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Published on: June 24, 2020
Gastric Antral Mucosal Changes in Children With Intestinal Metaplasia
Geling Li1,2, David R Kelly1,2, Elizabeth Mroczek-Musulman1,2
1Department of Pathology and Laboratory Medicine, 22078Children's of Alabama, Birmingham, AL, USA.
Insights
Pediatric gastric antral intestinal metaplasia (IM) increases with age and often coexists with other gastric pathologies. This condition can persist for months to years in children, particularly those with chronic gastritis or gastric eosinophilia.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
Background:
- Gastric antral intestinal metaplasia (IM) is a recognized condition, but its characteristics and implications in the pediatric population are not well-defined.
- Understanding associated mucosal changes and clinical outcomes in children is crucial for accurate diagnosis and management.
Purpose of the Study:
- To investigate the prevalence of gastric antral intestinal metaplasia (IM) in patients under 18 years old.
- To identify coexisting pathological findings alongside antral IM in pediatric patients.
- To assess the persistence of IM and the presence of dysplasia in follow-up biopsies.
Main Methods:
- Retrospective review of upper GI endoscopy and pathology reports for patients under 18 diagnosed with antral IM between 2009 and 2020.
- Evaluation of biopsies for IM, dysplasia, Helicobacter pylori, gastritis, and other pathological changes.
- Analysis of follow-up biopsies to determine the persistence of IM and development of dysplasia.
Main Results:
- 134 pediatric patients with antral IM were identified; 53.7% had coexisting pathologies like chronic gastritis and reactive gastropathy.
- Isolated IM was found in 46.3% of cases. IM prevalence increased with age and was more common in females.
- Of 27 patients with follow-up, 40.7% showed persistent IM; no cases of dysplasia were observed.
Conclusions:
- Pediatric gastric antral IM is often associated with other gastric pathologies and its incidence rises with age.
- Gastric IM can be persistent in children, lasting months to years, especially in cases with chronic gastritis and gastric eosinophilia.
- The absence of dysplasia in this cohort suggests a potentially benign course for pediatric IM, warranting further long-term studies.
Abstract:
Objectives: The gastric mucosal change accompanying gastric antral intestinal metaplasia (IM) in the pediatric population and its clinical implications remain unclear. Methods: We retrieved all patients younger than 18 years who had upper GI endoscopy with a pathology diagnosis of antral IM between 2009 and 2020. Each biopsy was evaluated for the presence of dysplasia, Helicobacter pylori, gastritis, and other pathologic changes. Results: A total of 134 patients with antral IM were identified; 72 (53.7%) with coexisting pathology including chronic gastritis (n = 22), reactive gastropathy (n = 16), focal mild chronic inflammation (n = 13), gastric eosinophilia (n = 9), chronic active gastritis associated with (n = 2) and without Helicobacter infection (n = 3), and others (n = 7). The remaining 62 (46.3%) showed isolated IM. Gastric IM increased with age, and was often accompanied by other pathologic changes, especially in female children. Twenty-seven patients had follow up biopsies; 11 of the 27 patients (40.7%) showed persistent IM in at least one repeat biopsies. None demonstrated dysplasia. Conclusions: In children, antral IM increases with age and often coexists with other pathologic changes. Gastric IM could persist for at least months to years in a significant subset of patients with chronic gastritis and gastric eosinophilia.
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