MORPHOLOGICAL AND FUNCTIONAL STATUS OF UPPER GASTROINTESTINAL TRACT IN CHILDREN WITH METABOLIC SYNDROME

Abstract

Background: Existence of clinical and pathophysiological relationship between gastrointestinal disorders and components of the metabolic syndrome in adults has been proved. Aim: To study morphological and functional status of upper gastrointestinal tract and the degree of its contamination with Helicobacter pylori in children with metabolic syndrome. Materials and methods: We examined 274 children aged from 9 to 16 years. Group 1 included 144 children with metabolic syndrome, group 2, 80 patients with obesity without metabolic syndrome, group 3, 50 normal weight children with various gastrointestinal disorders. The assessments included esophagogastroduodenoscopy with biopsy for morphological and bacteriological investigations. Results: The children from the groups 1 and 2 had significantly less complaints of pain in epigastric and pyloro-duodenal area than those from the group 3 (15.2, 26.8 and54% of patients, respectively; р for comparison of group 1 vs group 3 and group 2 vs group 3 were all < 0.05). Functional and structural abnormalities of upper gastrointestinal tract were found in 90.3,86.3 and 96% of children, esophagitis, in 19.4, 17.5 and 12%, respectively. Gastritis was significantly more frequent in groups 1 and 2 than in group 3 (31.9, 37.5 and 14%, respectively, р for comparison of group 1 vs group 3 and group 2 vs group 3 were all < 0.05), whereas in group 3 there were more cases of gastroduodenitis (37.5, 42.5 and 78%) and duodenal ulcers (1.4, 2.5 and 8%, respectively). Antral gastritis was diagnosed in 55.5, 45 and 40% of patients, stomach erosions, in 5.6, 7.5 and 4%, duodenitis, in 44.4, 50 and 86%, bulbar erosions, in 2.8, 1.3 and 2%, active ulcers, in 1.4, 2.5 and 8%, cardia insufficiency in 33.3, 22.5 and 28%, duodeno-gastric reflux, in 27.8, 26.3 and 24% patients from the groups 1, 2 and 3, respectively. Gastric mucosal biopsies of most patients, irrespective of the groups (83.3, 87.5 and 77.3%), showed signs of active chronic gastritis. Various degrees of contamination with Н. pylori was found in 61.5, 58.3 and 46.2% of children from the groups 1, 2 and 3, respectively. Conclusion: The rates of inflammatory abnormalities in upper gastrointestinal tract in all patient groups are similar (93–95%) and does not depend on bodyweight. Motor and evacuation abnormalities are more frequent in obese children than in those with normal bodyweight, and do not depend on the metabolic syndrome. Children with metabolic syndrome are characterized by moderate degree active chronic gastritis associated with Н. pylori, with minimal clinical signs and symptoms and predominance of focal rather than wide-spread inflammation.