Atrophic gastritis: Helicobacter Pylori versus duodenogastric reflux

Abstract

Objectives. The objective of this study was to asses the prevalence of atrophic
gastritis in children. We also wanted to compare the clinical manifestation, endoscopic
appearance and the degree of the gastric atrophy in children and to identify the possible
causes which determine gastric atrophy.
Methods. We evaluated 247 children with chronic gastritis (153 female/94
male, mean age 12.32 years). Atrophy was defined as the loss of normal glandular
components, including replacement with fibrosis and/or intestinal metaplasia.
Results. The prevalence of the atrophic gastritis was 16.6% (41 cases), mean
age 11.59+/-1.75 years, male-to-female ratio 16:25. The clinical manifestations were
correlated with the patient age (infants and toddlers were evaluated mostly for weight
loss – 4 cases, and older children for abdominal pain – 22 cases). The endoscopic
appearance was described as either nodular (15 cases), or erythematous gastritis (10
cases), or normal (10 cases). According to the Sydney System, the degree of atrophy
was found to be mild in 3 patients, moderate in 25, and severe in 13 patients; 14 cases
were associated with duodenogastric reflux, 5 with Helicobacter pylori and 2 with
Helicobacter heilmannii infection, but in 17 cases the etiology was unknown.
Conclusions. Atrophic gastritis is present in childhood, even at very young ages
(infants, toddlers). The endoscopic appearance is not characteristic for the presence
of atrophy. The degree of the atrophy is not correlated with the age of the children.
Because of the relatively high number of duodenogastric reflux associated with gastric
atrophy, further studies need to evaluate the potential causes and clinical course.