Abstract
Introduction: Chronic inflammation and duodenal gastric metaplasia (DGM) increase with the presence of Helicobacter pylori (Hp). DGM is considered the earliest change in the development of duodenal ulcer in children with Hp gastritis. Until now, histopathological duodenal changes in children with Hp associated gastritis had not been studied in Mexico, where there is a high gastric Hp prevalence. Objective: This study aims to describe the histopathological findings of duodenal biopsy in a Mexican children population with Hp-associated gastritis. Materials and Methods: This cross-sectional, retrospective and analytical study examined, using light microscopy, the gastric and duodenal biopsies from a consecutive series of cases of children with and without Hp gastritis, received from 2000 to 2007. In the duodenal biopsy, active or non-active chronic duodenitis and DGM were observed. The DGM was highlighted with alcian blue/PAS stain. Results: 306 patients with a histopathological diagnosis of chronic gastritis, 95 with Hp and 211 without Hp, are included in this study. The frequency of chronic duodenitis in patients with chronic gastritis by Hp is 100%. We found the highest gastric Hp frequency (p 0.05) between Hp-associated chronic gastritis and the following: alteration of villus height/crypt depth ratios, damage to surface enterocytes, loss of brush border, and duodenal ulcer. Conclusions: In the Mexican children population with and without Hp chronic gastritis studied, chronic duodenitis is a very common histopathological finding. The DGM is related to the presence and density of gastric Hp. To confirm DGM, an ancillary method could be used in the endoscopic duodenal biopsy.
Highlights
Chronic inflammation and duodenal gastric metaplasia (DGM) increase with the presence of Helicobacter pylori (Hp)
The prevalence of DGM has been observed in 13% to 42% of children infected with Hp [5,6,7], there is no definitive correlation between the influence of chronic duodenitis and duodenal ulceration with the presence DGM [8]
The aim of this study is to investigate the duodenal changes in children with Hp gastritis, because endoscopic gastric and duodenal biopsies are frequent and there is no information related to histopathological duodenal changes for Mexican children with Hp gastritis
Summary
Chronic inflammation and duodenal gastric metaplasia (DGM) increase with the presence of Helicobacter pylori (Hp). Histopathological duodenal changes in children with Hp associated gastritis had not been studied in Mexico, where there is a high gastric Hp prevalence. The prevalence and density of lymphocyte aggregates and follicles, the most common histopathological findings, strongly correlate with the severity of the inflammation of the antral mucosa and the presence of neutrophils with activity. Antral chronic inflammation causes duodenal gastric metaplasia (DGM), with the consequent development of duodenal inflammation and possible ulceration [6]. Duodenal ulcer prevalence increases with age, and its higher incidence is related with the chronic gastritis associated with Hp infection. Even though Hp causes duodenal ulcers, the organism is not found in duodenal mucosa except in instances of
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