Background and Aims: The prevalence of Helicobacter pylori (H.pylori) gastritis has been declined whereas H.pylori negative gastritis has become more common. We aimed to evaluate chronic gastritis in children in relationship to H.pylori status and celiac disease (CD).
Methods: Demographic, clinical, endoscopic and histologic features of children that underwent elective esophagogastroduodenoscopy were retrospectively reviewed. Gastric biopsies from the antrum and corpus were graded using the Updated Sydney System. H.pylori presence was defined by hematoxylin&eosin, Giemsa or immunohistochemistry staining and urease testing.
Results: 184 children (61.9% female) met the study criteria with a mean age of 10 years. 66.3% (122) had chronic gastritis; 60.7% (74) were H.pylori negative. Children with H.pylori negative gastritis were younger (p=0.003), less presented with abdominal pain (p=0.02) and were mostly of non-Arabic origin (p=0.011). Nodular gastritis was found to be less frequent in H.pylori negative gastritis (6.8%) compared to H.pylori positive gastritis (35.4%, p<0.001). The grade of the mononuclear infiltrates and neutrophils density was more severe in the H.pylori positive group (p<0.001). Pangastritis and lymphoid follicles were most commonly associated with H.pylori. Although less typical, lymphoid follicles were demonstrated in 51.3% of the H.pylori negative patients. Presence or absence of CD was not associated with the histological findings in H.pylori negative gastritis.
Conclusion: Our findings indicate that lymphoid follicles are a feature of H.pylori negative gastritis in children independent of their CD status. Additional long term follow-up studies in those young patients should help clarify the clinical significance of these findings.
