specialist Healthcare for Adults with Intellectual Disability (SHAID) Clinic,1 School of Population Health,2 Department of Medicine, University of Queensland,3 Queensland Medical Laboratories,4 Queensland Institute of Medical Research, Brisbane, Australia5

Received 6 April 2003/ Returned for modification 23 May 2003/ Accepted 11 July 2003

Helicobacter pylori infection is common among adults with intellectual disability. The acceptabilities and accuracies of different diagnostic tests in this population are unknown. We aimed to determine (i) patient acceptability and (ii) performance characteristics of serology, fecal-antigen, and urea breath tests among adults with intellectual disability. One hundred sixty-eight such adults underwent H. pylori testing with serology and fecal-antigen tests, and a portion underwent treatment. One year later, the participants were retested with fecal-antigen, serology, and urea breath tests. The numbers of specimens obtained and difficulties in collection reported by caregivers were noted. Test performance characteristics were assessed among participants and 65 of their caregivers, using serology as the reference. All participants provided at least one specimen, despite reported collection difficulties for 23% of fecal and 27% of blood specimens. Only 25% of the participants provided breath specimens; failure to perform this test was associated with lower intellectual ability and higher maladaptive behavior. The sensitivity, specificity, and positive and negative predictive values of the fecal test (baseline and 12 months versus caregivers) were 70 and 63 versus 81, 93 and 95 versus 98, 96 and 92 versus 93, and 53 and 74 versus 93%, respectively; those of the urea breath test (12 months versus caregivers) were 86 versus 100, 88 versus 95, 75 versus 89, and 94 versus 100%, respectively. With assistance, fecal or blood specimens for H. pylori assessment can be provided by most patients with intellectual disability regardless of their level of function or behavior. Only those with greater ability can perform the urea breath test. Using serology as the reference test, the limitations of performance characteristics of the fecal-antigen and urea breath tests are similar to those among a control group of caregivers.

* Corresponding author. Mailing address: The SHAID Clinic, 11 Gordon Rd., Bardon, 4065 Brisbane, Queensland, Australia. Phone: 0413 605 474. Fax: 61 7 3876 4201. E-mail: R.Wallace{at}sph.uq.edu.au.

Journal of Clinical Microbiology, October 2003, p. 4700-4704, Vol. 41, No. 10
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.10.4700-4704.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.





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