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[Clinico-endoscopic spectrum of gastritis associated with Helicobacter pylori in pediatrics]
E A Cueto Rua1, N Balcarce, M Cohen
1Servicio de Gastroenterología, Hospital de Niños Superiora Sor María Ludovica, La Plata, Argentina.
Insights
Recurrent abdominal pain is a key indicator of pediatric chronic gastritis (CG) linked to Helicobacter pylori. Understanding these unique clinical and endoscopic features aids diagnosis and prevention of adult gastric and esophageal diseases.
Area of Science:
- Pediatric Gastroenterology
- H. pylori Research
- Digestive Disease Research
Background:
- Chronic gastritis (CG) associated with Helicobacter pylori (H. pylori) presents distinct clinical and endoscopic characteristics in children.
- Previous understanding of pediatric H. pylori-associated CG was limited, necessitating further investigation.
Purpose of the Study:
- To elucidate the specific clinical and endoscopic features of pediatric chronic gastritis (CG) caused by Helicobacter pylori (H. pylori).
- To assess the diagnostic significance of recurrent abdominal pain (RAP) in H. pylori-associated pediatric CG.
Main Methods:
- Retrospective analysis of 81 biopsy-proven pediatric cases of H. pylori-associated chronic gastritis.
- Cases were divided into two groups based on the period of clinical recognition (early vs. mandatory diagnosis).
- Clinical symptoms (RAP, upper digestive tract hemorrhage) and endoscopic findings (mucosal granularity, smoothness) were evaluated.
Main Results:
- Recurrent abdominal pain (RAP) was the most frequent symptom (91%), followed by upper digestive tract hemorrhage (UDTG) (41.9%).
- Gastroesophageal reflux (GER) and esophagitis (E) co-occurred in 64.2% of cases.
- Mucosal granularity correlated with RAP, GER, and esophagitis, while mucosal smoothness was more common in UDTG.
Conclusions:
- Symptomatic H. pylori-associated CG in children exhibits unique clinical and endoscopic features.
- The high prevalence of RAP (91%) suggests its inclusion in the differential diagnosis for this condition.
- Improved understanding of these features can lead to better treatment and prevention of adult gastric and esophageal diseases.
Abstract:
In order to gain further knowledge about the clinical and endoscopic features of chronic gastritis (CG) associated with Helicobacter pylori (H py) we retrospectively analyzed 81 pediatric cases. All were biopsy-proven. The cases were divided in two groups: Group (1988-1992) included 21 cases. These represented the early stage of clinical recognition of the disease. Group 2(1993-1995) comprised 60 cases and represents the stage in which the disease was mandatory. Mean number of cases/year was 4.2 and 20 for group 1 and 2, respectively. Recurrent abdominal pain (RAP) was the most frequent clinical symptom (74/81; 91%), followed by upper digestive tract hemorrhage (UDTG) (34/81; 41.9%). The combination gastroesophageal reflux (GER) and esophagitis (E) was found in 52/81 (64.2%) of the children. Endoscopically, granularity of the mucosa was more frequently found in cases with RAP (47/74), GER (28/36) and E, while a smooth mucosa predominated in patients with UDTH (23/34). Our findings strongly suggest that symptomatic CG with H py in children expresses peculiar clinical and endoscopic features. Since RAP was present in 91% of the cases it appears adequate to include this disease in the differential diagnosis of it. These clinical manifestations have not been previously linked to CG with H py. Better understanding of the clinical and endoscopic spectrum of CG with H py results in adequate treatments and possibly prevention of gastric (and esophageal) diseases found in adults.