Unique Endoscopic Futures of Corpus Gastritis with H. Pylori Infection in Children and Adolescents; Close Observation By Conventional Endoscopy and Magnified Endoscopy

Abstract

Backgrounds: Antral nodularity is the only reliable endoscopic feature in H. pylori (Hp) infected children. We reported that the regular arrangement of collecting venules (RAC) visible as numerous minute points by close observation of the gastric corpus with conventional endoscopy was indicative of Hp-negative normal stomachs. Aims: To evaluate the endoscopic futures of corpus gastritis with Hp infection in children and adolescents. Methods: From January 2001 to March 2005, 87 consecutive children and adolescents underwent EGD for UGI symptoms or anemia (38 boys, median age 13 y, range 9∼15 years). Hp positive was defined as both positive of 13C-UBT and histology. EGD was performed using a standard small caliber endoscope (GIF-XP 240 or 260; Olympus) and biopsy specimens were taken from the antrum, lower corpus lesser curvature, and upper corpus greater curvature for histopathology. After the routine EGD, close observation was performed at the point of lower corpus lesser curvature and upper corpus greater curvature (near biopsy sites). Each case was scored as RAC positive if the minute points were irregularly present or if absent, as RAC negative. In 8 patients (4 Hp negative and 4 positive) EGD was performed using magnifying endoscopy (GIF-Q240Z; Olympus) and the magnified view was compared to RAC pattern. Results: Of the 87 patients, 25 (29%) were Hp positive. By routine endoscopy, 7 patients were diagnosed as DU with Hp infection; 21 had antral nodularity with Hp gastritis. The RAC-negative pattern was observed in 27 patients and 21 (78%) were Hp positive. In the upper corpus greater curvature RAC was negative in 30 patients and 25 (83%) were Hp positive. The sensitivity, specificity, and accuracy of RAC-negative were 100%, 87%, and 91% in the lower corpus lesser curvature and 100%, 91%, and 94% in the upper corpus lesser curvature. In Hp negative and RAC-positive patients, magnifying endoscopy showed true capillaries forming around collecting venules in the gastric corpus. In Hp positive and RAC-negative patients, collecting venules and true capillaries were not seen and gastric pits and sulci were observed. Conclusion: The RAC negative pattern as identified by close observation of the gastric corpus using conventional endoscopy uniquely reflects corpus gastritis with Hp infection in children and adolescents.