Primary antral gastritis in young American children

Abstract

Although Helicobacter pylori (H. pylori) is considered by many to be the major cause of primary antral gastritis (PAG), several important questions concerning its pathogenetic role remain unanswered. The most basic unresolved issue relates to the low prevalence of H. pylori in children in developed countries. If H. pylori is the cause of PAG, the prevalence of PAG should also be low, but previous studies have not provided data on this issue. To answer this question, we prospectively studied 408 children who underwent esophagogastroduodenoscopy and biopsy from January 1, 1988, to December 31, 1990, for symptoms consistent with peptic disease or immunocompromise. Although the prevalence of PAG was similar (about 20%) in the four age groups of patients studied (< 5, 5-9, 10-14, and 15-20 years), the prevalence of H. pylori infections was significantly greater in the oldest age group (67%, P < 0.0001). Only four of 39 children < 10 years old with PAG had evidence of H. pylori. H. pylori is an uncommon finding in our population of young American children with PAG, indicating that it does not play an important role in the pathogenesis of this disorder in this age group.

In French Children, Primary Gastritis Is More Frequent Than Helicobacter pylori Gastritis

“…Chronic follicular gastritis was suggested to be specific to H. pylori infection [1,2,10]. Chronic follicular gastritis corresponds to a diffuse and polymorphic inflammatory infiltrate comprising a very high number of lymphoid follicles in a gastric mucosa [1].…”

“…The lowest prevalence of chronic gastritis was reported by American pediatric series: 32% for Elitsur et al [21] and 26.31% for Mahony et al [22]. Chronic gastritis occurs in boys as well as in girls [4,10]. Furthermore, the frequency of gastritis increases in correlation with age [5,14,21], in agreement with our results.…”

“…This difference, potentially linked to lower infection prevalence in children, also reflects the probable existence of other causes of gastritis, which could be masked in adults by the strong incidence of subjects carrying H. pylori. The detection of primary antral gastritis (PAG) in about 20% of children with recurrent abdominal pain (RAP) [10], and the discovery of other types of germs in the mucous membrane of some subjects with gastritis, could support this assumption [11]. The low concentration of germs on the surface of the mucous membrane related to the recent character of the infection in the child could also explain the high histological rate of gastric inflammation without H. pylori isolation [9].…”

“…In a previous study [37], we found an extremely high prevalence of macroscopic and histologic gastritis (71.7%) in noninfected children [37]. This highly selected population of children with epigastric pain was actually close to that depicted by Snyder et al [10], where PAG was found in about 20% of the four different age groups of 408 children, with only 4/39 children \10 years old with PAG having evidence of H. pylori infection. Trinh et al [31] compared prospectively two groups of children, one with a histological gastritis and the other one with a normal histology, with no significant difference between the two groups with regard to existence of digestive symptoms.…”

Morphological alterations of upper gastrointestinal tract in patients with new onset-dermatomyositis: correlation with demographic, clinical and laboratory features

“…A hypothesis for these associations, although not explored in the present study, is that male patients may have a higher frequency of Helicobacter pylori, which is strongly associated with higher prevalence of gastritis in the antral region. [25][26][27] …”