Gastritis In Children Research Articles

Expression of CDX2, CK20 and CK7 in the epithelium of the gastric mucosa in schoolchildren with CagA H. pylori-associated gastritis

Aim. To study the association of protein expression CDX2, CK20, CK7 in the epithelium of the gastric mucosa in schoolchildren with CagA H. pylori-associated gastritis. Material and methods. Gastroscopy was performed with the collection of biopsy material from the mucous membrane of the antrum and body of the stomach in 89 schoolchildren (7-17 years old) with gastroenterological complaints. The morphological method confirmed the diagnosis of gastritis and determined the presence of H. pylori. Gastric biopsies were examined immunohistochemically to identify the proteins CDX2, CK20, CK7 in the epithelium. Blood was also collected to determine the CagA strain of H. pylori using enzyme immunoassay. Results. In schoolchildren infected with CagA H. pylori, higher expression of CK7 was found in both parts of the stomach (in the body (p = 0.044), in the antrum (p = 0.014)) compared to uninfected children. Changes in the expression of CDX2 and CK20 in children infected with H. pylori CagA have not been established. CDX2 protein was detected more often among schoolchildren aged 12-17 years with H. pylori infection than in children without H. pylori (p = 0.062) and in children with CagA H. pylori (p = 0.017). In the group of younger children with CagA H. pylori, there were higher levels of CK7 expression in the epithelium of the antrum of the stomach, compared with uninfected children (p = 0.033). They also had higher CK7 in the body than in CagA H. pylori-associated gastritis in children of the older age group (p = 0.001). Boys with CagA H. pylori had the highest expression of CK7 in the gastric body, which was higher than in uninfected boys (p = 0.021). Conclusion. Thus, in children, the features of the association of CDX2, CK20, CK7 with CagA H. pylori-associated gastritis have been established, including depending on the age and gender of the child.

Clinicopathological features and mucosal microbiota in gastric mucosal damage between nodular and non-nodular gastritis in children with Helicobacter pylori infection

AimsNodular gastritis (NG) represents a frequently observed clinical presentation of Helicobacter pylori (H. pylori) infection in pediatric patients. This investigation aimed to explore the microbiota and histological features of the gastric mucosa in children with H. pylori colonized NG. Main methodsThe current investigation examined a sample of 120 children who underwent gastroscopy due to symptoms of gastrointestinal distress, which showed that 64 were patients with H. pylori infection. Endoscopic procedures were conducted to acquire mucosal biopsies for the purpose of DNA extraction and histopathological analysis. The 16S rRNA profiling was utilized to examine the gastric mucosal microbiota. Key findingsIn conjunction with endoscopic evaluation, 26 of 64 patients were diagnosed with NG. The NG group had significantly higher inflammation scores and activity scores on histological assessment than the non-NG group. The NG group exhibited a significant reduction in the richness levels of the five genera. In terms of the predicted functions, the pathways of synthesis and degradation of ketone bodies and phagosome in the NG group were less abundant compared with the non-NG group, while the Wnt signaling pathway was significantly enriched. NG does not increase a microbial community that possesses genotoxic potential within the gastric mucosa. SignificanceIn conclusion, NG group exhibited significant severe inflammation and reduced abundance levels of several bacterial genera compared to the non-NG group. However, individuals with NG did not have a dysregulated microbial community with genotoxic potential.

Prevalence of Esophageal Eosinophilia, Eosinophilic Esophagitis, and Lymphocytic Gastritis in Children with Celiac Disease: A Saudi Tertiary Center Experience.

Celiac disease (CD) is an immune-mediated enteropathy that has been associated with other immune-related gastrointestinal disorders, such as eosinophilic esophagitis (EoE) and lymphocytic gastritis (LG). To our knowledge, this is the first study in Saudi Arabia that has described such an association. To evaluate the prevalence of EoE and LG in children and adolescents with CD. This was a retrospective cross-sectional study of all pediatric patients (aged 0-18 years) with CD following up at King Abdulaziz University Hospital, between January, 2014, and December, 2021. The study examined clinical, demographic, endoscopic, and histopathological data. Seventy-five patients with CD were included in the analysis. The median age was 12 years (range, 2-18 years). Male constituted 54.7% of the overall cohort (n = 41). The most common clinical symptoms were short stature (54.7%), weight loss (34.7%), abdominal pain (33.3%), abdominal distension (29.3%), anorexia (29.3%), diarrhea (24%), and vomiting (21.3%). The esophageal biopsy results reported were basal cell hyperplasia in 24 patients (32.9%), esophageal eosinophilia in 23 patients (31.5%), and EoE in 3 patients (4.1%). The gastric biopsy results were normal in 40 patients (53.3%). The most common abnormality was chronic inactive gastritis with no Helicobacter pylori (HP) infection (16%). LG was found in 3 patients (4%). The prevalence of EoE in this cohort of patients with CD was lower than the prevalence recorded in a number of other studies. Further studies are needed to determine the effects of a gluten-free diet (GFD) on EOE and LG.

Course of Helicobacter pylori-associated gastritis in adolescents with hypovitaminosis D

Introduction. The multifactorial nature of the occurrence and phasing of inflammatory changes in the gastric mucosa determine the need to search for conditions that can affect the slowing of the progression of gastritis in children.
 Aim: to determine the manifestations of Helicobacter pylori-associated antrum gastritis in adolescents with hypovitaminosis D.
 Material and methods. Ninety three 12–17 years adolescents with a morphologically confirmed diagnosis of gastritis were exa­mined. The content of vitamin D in the blood was determined using the ELISA method. Adolescents were divided into groups depending on the level of vitamin D supply and the period of solar insolation at the time of the examination. 
 Results. H. pylori infection in adolescents with hypovitaminosis D had a pronounced tendency to increase — 75% (53.6% in child­ren with sufficient vitamin D levels; p = 0.067).
 The frequency of H. pylori among adolescents examined during low solar insolation was higher than during high solar insolation (p = 0.015). During the period of low solar insolation, the highest rates of H. pylori infection in children were found among adolescents with vitamin D deficiency (88.2% compared to 62.1% among children with a normal vitamin D supply; p = 0.057). During the period of high insolation, H. pylori infection was approximately the same (p = 0.82).
 Antral gastritis with high activity was predominantly detected in adolescents infected with H. pylori and its frequency did not depend on the level of vitamin D in the blood.
 Conclusion. Hypovitaminosis D is associated with H. pylori-associated gastritis, characterized by greater activity of the inflammatory process and has a clear relationship with the intensity of solar insolation.

Clinical presentation and outcomes of Helicobacter heilmannii gastritis in children in the New England region of the United States.

To describe the clinical, endoscopic, histologic, and treatment outcomes of Helicobacter heilmannii (H. heilmannii) associated gastritis in children in the New England region of the United States. Retrospective study of children (1-18 years) with H. heilmannii identified on gastric mucosal biopsies from two pediatric centers over a 21-year period, January 2000-December 2021. Cases were identified by querying pathology databases at each institution. Demographic and clinical data were obtained from the medical record. Endoscopic and histologic findings were extracted from endoscopy and pathology reports, respectively. Thirty-eight children were diagnosed with H. heilmannii-associated gastritis during the study period. The mean age at diagnosis was 10.1 ± 5.3 years, and 25/38 (66%) cases were male. Abdominal pain (32%) and nausea with or without vomiting (26%) were the most common symptoms. Thirty-two children (84%) had endoscopic findings including gastric nodularity (55%) and erythema (26%). All children had histologic signs of chronic gastritis, including those with normal endoscopic exams. Antibiotic regimens used for treating Helicobacter pylori were frequently prescribed. Of the 17 children who underwent a follow-up endoscopy (range 2-68 months), 15 (88%) did not have H. heilmannii identified on gastric biopsies. H. heilmannii was an infrequent but potential cause of epigastric abdominal pain and nausea in our cohort of New England children. While morphologically distinct from H. pylori, the bacteria can result in similar endoscopic and histologic findings of nodularity and chronic gastritis, respectively. The rate of eradication, as assessed by histology following treatment with H. pylori therapies, was below the 90% recommended goal for antimicrobial therapies.

Retrospective study on endoscopic findings of gastritis in children attending the gastrointestinal tract endoscopic unit of Assiut University Children Hospital over a 15-year-period

Background: Children with gastritis typically exhibit recurrent stomach pain and dyspepsia or vomiting.Objectives: To assess the frequency, clinical manifestations, endoscopic pictures, aetiology and outcome of gastritis in children who visited the gastrointestinal tract (GIT) endoscopic unit of Assiut University Children Hospital.Method: This was a retrospective, crosssectional study conducted at Assiut University Children Hospital GIT Endoscopic Unit from 1st January 2005 to 31st December 2019.Results: Upper GI endoscopy, done in all cases, showed that 66 (8.1%) had erythematous gastric mucosa, 106 (13%) had nodular gastric mucosa, 212 (25.9%) had erythematous gastric mucosa and hyperaemia, 147 (18%) had erythematous gastric mucosa and nodularity, 156 (19.1%) had hyperaemic mucosa and petechiae, 77 (9.5%) had hyperaemic mucosa and erosion, and 53 (6.5%) had multiple erosions and ulcers.Conclusions: Gastritis represented 9.4% of children who underwent upper GI endoscopy. Helicobacter pylori was the commonest cause with high recurrence. Patients presented with recurrent GI bleeding, and those with erythematous hyperaemic mucosa on endoscopy showed recurrence compared to their counterparts.

Management of collagenous gastritis in children: Case series and literature review.

Collagenous gastritis (CG) is a rare histopathological finding on gastric biopsies in children. It is associated with abdominal pain and iron deficiency anemia, usually not respondent to oral iron supplements. The aim of this study was to describe our experience in the management of pediatric patients with CG. Moreover, we propose to review the literature on this topic.We retrospectively reviewed all pediatric patients diagnosed with CG at our centre from January 2014 to January 2019.Three pediatric patients (2 F, mean age 12.3) were diagnosed with CG during the study period. Two presented with moderate and one with severe anemia. Symptoms were abdominal pain, asthenia and headache in two and asthenia and abdominal pain in one. All underwent upper and lower gastrointestinalendoscopy. All were firstly started with oral iron supplements with no benefit, principally due to poor compliance secondary to the worsening of the epigastric pain and proton pump inhibitor resistance. Therefore, they underwent ferric carboxymaltose (FCM) infusion with good clinical and laboratory response. Patients received a mean of two infusions/year, with stable hemoglobin levels and no adverse outcomes.Our review failed to identify a consistent response to specific treatments. Considering the apparent benign nature of the disease, symptomatic and supportive treatments are advisable. Iron deficiency anemia is largely present and therapy with oral iron supplements is not always successful. In our study, FCM infusion was effective in increasing the key blood indices in patients who poorly tolerated oral supplements.

Chronic gastritis in pediatrics

Chronic gastritis is one of the most common diseases of the gastrointestinal tract. High rates of gastritis in children are associated with poor nutrition, physical inactivity, drug abuse, bad habits, a number of concomitant diseases, immune disorders, allergization of the body, and stress. Although a significant proportion in the structure of chronic gastritis is occupied by gastritis associated with Helicobacter pylori infection, many clinical forms are diagnosed that are not associated with the presence of a microbial pathogen in the gastric mucosa. The goal is to highlight the problem of chronic gastritis in children, including risk factors, etiology, clinical manifestations, diagnosis and treatment. Materials and methods. To achieve these goals, a literature search was carried out in the PubMed and Google Scholar databases. The search depth did not exceed 5 years. Uninformative and duplicate articles were excluded. The final list of references included 42 articles. Results. In addition to traditional risk factors for adults, the incidence of chronic gastritis in children is influenced by artificial feeding, pathology of pregnancy and childbirth, respiratory infections, decreased mobility, and concomitant pathology. Helicobacter pylori infection is detected in 56% of children referred to a gastroenterologist for gastrointestinal symptoms. Manifestations of gastritis vary from asymptomatic to epigastric pain with dyspeptic symptoms. Conclusion. 1) Currently, up to 30-40% of children suffer from chronic gastritis. 2) Triple therapy regimens are traditionally used to eradicate Helicobacter pylori, but quadruple therapy is used in populations with high resistance to antimicrobial drugs. 3) In the treatment of eosinophilic gastritis, the drugs benralizumab and vedolizumab demonstrate high effectiveness, leading to depletion of the pool of eosinophils in the blood and tissues of the stomach, as well as clinical improvement. 4) Effective treatment for collagen gastritis has not yet been developed. The treatment regimen includes an elimination diet, proton pump inhibitors, and iron supplements.

The usefulness of transabdominal ultrasound elastography in Helicobacter pylori gastritis in children.

Helicobacter pylori can colonize the submucosal layer as well as the mucosa in the stomach. Inflammation and erosions cause both mucosal and submucosal thickening in patients with Helicobacter pylori gastritis. Elastography is a method for measuring the elasticity and hardness of tissues by visualization of their response to the applied force. Hard tissues respond to applied compression differently compared to soft tissues. Hard tissues displace as a whole without deforming as opposed to soft tissues. In this study, we investigated the diagnostic performance of transabdominal ultrasound elastography in detecting Helicobacter pylori gastritis in children. Nineteen children (group 1) with Helicobacter pylori gastritis, 33 children (group 2) with Helicobacter pylori (-) gastritis and 37 healthy children (group 3) were included the study. These groups were compared in terms of their strain index values. Ultrasonographic examinations were performed with a single transducer at 1.8-6.2 MHz frequency range. Both group 1 and 2 had significantly higher strain index values compared to the control group (2.7, 2.2 and 1.4 respectively). Additionally, the mean strain index value was significantly higher in group 1 compared to group 2. Transabdominal ultrasound elastography has diagnostic value in differentiating Helicobacter pylori (+) gastritis from Helicobacter pylori (-) gastritis as well as in the diagnosis of gastritis in children.

Antimicrobial Resistance Molecular Mechanisms of Helicobacter pylori in Jordanian Children: A Cross-Sectional Observational Study

H. pylori antimicrobial resistance causes increasing treatment failure rates among H. pylori gastritis in children. This study investigates the molecular mechanisms of H. pylori antimicrobial resistance among Jordanian children. Demographic, clinical, and laboratory data were recorded for children referred to Prince Hamzah Hospital. Clarithromycin, Metronidazole, and Levofloxacin susceptibility were tested via E-test. Clarithromycin-related mutations were investigated using Real-Time (RT)-PCR and Levofloxacin resistance was analyzed with DNA sequencing of the gyrA gene. 116 children were recruited, including 55.2% females and 55.2% in the age range of 10.1 to 14 years. A total of 82.7% were naïve to eradication therapy. H. pylori positivity was 93.9%, 89.6%, 61.7%, and 84.3% according to Rapid Urease Test, histology, culture, and RT-PCR, respectively. Resistance rates were 25.9% for Clarithromycin, 50% for Metronidazole, and 6.9% for Levofloxacin via E-test. A2142G or A2143G or a combination of both mutations concerning Clarithromycin resistance were documented in 26.1% of samples, while mutations in gyrA gen-related to Levofloxacin resistance were reported in 5.3% of samples. Antibiotic resistance was significantly affected by abdominal pain, anemia, hematemesis, and histological findings (p < 0.05). H. pylori resistance was documented for Metronidazole and Clarithromycin. RT-PCR for H. pylori identification and microbial resistance determination are valuable alternatives for cultures in determining antimicrobial susceptibility.

Four cases of collagenous gastritis in children

4例男性患儿均表现为缺铁性贫血，其中2例伴有腹痛。胃镜组织活检病理诊断均符合胶原性胃炎表现，2例累及十二指肠。4例患儿均口服铁剂补铁，2例加用泼尼松口服治疗。1例患儿失访，另3例贫血症状均有改善，其中使用激素治疗的患儿胶原沉积减轻。.

Autoimmune gastritis in children with type I diabetes mellitus

Diabetes mellitus continues to be the most common endocrine-metabolic pathology. In childhood, type 1 diabetes mellitus prevails - an autoimmune, genetically determined disease, as a result of which this type of diabetes is often combined with other autoimmune diseases. Autoimmune gastritis, the marker of which is antibodies to the parietal cells of the stomach, is quite rare in the children’s population, but with type 1 diabetes, its frequency increases significantly. The article presents the results of recent studies of the relationship between type 1 diabetes mellitus and autoimmune gastritis in children. The results of a study of the prevalence of antibodies to parietal cells of the stomach in type 1 diabetes mellitus in children, factors affecting this indicator are presented. The pathogenetic aspects of the relationship of these diseases are analyzed.

Хронический гастрит у детей: новые возможности диетотерапии

Хронический гастрит у детей: новые возможности диетотерапии

Functional state of the glands of the gastric mucosa in chronic Hp-associated gastritis in children

Introduction . Studies of the gastric mucosa using biomarkers of its functional state in children are isolated, and there is also no normative base for their assessment. The aim of the work was to establish the reference values of the levels of gastrin-17, pepsinogens I and II in the blood serum of children and the nature of their changes in chronic Hp-associated gastritis. Material and methods . 112 children aged 7–15 years with chronic gastritis associated with Hp were examined. The examination program included esophagogastroduodenoscopy, morphological examination of gastrobioptates and determination of serum concentrations of gastrin-17, pepsinogens I and II, class G antibodies to Hp. Results . A regulatory framework has been developed to assess serum concentrations of gastrin and pepsinogens in childhood. It was found that as infl ammation progresses in chronic Hp-associated gastritis in children, an increase in the level of biomarkers, as well as the titer of class G antibodies to Hp, is observed. Changes in the content of biomarkers in the blood serum of children are uninformative in relation to the diagnosis of atrophic gastritis. Conclusion . These studies of serum levels of gastrin-17, I and II and class G antibodies to Hp pepsinogens can be used as an additional non-morphological criterions for the severity of the infl ammatory process in the gastric mucosa during dynamic monitoring of children with chronic gastritis.

Antigastric parietal cell antibody as a screening test for Autoimmune gastritis in Egyptian children and adolescents with juvenile autoimmune thyroid disease and those with type 1 diabetes, single center experience

Purpose: The diagnosis of pediatric autoimmune gastritis (AIG) is critical due to the poor outcome and risk of malignancy. Therefore, we evaluated the prevalence of autoimmune gastritis in children with autoimmune thyroid disease (ATD) and type 1 diabetes mellitus (T1D), using parietal cell antibody (PCA) to identify its use as a screening test. Methods: PCA was measured in 90 patients; 45 patients with ATD (Hashimoto Thyroiditis and Graves' Disease) and 45 patients with T1D. Their ages ranged from 5 to 18 years. Hemoglobin, ferritin, and HbA1c (in diabetic patients) were measured. Results: PCA demonstrated a statistically significant difference between the two groups of patients with a p-value (0.024). The mean value of PCA in patients with T1D was 196.45, while it reached 148.58 in patients with ATD, with a p-value (0.003). Thirty-one (68.9%) and twelve (26.7%) of patients with T1D had high (30-200) and extremely high (&gt; 200) values of PCA, respectively, compared to twenty-six (57.8%) and eight (17.8%) of patients with ATD who had high (30-200) and extremely high (&gt; 200) values of PCA, respectively. Seven (87.5%) of patients with ATD with extremely high PCA( above 200) also had normocytic anemia.

Morphofunctional state of the gastric mucosa in children with chronic gastritis and the persistence of Epstein-Barr virus

The aim is to establish the effect of the persistence of the Epstein-Barr virus on the morphofunctional state of the gastric mucosa in chronic gastritis in children. Methods. 324 children aged 6—16 years with chronic gastritis were examined. We analyzed clinical and anamnestic data, the results of esophagogastroduodenoscopy with biopsy, genetic typing of Hp with the identification of pathogenicity genes VacA, CagA, IceA, BabA. The persistence of the Epstein-Barr virus was determined by the detection of its DNA in the materials of gastrobiopsy. The titer of class G antibodies to gastric parietal cells was studied in 110 patients.The results of the study. In children with chronic gastritis, Epstein-Barr virus was detected in the gastric mucosa in 49.1% of cases. In these patients, its colonization by highly pathogenic Hp strains was detected 1.8 times more often than in patients who had no infection with this virus. The persistence of the Epstein-Barr virus contributed to an increase in the severity of inflammation, the appearance of signs of indefinite atrophy of the mucous membrane and in the absolute majority of children was not accompanied by an increase in the titer of antibodies to the parietal cells of the stomach.Conclusion. The persistence of Epstein-Barr virus in the gastric mucosa in chronic Hp-associated gastritis contributes to its infection with highly pathogenic Hp strains and severe inflammation. No data have been obtained indicating the role of Epstein-Barr virus in the formation of atrophic or autoimmune gastritis in childhood.

Helicobacter pylori Chronic Gastritis in Children and Adolescents was not Associated with Anaemia

Background: Helicobacter pylori (H. pylori) colonizes the gastric mucosa, leading to chronic inflammation. Epidemiological studies have demonstrated that H. pylori infection is high in areas with a high prevalence of anaemia. Consequently, patients infected with H. pylori are at a higher risk of anaemia. However, the relationship between H. pylori and anaemia remains controversial. Therefore, a study conducted among children with chronic abdominal pain with organic dyspepsia (chronic gastritis due to H. pylori and (or?) Esophagitis), and a functional disorder (Irritable Bowel Syndrome), will be appropriate. Objective: Compare the prevalence of Anaemia in children and adolescents with chronic abdominal pain, divided into: 1) Non-ulcer dyspepsia associated with H. pylori gastritis., 2) Dyspepsia associated with chronic Esophagitis, and Irritable Bowel Syndrome. Methods: The study was a single-centre, observational retrospective cohort. Inclusion and Exclusion Criteria. All children must be well categorized with signs and symptoms consistent with chronic abdominal pain and aged between 5-and 18 years. Exclusion criteria: genetic, metabolic, immune, cardiac, hepatic or renal diseases, neurodevelopmental delay, and previous surgery. Laboratory tests were performed for all patients: complete blood cell count, Erythrocyte Sedimentation Rate, urinalysis, stool for ova &amp; parasites, and H. pylori serology. Another diagnostic test was decided at the discretion of the gastroenterology team. The chronic dyspeptic syndrome with non-ulcer dyspepsia associated with H. pylori if they presented both results: the rapid urease test positive and the histological examination of the gastric mucosa confirming the presence of the bacterium. Dyspepsia associated with chronic Esophagitis was based on clinical symptoms/signs and endoscopic and histologic evaluation. Patients with IBS were diagnosed according to Rome Criteria. Results: Three hundred and seven children/adolescents: H. pylori gastritis (154, 50%), Esophagitis (41, 14%), and IBS (112, 36%) were included. There was a non-statistically significant difference in the baseline characteristics (sex, first-born child, age of mothers, age of fathers, crowding index, duration of pain symptoms, headache and limb pain, overweight/obesity and malnutrition) between the three groups. Clinical characteristics demonstrated: H. pylori and Esophagitis have epigastric pain and IBS periumbilical pain. There was a non-statistically significant difference in haemoglobin values and red cell parameters between the three groups in laboratory investigation. The prevalence of anaemia was very low, with no difference between the groups. Urinalysis and stool for ova &amp; parasites were negative in all children. Conclusion: Anaemia was not present in children with chronic abdominal pain, both organic and functional disorders. Age, good nutritional status, good sanitation and hygiene may have contributed to the results in this study.

Iron pill induced gastritis in children with iron deficiency anemia

Iron pill induced gastritis in children with iron deficiency anemia

Stress Ulcer Prophylaxis in Hospitalized Asthmatics

Source: Roberts AR, Roddy M, Wilsey MJ, et al. Stress ulcer prophylaxis for critical asthma. Pediatrics. 2022;149(4):e2021054527; doi:10.1542/peds.2021-054527Investigators from Johns Hopkins All Children’s Hospital, St. Petersburg, FL, conducted a retrospective study to assess trends in the use of stress ulcer prophylaxis (SUP) in children admitted to a PICU with critical asthma and compare rates of gastrointestinal (GI) bleeding, gastritis, gastric ulceration, and SUP-related adverse events among those with and without SUP. For the study, they reviewed data in Pediatric Health Information System (PHIS) database. PHIS includes demographic, encounter, diagnostic, procedure, and pharmacy information on children seen at more than 50 children’s hospitals. Study participants were patients 3-17 years old admitted to the ICU at 42 children’s hospitals with a diagnosis of critical asthma, identified by ICD-9 and ICD-10 codes, from 2010–2019. Only patients with pharmacy orders for systemic corticosteroids and ICU length of stay (LOS) ≥1 day were included. SUP was defined as an order for a histamine-2 blocker (H2B) or proton pump inhibitor (PPI) on the first encounter day. The primary study outcome was major GI bleeding event, and secondary outcomes included gastritis, gastric ulcers, intestinal perforations, and SUP-related adverse events (thrombocytopenia, necrotizing enterocolitis, and C. difficile colitis). Rates of outcomes in patients with or without SUP were compared with chi-square of Fisher’s exact tests. Joinpoint regression was used to evaluate chronologic trends in SUP prescribing for children with critical asthma.Data on 30,177 children with critical asthma were included in the analyses. Study participants had a mean age of 8.3 ±3.8 years, and 66.3% were male; mean LOS was 3.2 ±2.1 days, and 11.3% were treated with mechanical ventilation. Overall, 10,387 (34.4%) children received SUP, with 81.6% of these prescribed H2B and 18.4% receiving PPI. No major GI bleeding events occurred in any study patient. One child receiving SUP was diagnosed with gastric ulceration. There were 32 patients diagnosed with gastritis, with no difference in rates of gastritis in children with or without SUP (rates, 0.11% and 0.10%, respectively; P = 0.706). Among the SUP-related adverse events evaluated, only thrombocytopenia was documented, occurring in 24 children; thrombocytopenia was significantly less common in children treated with SUP (0.05% compared to 0.14% in those not prescribed SUP; P = 0.008). During the study, period rates of SUP for children with critical asthma increased from 25.5% in 2010 to 42.1% in 2019, with a mean annual increase of 1.9% ±6.0%.The authors conclude that no major GI bleeds occurred in children hospitalized with critical asthma during a 10-year period and suggest that SUP may not be routinely warranted in these patients.Dr Winer has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Critical asthma (asthma exacerbation) is a common problem treated in pediatric ICUs. SUP has become standard of care for patients receiving prolonged mechanical ventilation, but its use has spread to other disease states, especially those involving systemic corticosteroid therapy.1 However, concerns have arisen that these interventions may not be without significant risks, including ventilator associated pneumonia, C. difficile colitis, necrotizing enterocolitis, and acute thrombocytopenia.2As therapies spread beyond their initial intended use, they may be used to treat disease processes with lower risk, less evidence of positive effect, and to prevent negative outcomes with lower prevalence. Despite 10 years of multicenter data, the current investigators were unable to power their study to test whether SUP could prevent adverse outcomes.However, what is clear is that these negative effects were rare in both the SUP and non-SUP groups. Assuming 100% effectiveness (which is a huge stretch), based on the data presented in the current study, the number needed to treat would be approximately 900 (95% CI, 650, 1,250) for gastritis and 30,000 (95% CI, 5,300, 170,000) for gastric ulceration.Both gastritis and stress ulcers are very rare in children with critical asthma, and the evidence for effectiveness of SUP is poor. Routine use of SUP likely can be avoided in children with critical asthma.

Patterns of changes in cellular composition of the stomach in chronic gastritis in children and adolescents

The aim of the work is to establish the regularities of changes in the cellular composition of the fundal and pyloric glands in chronic gastritis in children. Material and methods. 213 patients aged 7-17 years with chronic Hp-associated gastritis were examined. The cellular composition of the fundal and pyloric glands was determined in gastrobioptates. Immunohistochemical analysis was used to determine cells containing gastrin, somatostatin, pepsinogens I and II, acidic and neutral mucins. The results were expressed in‰ per 1000 epithelial cells. Results. As inflammation increases in the fundal glands, the number of main and cells containing pepsinogens I and II decreases, the number of lining, additional and endocrine cells increases. In the pyloric glands, the pool of endocrinocytes increases, the number of lining cells and cells immunopositive to pepsinogen II significantly decreases. Parallel to the severity of the process, there is a sharp increase in D- and G-cells and an increase in the number of epithelial cells containing acidic and neutral mucins. Conclusion. Chronic inflammation of the gastric mucosa is accompanied by a significant restructuring of the cellular composition of its glands.