Association Between Gastric Atrophy and Helicobacter pylori Infection in Japanese Children: A Retrospective Multicenter Study

Abstract

The purpose of this study was to determine whether Helicobacter pylori infection and mucosal inflammation result in gastric atrophy in Japanese children. A total of 196 patients ages 1-16 years were retrospectively studied: 131 patients were infected with H. pylori and 65 patients were uninfected. Antral (n = 196) and corpus biopsy specimens (n = 70) were investigated based on the Updated Sydney system. In both the antrum and corpus, H. pylori-infected patients showed significantly higher degrees of inflammation and activity of gastritis, compared with noninfected patients. The prevalence of grade 2 or 3 atrophy in the antrum was 10.7% in H. pylori-infected patients and 0% in the noninfected patients (P < .01) and in corpus 4.3% and 0%, respectively (P = .20). The frequency of intestinal metaplasia in the 2 study groups was 4.6% and 4.6% in the antrum and 0% and 4.2% in the corpus, respectively. Among H. pylori-infected patients, the antrum showed significantly higher degrees of H. pylori density, inflammation and activity of gastritis, and atrophy than the corpus. In the antrum, atrophy was significantly correlated with activity, whereas in the corpus, atrophy correlated with H. pylori density, inflammation, and activity. H. pylori-induced gastric inflammation can cause atrophy in Japanese children, predominantly in the antrum. It remains to be determined whether H. pylori-infected children with gastric atrophy are at increased risk for gastric cancer.

Intestinal Metaplasia and Gastric Atrophy in Children is not as Frequent as Adults

“…18 A recent study investigating the association between gastric atrophy and H. pylori infection in 196 children with a mean age of 11 years demonstrated that the prevalence of gastric atrophy in antrum and corpus were 10.7% and 4.3%, respectively, in H. pyloriinfected children and 0% in H. pylori-negative children. 19 In the same study, intestinal metaplasia was found in 4.6% of H. pylori-infected cases.…”

Endoscopic and Histopathologic Findings Associated with H. pylori Infection in Very Young Children

“…The age of acquisition of the bacteria has been proposed as a significant factor determining the clinical outcome of the infection [2,3]. This hypothesis is based on the assumption that acquisition of H. pylori at very early ages may result in more intense inflammation and the early development of atrophic gastritis with subsequent risk of gastric ulcer and cancer development [8,9]. In this study, the prevalence of H. pylori infection among young infants who underwent an upper gastrointestinal endoscopy was 26.3% and more than half of the infants infected with H. pylori also had histopathological gastritis.…”

“…It has been suggested that concurrent or previous H. pylori infection may be associated with an increased risk of development of gastric cancer [9,34]. The sequence of gastric pathology starts with mucosal atrophy and intestinal metaplasia and finally gastric cancer develops over several decades in susceptible individuals with persistent H. pylori gastritis [35].…”

“…This preneoplastic condition of adulthood has not been well evaluated in children, and the prevalence of gastric atrophy varies between 0% and 72% according to different studies in children [38]. A recent study investigating the association between gastric atrophy and H. pylori infection in 196 children with a mean age of 11 years demonstrated that the prevalence of gastric atrophy in antrum and corpus were 10.7% and 4.3%, respectively, in H. pylori-infected children and zero in H. pylori-negative children [9]. In the same study, intestinal metaplasia was found in 4.6% of H. pylori-infected cases.…”

“…Since there is accumulating evidence supporting the association between the duration of H. pylori infection and gastric atrophy, intestinal metaplasia, and the development of adenocarcinoma of the stomach in adults, the clinical course and outcome of the infected infants should be an important concern in populations with high endemicity for H. pylori infection [8,9]. But data on clinical presentation, endoscopic, and histopathological findings of H. pylori in children younger than 2 years of age are still scarce.…”