Symptom and Gastritis Severity in Pediatric Duodenogastric Reflux: Interaction with Helicobacter pylori Infection

Background: Duodenogastric reflux (DGR) is increasingly recognized in children with dyspeptic complaints; however, its association with symptom severity and histopathological gastritis remains unclear. This study aimed to evaluate the relationship between dyspeptic symptom severity and gastric histopathological findings in children with DGR and to assess the contribution of concomitant Helicobacter pylori (H. pylori) infection. Methods: This multicenter observational cross-sectional study included children aged 5-18 years who underwent upper gastrointestinal endoscopy for dyspeptic symptoms. Symptom severity was assessed using a standardized Likert dyspepsia scale. Patients were classified into four groups based on the presence of DGR and H. pylori infection. Results: A total of 180 children were analyzed. Significant differences were observed among the study groups for all individual dyspeptic symptoms and total symptom severity scores (p ≤ 0.006). Post hoc pairwise comparisons demonstrated that children with DGR, either alone or in combination with H. pylori infection, had significantly higher symptom severity scores than the control group, with the highest scores observed in the H. pylori-positive/DGR-positive group. Histopathological gastritis severity and inflammatory activity were significantly associated with H. pylori infection (p < 0.001). In contrast, DGR was predominantly associated with mild histopathological gastritis despite a marked increase in dyspeptic symptom severity. Conclusions: DGR is independently associated with increased dyspeptic symptom severity in children, regardless of histopathological gastritis severity. While H. pylori infection is linked to more severe gastritis and a clinically relevant symptom burden, the coexistence of both conditions results in the greatest symptom severity. These findings highlight that symptom severity in pediatric dyspepsia cannot be explained solely by histopathological inflammation and underscore the clinical relevance of DGR.