Gastric lymphoid hyperplasia: radiological evidence of childhood Helicobacter pylori infection

Abstract

Helicobacter pylori is a spiral-shaped bacterial pathogen that lives almost exclusively in human gastric mucosa. Infection with H. pylori occurs primarily in early childhood1–3 causing chronic gastritis. This is associated with the development of gastric and duodenal ulceration, gastric adenocarcinoma and non-Hodgkin's lymphoma.4 The potential benefits of identification in a symptomatic patient and subsequent eradication are therefore considerable. The presenting symptoms of H. pylori in paediatric patients can include nausea, vomiting and epigastric pain,5 a clinical setting in which an upper gastrointestinal contrast study is often carried out. Therefore any manifestation of H. pylori that can be identified on contrast studies would be important. The radiological appearances that have been shown to be significantly associated with H. pylori infection include gastric fold thickening, polypoid gastritis, enlarged areae gastricae and antral erosions.6 An endoscopic feature of H. pylori often seen in children is gastric lymphoid hyperplasia.7 This finding has, however, only been described once in childhood on an upper gastrointestinal double contrast study, in a single case report.8 We present a case series of six paediatric patients who were demonstrated to have radiological evidence of lymphoid hyperplasia and subsequently had H. pylori infection confirmed. Strong evidence is therefore provided that the radiological appearance of lymphoid hyperplasia in children is synonymous with H. pylori infection.