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Helicobacter pylori-negative Chronic Gastritis in Children: A Systematic Review
Amit Assa1, Osvaldo Borrelli2, Ilse Broekaert3
1The Juliet Keidan institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel.
Insights
Helicobacter pylori-negative gastritis is uncommon and often underdiagnosed. Evidence on its natural history, treatments, and outcomes is limited, particularly for autoimmune and collagenous types.
Area of Science:
- Gastroenterology
- Pathology
- Internal Medicine
Background:
- Chronic gastritis can occur in the absence of Helicobacter pylori infection.
- Various distinct forms of H. pylori-negative gastritis exist, including eosinophilic, autoimmune, collagenous, focally enhanced, and lymphocytic gastritis.
- These conditions are often uncommonly reported, leading to a potential underestimation of their true prevalence.
Purpose of the Study:
- To systematically review the existing evidence on the natural history, available therapies, and outcomes of Helicobacter pylori-negative chronic gastritis.
- To consolidate current knowledge on the prevalence and clinical presentation of different subtypes of H. pylori-negative gastritis.
Main Methods:
- A systematic search of MEDLINE and EMBASE databases was conducted.
- Included studies focused on prevalence, treatment, or outcomes of H. pylori-negative gastritis.
- Data from original human research articles published up to October 31, 2021, were analyzed.
Main Results:
- Fifty-four studies were included, covering various gastritis types.
- Paediatric eosinophilic gastritis has a prevalence of 5-7/100,000 with good treatment response.
- Autoimmune and collagenous gastritis are rare, often presenting with anemia; lymphocytic gastritis is common in children with celiac disease. Limited data exists for treatment outcomes in autoimmune and collagenous gastritis.
Conclusions:
- Helicobacter pylori-negative gastritis is infrequently reported, often in small studies or case reports.
- Non-specific symptoms may lead to underdiagnosis and underreporting.
- Further research is needed to understand the natural history, treatment, and outcomes of these distinct gastric disorders.
Objectives:
To systematically review the current evidence on Helicobacter pylori-negative chronic gastritis including natural history, available therapies and outcomes.
Methods:
Articles providing data on the prevalence, treatment or outcomes of Helicobacter pylori-negative gastritis were identified through a systematic search in the MEDLINE and EMBASE databases. All original research articles from human studies until October 31, 2021, were included.
Results:
A total of 54 studies were included consisted of eosinophilic gastritis (n = 9), autoimmune gastritis (n = 11), collagenous gastritis (n = 16), focally enhanced gastritis (n = 6), lymphocytic gastritis (n = 5) and other causes including idiopathic gastritis and chronic renal failure related (n = 7). Most of the included studies were either cross-sectional or longitudinal cohorts except for collagenous gastritis, which mainly included case reports and case series. The prevalence of paediatric eosinophilic gastritis ranges between 5 and 7/100,000 and patients have generally favourable outcome with 50% to 70% clinical and histological response to either corticosteroids or elimination diets. Autoimmune gastritis and collagenous gastritis are extremely rare entities, commonly present with refractory iron deficiency anaemia, while lymphocytic gastritis is relatively common (10%-45%) in children with coeliac disease. Data on treatments and outcomes of autoimmune, collagenous, and focally enhanced gastritis are lacking with limited data implying poor response to therapy in the former 2 diagnoses.
Conclusions:
Helicobacter pylori-negative gastritis is uncommonly reported, mainly in small cohorts, mixed adult-paediatric cohorts or as sporadic case reports. As common symptoms are not specific, thus not always result in an endoscopic evaluation, the true prevalence of these distinct disorders may be underestimated, and thus under reported.
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