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[Chronic gastritis in children]
Samir Boukthir1, Faten Aouididi, Sonia Mazigh Mrad
1Service de Médecine Infantile C, Hôpital d'Enfants de Tunis.
Insights
Chronic gastritis and Helicobacter pylori (H. pylori) infection are common in children, often presenting with non-specific symptoms like abdominal pain. Atrophic gastritis was observed in 14.5% of cases, frequently linked to H. pylori.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Gastrointestinal Pathology
Background:
- Active gastritis, atrophic gastritis (AG), and intestinal metaplasia are recognized H. pylori-associated lesions in adults.
- Helicobacter pylori (H. pylori) infection is a significant global health concern, particularly in pediatric populations.
- Understanding the prevalence and characteristics of gastritis in children is crucial for early diagnosis and management.
Purpose of the Study:
- To determine the prevalence of chronic gastritis in children.
- To analyze the histological features and clinical presentations of gastritis in pediatric patients.
- To investigate the association between H. pylori infection and various gastritis subtypes in children.
Main Methods:
- A cohort of 345 children (mean age 8.6 years) with gastritis symptoms underwent upper gastrointestinal endoscopy.
- Four gastric biopsy specimens were collected per patient and evaluated using the updated Sydney system.
- H. pylori infection was diagnosed based on a combination of culture, histology, and rapid urease testing.
Main Results:
- H. pylori infection was detected in 62.3% and chronic gastritis in 64.05% of the children.
- Recurrent abdominal pain was the most common symptom (67.4%), but no single clinical feature was specific for gastritis.
- Nodular gastritis (40.72%) and congestive gastritis (38%) were the predominant endoscopic findings. Active gastritis was present in 52% of cases, and atrophic gastritis (AG) in 14.4%, both significantly associated with H. pylori infection.
Conclusions:
- Chronic gastritis is highly prevalent in the pediatric population.
- H. pylori infection is a major contributing factor to chronic gastritis in children, particularly associated with nodular and active gastritis.
- Atrophic gastritis affects a notable proportion of children with chronic gastritis, underscoring the long-term implications of H. pylori infection.
Background:
Active gastritis, atrophic gastritis (AG) and intestinal metaplasia are lesions associated with Helicobacter pylori (H. pylori) infection in adults.
Aim:
To assess the prevalence of chronic gastritis, its histological characteristics and clinical features in children.
Methods:
345 children (M/F: 151/194, mean age: 8.6 +/- 3.7 years; range: 1-18 years) were enrolled, referred for upper gastrointestinal endoscopy (UGI endo) with clinical manifestations of gastritis, i.e., recurrent abdominal pain (n = 232, 67.2%), upper gastrointestinal bleeding (n = 59, 17.1%) and miscellaneous (n = 53, 15.3%). Four perendoscopic gastric biopsy specimens (antrum: 2, fundus: 2) were taken. Biopsies were assessed and graded according to the updated Sydney system. H. pylori infection was considered if 2 out 3 tests were positive (culture, histology and rapid urease test), whereas 3 concordant negative results identified H. pylori negative children.
Results:
H. pylori infection and chronic gastritis were detected in 215/345 (62.3%) (M/F: 104/117, sex ratio M/F = 0.89) and 221/345 (64.05%) children, respectively. Recurrent abdominal pain (n = 149, 67.4%) was the main clinical features of chronic gastritis followed by vomiting (n = 43, 19.5%) and upper gastrointestinal bleeding (n = 41, 18.6%). Any clinical features were however found to be specific. UGI endo showed; nodular gastritis (n = 90, 40.72%), congestive gastritis (n = 84, 38%), gastric ulcer (n = 9), bulbar ulcer (n = 5) and normal (n = 47, 21.2%). Chronic gastritis was active in 115 cases (52%) and was significantly associated with nodular gastritis (p < 0.05). Thirty two chronic gastritis (14.4%) exhibited AG (M/F: 16/16, mean age: 9.4 +/- 3.4 years) and 30/32 (93.7%) were H. pylori positive. AG was significantly associated with H. pylori infection (p < 0.0001) and nodular gastritis (p < 0.005). Active, follicular and AG were significantly associated with H. pylori infection (p < 0.00001). Three patients exhibited intestinal metaplasia.
Conclusion:
Chronic gastritis is frequent in children. Any clinical features were found to be specific. It significantly associated H. pylori infection and nodular gastritis. Atrophic gastritis was found in 14.5% of children.
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