Endoscopic nodular gastritis with helicobacter pylori infection: An indicator of high-grade bacterial colonization and severe gastritis in children.

Background: Helicobacter pylori infection is a common and universally distributed bacterial infection. It is predominantly acquired in childhood. Endoscopic findings of antral nodularity can be seen in children much more frequently than in adults and believed that this gross change may suggest H. pylori infection and histologic gastritis. We conducted a study to assess the significance of Helicobacter pylori infection associated with endoscopic nodular gastritis (NG). Methods & Materials: This prospective study carried out over two years period and included 468 children in whom upper digestive endoscopy was performed for gastrointestinal symptoms and gastric antral mucosal biopsy was taken. Sixty-seven children were diagnosed as having NG and were included in the study. Demographics, clinical characteristics, endoscopic and pathologic findings were recorded. H pylori were recognized in gastric biopsy on H&E sections; a modified Giemsa stain was performed in biopsy suspicious for H pylori. Results: The prevalence of NG in children was 14.3% (67/468) and consisted of 46.3% male and 53.7% female. Children age ranged from 3-18 years (mean age, 9.2 + 0.4 years). The prevalence of NG increased gradually with age. H pylori infection was identified in 68/468 (14.5%) children. Nodular gastritis had a poor accuracy rate to determine H. pylori infection (sensitivity, 40.3%; positive predictive value, 39.7%) and was observed in 27/68 (39.7%) H pylori positive patients and in 40/400 (10%) H pylori negative patients. There was a significant increase in grade of inflammation, activity, atrophy, number of lymphoid follicles and H. pylori density on histologic evaluation in H pylori positive patients with NG than other groups. Conclusion: Nodular gastritis has a poor prediction for H. pylori infection in children. Gastric biopsies should always be obtained during endoscopy in children to establish the H pylori infection. H. pylori infection in children with NG identifies cases with severe gastritis and marked bacterial colonization. [ABSTRACT FROM AUTHOR]