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Lymphoid follicles in children with Helicobacter pylori-negative gastritis

Authors Broide E, Richter V, Mendlovic S, Shalem T, Eindor-Abarbanel A, Moss SF, Shirin H

Received 28 January 2017

Accepted for publication 26 May 2017

Published 11 August 2017 Volume 2017:10 Pages 195—201


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Professor Andreas M Kaiser

Efrat Broide,1–3,* Vered Richter,2,* Sonia Mendlovic,4 Tzippora Shalem,1,5 Adi Eindor-Abarbanel,5 Steven F Moss,6 Haim Shirin2,3

Pediatric Gastroenterology Service, Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Assaf Harofeh Medical Center, Tzrifin, Israel; 2Gastroenterology Service, Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Assaf Harofeh Medical Center, Tzrifin, Israel; 3Sackler School of Medicine, Tel Aviv University, 4Pathology Institute, Assaf Harofeh Medical Center, Tzrifin, Israel; 5Department of Pediatrics, Assaf Harofeh Medical Center, Tzrifin, Israel; 6Division of Gastroenterology, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA

*These authors contributed equally to this work

Purpose: The prevalence of Helicobacter pylori gastritis has been declining, whereas H. pylori-negative gastritis has become more common. We evaluated chronic gastritis in children with regard to H. pylori status and celiac disease (CD).
Patients and methods: Demographic, clinical, endoscopic, and histologic features of children who underwent elective esophagogastroduodenoscopy were reviewed retrospectively. Gastric biopsies from the antrum and corpus of the stomach were graded using the Updated Sydney System. H. pylori presence was defined by hematoxylin and eosin, Giemsa, or immunohistochemical staining and urease testing.
Results: A total of 184 children (61.9% female) met the study criteria with a mean age of 10 years. A total of 122 (66.3%) patients had chronic gastritis; 74 (60.7%) were H. pylori-negative. Children with H. pylori-negative gastritis were younger (p=0.003), were less likely to present with abdominal pain (p=0.02), and were mostly of non-Arabic origin (p=0.011). Nodular gastritis was found to be less prevalent in H. pylori-negative gastritis (6.8%) compared with H. pylori-positive gastritis (35.4%, p<0.001). The grade of mononuclear infiltrates and neutrophil density was more severe in the H. pylori-positive group (p<0.001). Pan-gastritis and lymphoid follicles were associated most commonly with H. pylori. Although less typical, lymphoid follicles were demonstrated in 51.3% of H. pylori-negative patients. The presence or absence of CD was not associated with histologic findings in H. pylori-negative gastritis.
Conclusion: Our findings suggest that lymphoid follicles are a feature of H. pylori-negative gastritis in children independent of their CD status.

Keywords: child, gastritis, Helicobacter pylori, lymphoid follicles

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