Prevalence and Clinical Significance of Helicobacter Pylori‐negative Chronic Gastritis in Children

Abstract

Objectives: The clinical significance of Helicobacter pylori-negative chronic gastritis (HPNCG) in children is unclear. We examined this issue in patients who had undergone esophagogastroduodenoscopy with systematic gastric sampling. Methods: Data of 1178 consecutive children who underwent diagnostic esophagogastroduodenoscopy were collected. Baseline characteristics and long-term outcomes were compared between children with active and inactive HPNCG and those with normal gastric histology. Follow-up data were available for up to 13 years. Results: Altogether 24 (2.0%) children had active and 235 (19.9%) inactive HPNCG, 27 (2.3%) were Hpylori-positive, 46 (3.9%) had other gastric pathology, and 846 (71.8%) normal histology. Diarrhea (31.3% vs 25.1%, P ¼ 0.033), poor growth (23.6% vs 14.7%, P < 0.001), bloody stools (13.9% vs 7.2%, P < 0.001), anemia (46.5% vs 23.4%, P < 0.001), hypersedimentation (39.7% vs 21.4%, P < 0.001), hypoalbuminemia (40.4% vs 16.2%, P < 0.001), and elevated fecal calprotectin (62.4% vs 31.5%, P < 0.001) were more common and heartburn (13.9% vs 22.9%, P ¼ 0.002) less common in the HPNCG group than in the controls. Both active (OR 3.64,95% CI 1.35-9.82) andinactive (2.98, 2.18-4.08) HPNCG predicted a diagnosis in the initial investigations. Crohn disease (41.7%) was the most common diagnosis in active HPNCG and celiac disease (37.4%) in inactive HPNCG. During follow-up, 7 (9.9%) of the 71 initially nondiagnosed HPNCG children received a diagnosis. Conclusions: HPNCG is a frequent finding in children undergoing EGD, the active form being associated especially with Crohn disease and the inactive with celiac disease. The long-term prognosis of patients with HPNCG who do not receive an initial diagnosis is good.

Differential diagnosis and long-term outcomes of non-atrophic duodenal changes in children

“…There may also be spatial variation in duodenum ( 28 ) and biopsy processing before cutting may have an effect ( 29 ). Finally, findings in other parts of the gastrointestinal tract can also be relevant ( 23 , 28 , 30 ), as demonstrated here by the higher frequency of gastric abnormalities in children with IBD. These issues should be considered when generalizing our results to different clinical settings and patient scenarios.…”

Helicobacter pylori-Associated Iron Deficiency Anemia in Childhood and Adolescence-Pathogenesis and Clinical Management Strategy

“…Thus, upper gastrointestinal mucosal lesions do not appear to play a direct or central role for IDA pathogenesis in H. pylori-infected children (Figure 2). In some Western countries, Celiac disease is important as a cause of IDA, irrespective of H. pylori infection [20,35]. In developing countries, other non-H. pylori infections, in particular gastrointestinal parasitic infection, should be considered as risk factors of ID/IDA in addition to contributing factors of poor iron intake and low dietary iron bioavailability that occur in parasite endemic regions of the world [20].…”