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Updated: Feb 23, 2026
Author Spotlight: Gastric Epithelial Cell Responses in Helicobacter pylori infection
Published on: July 5, 2024
Lymphoid follicles in children with Helicobacter pylori-negative gastritis
Efrat Broide1,2,3, Vered Richter2, Sonia Mendlovic4
1Pediatric Gastroenterology Service, Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Assaf Harofeh Medical Center, Tzrifin, Israel.
Insights
Helicobacter pylori (H. pylori)-negative gastritis is increasing in children. This study found lymphoid follicles are common in H. pylori-negative gastritis, regardless of celiac disease (CD) status.
Area of Science:
- Pediatric Gastroenterology
- Microbiology
- Histopathology
Background:
- The prevalence of Helicobacter pylori (H. pylori) gastritis is decreasing, with a concurrent rise in H. pylori-negative gastritis.
- Understanding the distinct characteristics of H. pylori-negative gastritis in children is crucial for accurate diagnosis and management.
Purpose of the Study:
- To evaluate chronic gastritis in pediatric patients, focusing on H. pylori status and the association with celiac disease (CD).
- To identify specific histological features differentiating H. pylori-positive from H. pylori-negative gastritis in children.
Main Methods:
- Retrospective review of demographic, clinical, endoscopic, and histologic data from 184 children undergoing esophagogastroduodenoscopy.
- Gastric biopsies were analyzed using the Updated Sydney System, with H. pylori presence confirmed via staining and urease testing.
Main Results:
- Of 122 children with chronic gastritis, 74 (60.7%) were H. pylori-negative.
- H. pylori-negative gastritis was associated with younger age, less frequent abdominal pain, and non-Arabic origin.
- Nodular gastritis and more severe mononuclear infiltrates/neutrophil density were prevalent in H. pylori-positive cases, while lymphoid follicles were common in H. pylori-negative gastritis (51.3%) independent of CD status.
Conclusions:
- Lymphoid follicles are a significant histological finding in pediatric H. pylori-negative gastritis.
- The presence of lymphoid follicles in this context is independent of celiac disease status.
Purpose:
The prevalence of Helicobacter pylori gastritis has been declining, whereas H. pylori-negative gastritis has become more common. We evaluated chronic gastritis in children with regard to H. pylori status and celiac disease (CD).
Patients And Methods:
Demographic, clinical, endoscopic, and histologic features of children who underwent elective esophagogastroduodenoscopy were reviewed retrospectively. Gastric biopsies from the antrum and corpus of the stomach were graded using the Updated Sydney System. H. pylori presence was defined by hematoxylin and eosin, Giemsa, or immunohistochemical staining and urease testing.
Results:
A total of 184 children (61.9% female) met the study criteria with a mean age of 10 years. A total of 122 (66.3%) patients had chronic gastritis; 74 (60.7%) were H. pylori-negative. Children with H. pylori-negative gastritis were younger (p=0.003), were less likely to present with abdominal pain (p=0.02), and were mostly of non-Arabic origin (p=0.011). Nodular gastritis was found to be less prevalent in H. pylori-negative gastritis (6.8%) compared with H. pylori-positive gastritis (35.4%, p<0.001). The grade of mononuclear infiltrates and neutrophil density was more severe in the H. pylori-positive group (p<0.001). Pan-gastritis and lymphoid follicles were associated most commonly with H. pylori. Although less typical, lymphoid follicles were demonstrated in 51.3% of H. pylori-negative patients. The presence or absence of CD was not associated with histologic findings in H. pylori-negative gastritis.
Conclusion:
Our findings suggest that lymphoid follicles are a feature of H. pylori-negative gastritis in children independent of their CD status.
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