Histopathological differences in pediatric duodenogastric reflux: a comparative study

The histopathological effects of duodenogastric reflux (DGR) in children remain poorly described. This study aimed to evaluate and compare the gastric histopathological findings of pediatric patients with endoscopically confirmed DGR gastritis and those without, to identify potential morphological changes associated with bile reflux in childhood. This retrospective study compared children with endoscopically confirmed DGR to age- and sex-matched controls without DGR. Gastric biopsy samples were re-evaluated by a single pathologist blinded to clinical data. Histopathological features, including inflammation severity, activity, fibrosis, vascular congestion, edema, foveolar hyperplasia, the presence of Helicobacter pylori, lymphoid aggregates, reactive gastropathy, intestinal metaplasia, and glandular atrophy were compared. Logistic regression was used to identify significant predictors of DGR. A total of 73 patients with DGR and 65 controls were included. Fibrosis (60.2% vs. 9.2%, p < 0.001), congestion (63.0% vs. 27.7%, p < 0.001), foveolar hyperplasia (32.9% vs. 6.2%, p < 0.001), and edema (24.7% vs. 6.2%, p = 0.003) were significantly more common in the DGR group. Logistic regression identified foveolar hyperplasia (OR 10.67), edema (OR 9.01), fibrosis (OR 6.98), and congestion (OR 5.85) as independent predictors of DGR.

Fibrosis, congestion, foveolar hyperplasia, and edema are significantly associated with DGR in pediatric patients and may serve as supportive histological markers for diagnosis.

• DGR in children lacks a standardized diagnostic method, with endoscopy and histopathology being commonly used. • Histopathological features such as foveolar hyperplasia and fibrosis are known in adults but less studied in children.

• This study identifies fibrosis, congestion, foveolar hyperplasia, and edema as significant histopathological markers in pediatric DGR. • It suggests that endoscopic findings, combined with histopathology, can aid in the diagnosis of DGR in children.