Relationship between Helicobacter pylori positivity based on stool antigen testing and AST levels: pediatric outpatient clinic data

Year 2026, Volume: 7 Issue: 1, 175 - 181, 20.02.2026

Esranur Çiğ

https://izlik.org/JA25RY34LU

Abstract

Aims: This study aimed to evaluate the association between stool Helicobacter pylori (H. pylori) antigen positivity and biochemical and hematological blood parameters in patients presenting to a pediatric outpatient clinic with dyspeptic complaints.
Methods: Data from patients who underwent stool H. pylori antigen testing (n=870) were retrospectively reviewed. Concurrent measurements of ferritin, vitamin B12, ALT (alanine aminotransferase), AST (aspartate aminotransferase), and complete blood count were recorded. Randomly selected patients were divided into two groups: H. pylori antigen-positive (n=25) and H. pylori antigen-negative (control group) (n=75).
Results: AST levels were higher in the H. pylori antigen-positive group than in the antigen-negative group (p=0.019). In regression analyses adjusted for age and sex, H. pylori positivity was significantly associated with AST (p=0.023), AST/ULN (p=0.033), and AST>ULN (p=0.049). When ALT and log(CRP+1) were added as covariates (sensitivity analysis), only the association with AST remained significant (p=0.037). No significant between-group differences were observed for ALT or for the other evaluated parameters.
Conclusion: In this study, AST levels were significantly higher in children with stool H. pylori antigen positivity compared with antigen-negative controls. To our knowledge, this is the first study in our country to examine the association between SAT-confirmed H. pylori positivity and AST levels among children with dyspeptic complaints. When AST levels are elevated in children presenting with dyspeptic symptoms, stool H. pylori antigen positivity may be considered as one of the possible accompanying factors. Given the single-center retrospective design and the limited number of antigen-positive cases (n=25), these findings should be interpreted as associative and hypothesis-generating rather than causal.

Keywords

Helicobacter pylori , dyspepsia , stool antigen test , AST , AST/ULN , transaminase

References

• Malfertheiner P, Camargo MC, El-Omar E, et al. Helicobacter pylori infection. Nat Rev Dis Primers. 2023;9(1):19. doi:10.1038/s41572-023-00431-8
• Hooi JKY, Lai WY, Ng WK, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology. 2017;153(2):420-429. doi:10.1053/j.gastro.2017.04.022
• Yuan C, Adeloye D, Luk TT, et al. The global prevalence of and factors associated with Helicobacter pylori infection in children: a systematic review and meta-analysis. Lancet Child Adolesc Health. 2022;6(3):185-194. doi:10.1016/S2352-4642(21)00400-4
• Bui D, Brown HE, Harris RB, Oren E. Serologic evidence for fecal-oral transmission of Helicobacter pylori. Am J Trop Med Hyg. 2016;94(1):82-88. doi:10.4269/ajtmh.15-0297
• Mărginean CO, Meliț LE, Săsăran MO. Traditional and modern diagnostic approaches in diagnosing pediatric Helicobacter pylori infection. Children (Basel). 2022;9(7):994. doi:10.3390/children9070994
• Kato S, Gold BD, Kato A. Helicobacter pylori-associated iron deficiency anemia in childhood and adolescence-pathogenesis and clinical management strategy. J Clin Med. 2022;11(24):7351. doi:10.3390/jcm 11247351
• Walle M, Tesfaye A, Agidew MM, Semaw M, Mekuria S, Getu F. The association of Helicobacter pylori infection with the risk of anemia in children: systematic review and meta-analysis. BMC Infect Dis. 2025; 25(1):23. doi:10.1186/s12879-024-10427-8
• Talebi Bezmin Abadi A. Diagnosis of Helicobacter pylori using invasive and noninvasive approaches. J Pathog. 2018;2018:9064952. doi:10.1155/ 2018/9064952
• Pohl D, Keller PM, Bordier V, Wagner K. Review of current diagnostic methods and advances in Helicobacter pylori diagnostics in the era of next generation sequencing. World J Gastroenterol. 2019;25(32):4629-4660. doi:10.3748/wjg.v25.i32.4629
• Wang YK, Kuo FC, Liu CJ, et al. Diagnosis of Helicobacter pylori infection: current options and developments. World J Gastroenterol. 2015;21(40):11221-11235. doi:10.3748/wjg.v21.i40.11221
• Cardos AI, Maghiar A, Zaha DC, et al. Evolution of diagnostic methods for Helicobacter pylori infections: from traditional tests to high technology, advanced sensitivity and discrimination tools. Diagnostics (Basel). 2022;12(2):508. doi:10.3390/diagnostics12020508
• Sabbagh P, Mohammadnia-Afrouzi M, Javanian M, et al. Diagnostic methods for Helicobacter pylori infection: ideals, options, and limitations. Eur J Clin Microbiol Infect Dis. 2019;38(1):55-66. doi:10.1007/s10096-018-3414-4
• Jones NL, Koletzko S, Goodman K, et al. Joint ESPGHAN/NASPGHAN guidelines for the management of Helicobacter pylori in children and adolescents (update 2016). J Pediatr Gastroenterol Nutr. 2017;64(6):991-1003. doi:10.1097/MPG.0000000000001594
• Miftahussurur M. Noninvasive Helicobacter pylori diagnostic methods in Indonesia. Gut Liver. 2020;14(5):553-559. doi:10.5009/gnl19264
• Qiu E, Li Z, Han S. Methods for detection of Helicobacter pylori from stool sample: current options and developments. Braz J Microbiol. 2021; 52(4):2057-2062. doi:10.1007/s42770-021-00589-x
• Lupu A, Miron IC, Cianga AL, et al. The prevalence of liver cytolysis in children with Helicobacter pylori infection. Children (Basel). 2022;9(10): 1498. doi:10.3390/children9101498
• Magen-Rimon R, Tal G, Kaplan M, Shaoul R. The significance of isolated aspartate aminotransferase elevation in healthy paediatric patients. Acta Paediatr. 2022;111:675-679. doi:10.1111/apa.16123
• Costa JM, Pinto SM, Santos-Silva E, Moreira-Silva H. Incidental hypertransaminasemia in children-a stepwise approach in primary care. Eur J Pediatr. 2023;182(4):1601-1609. doi:10.1007/s00431-023-04825-4
• Watanabe J, Kotani K. The effect of Helicobacter pylori eradication on C-reactive protein: results from a meta-analysis. Arch Med Sci. 2021; 18(4):958-964. doi:10.5114/aoms/130288
• Jamali A, Karbalai S, Tefagh G, Jamali R, Ahmadi A. The effects of Helicobacter pylori eradication on liver function and metabolic profile in non-diabetic non-alcoholic steatohepatitis: a 5-year randomized clinical trial. Middle East J Dig Dis. 2022;14(1):85-95. doi:10.34172/mejdd.2022.260
• 21. Yu YY, Tong YL, Wu LY, Yu XY. Helicobacter pylori infection eradication for nonalcoholic fatty liver disease: a randomized controlled trial. Sci Rep. 2022;12(1):19530. doi:10.1038/s41598-022-23746-0
• Dincă AL, Meliț LE, Gurzu S, Mocan S, Ghiga DV, Mărginean CO. Helicobacter pylori—the bridge between local and systemic inflammation in children. Appl Sci. 2023;13(4):2162. doi:10.3390/app13042162
• Sahin Y, Gubur O, Tekingunduz E. Relationship between the severity of Helicobacter pylori infection and neutrophil and lymphocyte ratio and mean platelet volume in children. Arch Argent Pediatr. 2020;118(3): e241-e245. doi:10.5546/aap.2020.eng.e241
• Erfanipour M, Dooki ME, Nikbakht HA, et al. Diagnostic value of neutrophil to lymphocyte ratio in identifying gastritis in children with chronic abdominal pain in northern Iran. BMC Res Notes. 2025;18(1):68. doi:10.1186/s13104-025-07148-9
• Uçak Semirgin S. Pediatric Helicobacter Pylori infection prevalence and iron deficiency anemia coincidence among children in North Central Turkey. J Curr Pediatr. 2019;17(2):209-219. doi:10.4274/jcp.2019.0019
• Ayyildiz Civan H. Vitamin B12 status in children with Helicobacter pylori gastritis. Med J Bakirkoy. 2020;16(2):120-124. doi:10.5222/BMJ. 2020.03522