Çocuklarda Helicobacter pylori enfeksiyonu ve antral nodülerite

Öz

Amaç: Çalışmanın amacı çocuklarda Helicobacter pylori enfeksiyon sıklığını ve antral nodülerite ile ilişkisini saptamaktır. Gereç ve yöntem: Üst gastrointestinal sistem endoskopisi yapılan 358 çocuk hasta (ort yaş:10,35±3,15, E/K:0,95) geriye dönük olarak klinik, endoskopik ve histopatalojik bulgular açısından değerlendirildi. Bulgular: Antral nodülarite 158 (%44,1) çocukta saptandı. Antral nodüleritesi olan çocukların 138’inde (% 83,4) H.pylori tespit edildi. H. pylori ile enfekte çocuklar yaş olarak daha büyük (11,1±2,91 ve 9,7±3,19) saptandı (p = 0,0001). Antral nodülarite H. pylori-pozitif çocuklarda H. pylori-negatif olanlara göre daha sık saptandı (p=0,0001, duyarlılık %52, özgüllük %78). Lenfoid foliküller ve agregat oluşumu antral nodülarite saptanan hastalarda daha sık gözlendi (p=0.0001 ve p= 0.017, sırasıyla). H. pylori dansitesi ile antral nodülarite arasında istatistiksel olarak anlamlı fark saptandı (p=0.0001). Sonuç: Antral nodülarite, H. pylori gastriti olan çocuklarda olmayanlara göre daha sık görülmektedir. Antral nodülarite ile istatistiksel olarak büyük yaş, H. pylori enfeksiyonu ve H. pylori dansitesi ilişkili bulunmuştur.

Anahtar Kelimeler

• Çocuk,endoskopi,Helicobacter pylori,nodüler gastritis

H. pylori infection and antral nodular gastritis in children

Öz

Objectives: The aim of the study was to determine the prevalence of antral nodularity and establish its association with Helicobacter pylori infection in children. Methods: A total of 358 children (mean age: 10.35±3.15 years, M/F:0.95) who had upper gastrointestinal endoscopy were evaluated retrospectively in terms of clinical, endoscopic and histological findings. The association between antral nodularity and H. pylori infection was determined. Results: Antral nodularity was observed in 158 (44.1%) patients. H. pylori was detected in 138 (83.4%) of those patients with antral nodularity. Infected children with H. pylori compared to non-infected group were older (p= 0.0001). The antral nodularity was observed significantly higher in H. pylori-positive patients than in H. pylori-negative cases (p=0.0001). The sensitivity was 52%, specificity 78%, positive predictive value 87% and negative predictive value was 37%. Lymphoid follicle and aggregates formation was observed higher in patients with antral nodularity than patients without (p=0.0001 and p=0.017, respectively). Statistically significant difference was observed between antral nodularity and the grades of H.pylori density (p=0.0001). Conclusions: Children with antral nodularity were more likely to have H. pylori gastritis compared to children without. The parameters associated significantly with antral nodularity were older age, H. pylori infection and H. pylori density.

Anahtar Kelimeler

• Children,endoscopy,Helicobacter pylori,antral nodularity

Kaynakça

1. 1. Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patient with gastritis and peptic ulceration. Lancet 1984;1:1311-5.
2. 2. Wyatt JI, Rathbone BJ. Immune response of the gastric mucosa to Campylobacter pylori. Scand J Gastroenterol Suppl 1988;142:44–49.
3. 3. Amieva MR, El-Omar EM. Host-bacterial interactions in Helicobacter pylori infection. Gastroenterology 2008;134(1):306-23.
4. 4. Algood HM, Cover TL. Helicobacter pylori persistence: an overview of interactions between H. pylori and host immune defenses. Clin Microbiol Rev 2006;19(4):597-613.
5. 5. Ohkusa T, Fujiki K, Takashimizu I, Kumagai J, Tanizawa T, Eishi Y. Endoscopic and histological comparison of nonulcer dyspepsia with and without Helicobacter pylori infection evaluated by the modified Sydney system. Am J Gastroenterol 2000;95(9):2195-9.
6. 6. Cho JH, Chang YW, Jang JY,et al. Close observation of gastric mucosal pattern by standard endoscopy can predict Helicobacter pylori infection status. J Gastroenterol Hepatol 2013;28(2):279-84.
7. 7. Luzza F, Pensabene L, Imeneo M, et al. Antral nodularity and positive CagA serology are distinct and relevant markers of severe gastric inflammation in children with Helicobacter pylori infection. Helicobacter 2002;7(1):46-52.
8. 8. Luzza F, Pensabene L, Imeneo M, et al. Antral nodularity identifies children infected with Helicobacter pylori with higher grades of gastric inflammation. Gastrointest Endosc 2001;53(1):60-4.

9. 9. Bahú Mda G, da Silveira TR, Maguilnick I, Ulbrich-Kulczynski J. Endoscopic nodular gastritis: an endoscopic indicator of high-grade bacterial colonization and severe gastritis in children with Helicobacter pylori. J Pediatr Gastroenterol Nutr 2003;36(2):217-22.
10. 10. Ukarapol N, Lertprasertsuk N, Wongsawasdi L. Recurrent abdominal pain in children: the utility of upper endoscopy and histopathology. Singapore Med J 2004;45(3):121-4. 11. Uhlig HH, Tannapfel A, Mössner J, et al. Histopathological parameters of Helicobacter pylori-associated gastritis in children and adolescents: comparison with findings in adults. Scand J Gastroenterol 2003;38(7):701-6.
11. 12. Uc A, Chong SK. Treatment of Helicobacter pylori gastritis improves dyspeptic symptoms in children. J Pediatr Gastroenterol Nutr 2002;34(3):281-5.
12. 13. Chen MH, Lien CH, Yang W, Wu CL. Helicobacter pylori infection in recurrent abdominal pain in children--a prospective study. Acta Paediatr Taiwan 2001;42(5):278-81.
13. 14. Serban R, Grigorescu-Sido P, Gheban D, Kiss E. Helicobacter pylori gastritis in children: endoscopical and histological aspects. Rom J Gastroenterol 2002;11(4):297-301.
14. 15. Sýkora J, Varvarovská J, Kuntscherová J,et al. Symptomatology and specific characteristics of chronic gastritis caused by Helicobacter pylori infection in children in the Czech population--epidemiologic, clinical, endoscopic and histomorphologic study]. Cas Lek Cesk 2002;141(19):615-21.
15. 16. Akcam M, Artan R, Gelen T, Yilmaz A, Eren E, Uygun V, Cig H. Long-term aspects of nodular gastritis in children. Pediatr Int 2007;49(2):220-5. 17. Prasad KK. Pathology and Pathogenesis of Helicobacter pylori infection. In: Vaishnavi C, eds. Infections in gastrointestinal system. 1st ed. India: Jaypee Brothers Medical Publishers Ltd.;2013. p. 165-186. 18. Kamada T, Hata J, Tanaka A, et al. Nodular gastritis and gastric cancer. Digestive Endoscopy 2006;18(2);79-83.
16. 19. Dixon MF, Genta RM, Yardley H, Correa P. Classification and grading of gastritis:the updated Sydney system. Am J. Surg. Pathol 1996;20:1161-81.
17. 20. Prasad KK, Thapa BR, Sharma AK, Nain CK, Singh K. Reassessment of diagnostic value of antral nodularity for Helicobacter pylori infection in children. Minerva Gastroenterol Dietol 2008;54(1):1-6.
18. 21. Carvalho MA, Machado NC, Ortolan EV, Rodrigues MA. Upper gastrointestinal histopathological findings in children and adolescents with nonulcer dyspepsia with Helicobacter pylori infection. J Pediatr Gastroenterol Nutr 2012;55(5): 523-9.
19. 22. Ozcay F, Kocak N, Temizel IN, Demir H, Ozen H, Yüce A, Gürakan F. Helicobacter pylori infection in Turkish children: comparison of diagnostic tests, evaluation of eradication rate, and changes in symptoms after eradication. Helicobacter 2004;9(3):242-8.
20. 23. Mazigh Mrad S, Abidi K, Brini I, Boukthir S, Sammoud A. Nodular gastritis: an endoscopic indicator of Helicobacter pylori infection in children. Tunis Med 2012;90(11):789-92. 24. Crone J, Granditsch G, Huber WD, et al. Helicobacter pylori in children and adolescents: increase of primary clarithromycin resistance, 1997-2000. J Pediatr Gastroenterol Nutr 2003;36(3):368-71.
21. 25. Kostaki M, Fessatou S, Karpathios T. Nodular gastritis and Helicobacter pylori infection in children. Ann Gastro 2000;13(2):138-141.
22. 26. Szczepanowska A, Kozioł-Montewka M, Ligieza J, Papierkowski A, Mroczkowska-Juchkiewicz. Evaluation of invasive tests in diagnosis of Helicobacter pylori infection and their correlation with endoscopic features in children with chronic gastritis. Wiad Lek 2005;58(7-8):403-6.
23. 27. Hidaka N, Nakayama Y, Horiuchi A, Kato S, Sano K. Endoscopic identification of Helicobacter pylori gastritis in children. Dig Endosc 2010;22(2):90-4.
24. 28. Machado RS, Viriato A, Kawakami E, Patrício FR. The regular arrangement of collecting venules pattern evaluated by standard endoscope and the absence of antrum nodularity are highly indicative of Helicobacter pylori uninfected gastric mucosa. Dig Liver Dis 2008;40(1):68-72.
25. 29. Ladas SD, Rokkas T, Georgopoulos S, et al. Predictive factors and prevalence of follicular gastritis in adults with peptic ulcer and nonulcer dyspepsia. Dig Dis Sci 1999; 44: 1156–1160.
26. 30. Czinn SJ. Serodiagnosis of Helicobacter pylori in pediatric patients. J Pediatr Gastroenterol Nutr 1999;28(2):132-4.
27. 31. Eidt S, Stolte M. Prevalence of lymphoid follicles and aggregates in Helicobacter pylori gastritis in antral. J Clin Pathol 1993;46:832–835.
28. 32. Chen XY, Liu WZ, Shi Y, Zhang DZ, Xiao SD, Tytgat GN. Helicobacter pylori associated gastric diseases and lymphoid tissue hyperplasia in gastric antral mucosa. J Clin Pathol 2002;55(2):133-7.
29. 33. Langner M, Machado RS, Patrício FR, Kawakami E. Evaluation of gastric histology in children and adolescents with Helicobacter pylori gastritis using the Update Sydney System. Arq Gastroenterol 2009;46(4):328-32.
30. 34. Koh H, Noh TW, Baek SY, Chung KS. Nodular gastritis and pathologic findings in children and young adults with Helicobacter pylori infection. Yonsei Med J 2007;48(2):240-6.