Endoscopic findings in children with Helicobacter pylori infection and abdominal tenderness

Background: Helicobacter pylori (Hp) infection often occurs in childhood and adolescence, with the frequency increasing with age. Hp infection is associated with insufficient hygiene, overcrowding and low socioeconomic status. Although declining in developed countries, children in the developing countries continue to have a high prevalence of Hp infection. As the association of Hp infection with chronic abdominal pain is not ubiquitously accepted, in this study we investigate the significance of endoscopic finding associated with Hp infection in children with abdominal tenderness.Methods: This cross-sectional study included 1,665 healthy children, aged 6 to 12 years, in whom Hp infection was evaluated using the IgG anti-H. pylori test. Hp-positive children with epigastric tenderness underwent upper gastrointestinal (GI) endoscopy. Urease activity of gastric mucosal biopsies was measured. The presence and density of Hp organisms, the presence of follicular gastritis, and the nature of inflammation and gastritis activity were assessed by histologic examination.Results: Of 1665 children, 429 (26%) subjects (51% girls, 49% boys) were seropositive for H. pylori. There was a significant association between Hp infection and older age (p<0.001) and male/female ratio (p<0.05). Epigastric tenderness was detected in 39 children (1%), 29 of whom underwent upper GI endoscopy. Nodular gastritis with antral erythema was the most common endoscopic finding (26/29; 89.7%). Histological findings revealed that, in all cases with endoscopic nodularity, lymphoid follicles were present. Bacterial density was low in 13 (44.8%), moderate in 14 (48.2%) and high in 2 (7%) subjects.Conclusion: The findings of the present study demonstrated that antral nodularity is the most common feature in children with Hp infection and epigastric tenderness was significantly associated with histological findings of lymphoid follicles.