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BACKGROUND: Helicobacter pylori is now an accepted gastroduodenal pathogen and is being investigated for possible implications in nongastroenterological conditions such as growth impairment. Subjects infected by cytotoxic Cag-A positive strains seem more likely to develop serious gastroduodenal diseases but the possible role of Cag-A positive strains in non gastroenterological diseases has not been fully investigated. OBJECTIVE: 1) To evaluate the prevalence of Helicobacter pylori infection and Cag-A positivity in short children compared to auxologically normal children. All the subjects were without gastro-intestinal symptoms and were not obese or significantly underweight. 2) To verify the reliability of the ELISA assay for H. pylori. SUBJECTS: H. pylori infection was assessed in 338 children, 182 auxologically normal and 156 short children, with and without deficiency in growth hormone, by the determination of specific IgG antibody. In 79 subjects (all seropositive and a random sample of seronegative children), 13C-urea breath test and cytotoxic Cag-A positive strains were examined. RESULTS: The overall seroprevalence of H. pylori infection by IgG antibody was 18/156 (11.5%) and 13/182 (7.1%) in short and auxologically normal children respectively. The 13C-urea breath test was positive in 29 children: 17 (10.9%) short and 12 (6.6%) auxologically normal. Western blotting documented infection by cytotoxic Cag-A positive strains in 12/17 (70.6%) and 8/12 (66.6%) of short and auxologically normal children respectively. None of the differences between the two groups were significant. CONCLUSIONS: 1) We found a similar prevalence of H. pylori infection and Cag-A positivity in two large pediatric populations of short or auxologically normal children. Therefore: 1) Our data did not confirm a role of H. pylori infection in short stature in children. 2) We found a high reliability of ELISA assay for the detection of IgG antibodies compared to breath test.