Pediatric gastritis and its impact on hematologic parameters

Abstract

Non-invasive biomarkers, such as neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios, may predict inflammation in various disorders, including gastritis, according to recent data. Nevertheless, various studies reported an association between Helicobacter pylori ( H pylori ) and immune thrombocytopenia in both adults and pediatric patients. The objective of our study was to evaluate the impact of pediatric gastritis, caused or not by H pylori infection on erythrocytes, their parameters, thrombocytes, mean platelet volume, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). We performed a prospective, case–control study on 151 patients aged between 1 and 17 years who presented with chronic dyspeptic symptoms. An upper digestive endoscopy with gastric biopsies and a complete blood count was performed in each case. Control group consisted of 67 patients with normal histological findings, while the two study groups were divided into group 1— H pylori -induced gastritis (31 patients) and group 2—non- H pylori- induced gastritis (53 patients). Children from the rural area were more likely to develop both types of gastritis ( P < .01). No significant difference was found between either of the study groups and control group in terms of platelets, mean platelet volume, NLR and PLR ( P > .05). However, significantly higher values of lymphocytes were associated with non- H pylori -induced gastritis ( P < .01). Comparison of the two study groups did not reflect any significant differences in terms of hematological parameters. When assessing these constants in relation to gastritis severity, severe gastritis led to a compelling decrease in hemoglobin (Hb) and hematocrit (Htc) levels. The comparison of parameters between severe, moderate, and mild gastritis did not reveal any significant results. Childhood and adolescent gastritis does not produce a significant effect upon platelet counts, their mean volume, PLR or NLR, according to our study. An important increase in lymphocyte count might predict non- H pylori pediatric gastritis. Moreover, severe gastritis might result in an important decrease in Hb and Htc levels.

Innate immunity – the hallmark of Helicobacter pylori infection in pediatric chronic gastritis

“…Although abdominal pain, nausea, vomiting, anorexia, weight loss, or heartburn are commonly encountered in children with H. pylori infection, the clinical picture remains unspecific[ 2 ]. Recent studies have also noted several extra-digestive manifestations such as thrombocytopenia, anemia, eosinophilic esophagitis, or otitis media that might be related to the presence of H. pylori in children[ 3 - 5 ]. Nevertheless, taking into account the difficulties related to performing endoscopic studies in children and therefore the scarcity of information in this age group, a precise cause-effect relationship between these manifestations and H. pylori has been difficult to establish.…”

Gastric Microenvironment—A Partnership between Innate Immunity and Gastric Microbiota Tricks Helicobacter pylori

“…Recent epidemiologic studies have reported a decreasing prevalence of pediatric H. pylori infection pointing out a significant difference between 25.6% in 2005 and 12.8% in 2017 [ 14 ]. Nevertheless, wide variations were reported among different populations in terms of prevalence mostly depending on the socio-economic status [ 7 , 8 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

“…Nevertheless, the symptoms in children with H. pylori infection remain unspecific including abdominal pain, nausea, vomiting, heartburn [ 21 , 23 ], and thus the most recent recommendation of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) is to perform the necessary investigation for identifying the underlying cause of the symptoms and not only for assessing the presence of this infection [ 24 ]. A wide spectrum of extra-digestive conditions were proven to be associated to this infection, among which cardiovascular diseases, stroke, anemia, idiopathic thrombocytopenic purpura, eczema, rosacea, chronic hives, diabetes, thyroid disease or Alzheimer’s disease, which might be explained by the systemic inflammatory status identified even in pediatric patients diagnosed with H. pylori -positive gastritis [ 7 , 8 ]. Taking into account the severity of these aforementioned conditions and their long-life chronic pattern, the assessment of H. pylori related systemic inflammation should be a main goal in patients with this infection.…”

“…Moreover, the same study pointed out that resistant strains to levofloxacin have emerged impairing its effectiveness as rescue therapy [ 6 ]. As we already mentioned, environmental factors also play a major role in the persistence of this infection, including socio-economic conditions, originating area, dietary habits or certain practices within the household [ 7 , 8 , 9 ]. Gastric microenvironment defined mostly by gastric microbiota influences the development of H. pylori gastritis and even immune responses [ 10 , 11 ].…”

Gestational obesity and subclinical inflammation

“…[ 8 , 16 , 17 ] Moreover, red blood cell distribution width is another CBC parameter, whose utility was recently proved in patients with stroke. [ 18 ] Both NLR and PLR are simple, noninvasive markers, computed based on a routine CBC count and their utility has been proven in multiple medical fields, such as gastroenterology, [ 19 , 20 ] cardiology, [ 21 ] and oncology, [ 22 ] their elevated levels being underlined as both diagnostic and prognostic markers not only in the setting of sepsis, [ 23 ] but also in a wide-spectrum of pathologies. Moreover, baseline NLR level seems to be useful in predicting the clinical outcome of both ischemic and hemorrhagic stroke.…”