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Systematic Review and Meta-analysis of Histological Gastric Biopsy Aspects According to the Updated Sydney System in
Nicolas Kalach1, Zrinjka Misak2, Patrick Bontems3
1Pediatric Clinic, Saint Vincent de Paul Hospital, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Catholic University of Lille, Lille, France.
Insights
Helicobacter pylori infection in children significantly increases the risk of gastric inflammation and atrophy. This risk is particularly noted in the antrum and corpus, with specific findings like neutrophils and lymphoid follicles.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
- Infectious Diseases
Background:
- Helicobacter pylori (H pylori) infection is a common cause of pediatric gastrointestinal issues.
- Histological assessment using the updated Sydney classification (USC) is crucial for diagnosing H pylori-related gastritis.
- Understanding the histological impact of H pylori in children is essential for effective management.
Purpose of the Study:
- To compare gastric histological findings in H pylori-positive versus H pylori-negative children.
- To analyze the prevalence of specific USC features associated with H pylori infection in pediatric patients.
- To provide a comprehensive overview of H pylori's histological impact in children.
Main Methods:
- Systematic review and meta-analysis adhering to the Prisma method.
- Inclusion criteria focused on USC, H pylori, children, endoscopy, and biopsy.
- Assessment of publication bias using the Newcastle-Ottawa Scale and meta-regression analysis.
Main Results:
- Analysis of 97 studies involving 25,867 children (5990 H pylori-infected, 17,782 uninfected).
- H pylori-positive children showed higher relative risk (RR) for chronic inflammation (antrum/corpus), neutrophils, lymphoid follicles, and atrophy.
- Intestinal metaplasia had a higher RR only in antral biopsies; meta-regression highlighted corpus activity risks.
Conclusions:
- H pylori infection in children is linked to increased risks of gastric inflammation and atrophy.
- Specific histological markers like neutrophils and lymphoid follicles are more prevalent in infected children.
- While atrophy is more common, intestinal metaplasia is significantly increased only in the antrum.
Objectives:
A descriptive and comparative study of gastric histological aspects according to the updated Sydney classification (USC), obtained from Helicobacter pylori-positive versus H pylori-negative children referred for upper gastrointestinal endoscopy.
Methods:
The Prisma method was used to perform a systematic review and meta-analysis. Selection criteria were based on following key words USC, H pylori, children, endoscopy, or biopsy. Publication biases were assessed according to the Newcastle-Ottawa Scale, and a meta-regression analysis was done. The study was registered on the PROSPERO platform.
Results:
Between 1994 and 2017, 1238 references were found; 97 studies were retained for the systematic review with a total number of 25,867 children; 75 studies were selected for the meta-analysis concerning 5990 H pylori-infected and 17,782 uninfected children.H pylori-positive versus H pylori-negative children, according to the USC, showed significantly higher relative risk for gastric antral and corpus chronic inflammation, presence of neutrophils, and of lymphoid follicles, and gastric mucosa atrophy, whereas, intestinal metaplasia showed a significantly higher RR only in antral biopsies. The meta-regression analysis showed that H pylori-positive versus H pylori-negative children had significantly higher risk only for corpus activity according to age, recurrent abdominal pain, and geographical area of low H pylori prevalence.
Conclusions:
H pylori infection in children was associated with higher relative risk for gastric antral and corpus chronic inflammation, presence of neutrophils, lymphoid follicles, and rare gastric mucosa atrophy, whereas, rare intestinal metaplasia was only significantly higher in the antral area.
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