Çocuklarda Güncel Sidney Sistemine Göre Gastrik İntestinal Metaplazilerin İncelenmesi: Tek Merkez Deneyimi

Abstract

Giriş: Bu çalışmada, üst gastrointestinal sistem endoskopisi yapılan çocuk hastalarda intestinal metaplazi sıklığının ve kliniğe yansımasının araştırılması amaçlandı. Materyal-Metod: Ocak 2019 ile Aralık 2022 tarihleri arasında XX Üniversitesi Tıp Fakültesi Hastanesi Çocuk Gastroenteroloji Kliniğinde çeşitli nedenlerle üst gastrointestinal sistem endoskopisi yapılan 1280 hastanın endoskopi ve patoloji raporları geriye dönük olarak değerlendirildi. Biyopsi örneklerinin histopatolojik incelemelerinde intestinal metaplazi tanısı konan 66 olgu çalışmaya dahil edildi. Bulgular: Hastaların 37’si (56.1%) kadın, 29’u (43.9%) erkekti. Kadınların yaş ortalaması 12.92±4.297 yıl (1-17 yaş min/maks), erkeklerin 12.07±4.765 yıl (2-17 yaş min/maks) idi. Ortalama endoskopi sayısı 1.66/kez idi (1-5/kez min/maks). Endoskopi endikasyonları arasında karın ağrısı, büyüme geriliği ve çölyak hastalığı şüphesi ilk üç sırada yer almaktaydı. %67.1’inde H. Pilori pozitifliği saptandı. Sonuç: Gastrik İntestinal Metaplazi çocukluk çağında nadir görülmekle beraber riski nedeniyle göz ardı edilmemelidir. Yamalı tutulum veya submukoza ya da daha derin tabakaları tutan hastalıklarda endoskopi ile alınan biyopsilerin tanısal anlamda yeterli olamayabileceği unutulmamalıdır.

Keywords

• çocuk
• endoskopi
• gastrik intestinal metaplazi
• helikobakter pilori

Investigation of Gastric Intestinal Metaplasia in Children According to the Current Sidney System: Single Centre Experience

Abstract

Aim: The purpose of this investigation was to examine the occurrence of intestinal metaplasia in pediatric patients who underwent upper gastrointestinal endoscopy and its clinical implications. Methods: A retrospective evaluation was conducted on the endoscopy and pathology reports of 1280 patients who underwent upper gastrointestinal system endoscopy for various indications at the Pediatric Gastroenterology Clinic of XX University Faculty of Medicine Hospital from January 2019 to December 2022. The study included 66 cases that were diagnosed with intestinal metaplasia based on the histopathological examination of biopsy samples. Results: Among the patients, 37 (56.1%) were female and 29 (43.9%) were male. The mean age for females was 12.92±4.297 years (ranging from 1 to 17 years), while for males it was 12.07±4.765 years (ranging from 2 to 17 years). The average number of endoscopies performed was 1.66 times (ranging from 1 to 5 times). The top three indications for endoscopy included abdominal pain, growth retardation, and suspicion of celiac disease. Detection of H. Pilori positivity was observed in 67.1% of cases. Conclusion: While Gastric Intestinal Metaplasia is uncommon in childhood, it should not be disregarded due to its associated risk. It is important to remember that endoscopic biopsies may not provide sufficient diagnostic information in cases involving patchy involvement or diseases affecting the submucosa or deeper layers.

Keywords

• chıld
• endoscopy
• gastric intestinal metaplasia
• helicobacter pylori

References

1. 1- Slack JM, Tosh D. Transdifferentiation and metaplasia—switching cell types. Curr Opin Genet Dev 2001;11:581-6.
2. 2- Slack JMW. Metaplasia and transdifferentiation: from pure biology to the clinic. Nat Rev Mol Cell Biol 2007;8:369-78.
3. 3- Sharma P, Falk GW, Weston AP, Reker D, Johnston M, Sampliner RE, et al. Dysplasia and cancer in a large multicenter cohort of patients with Barrett’s esophagus. Clin Gastroenterol Hepatol 2006;4:566-72.
4. 4- Correa P, Piazuelo MB, Wilson KT. Pathology of gastric intestinal metaplasia: clinical implications. Am J Gastroenterol 2010;105:493-8.
5. 5- Dixon MF, Genta RM, Yardley JH, Classification and grading of gastritis: the updated Sydney System, international workshop on the histopathology of gastritis, Houstan 1994. Am J Surg Pathol 1996;20: 1161-81.
6. 6- Correa P, Piazuelo MB, Wilson KT. Pathology of gastric intestinal metaplasia: clinical implications. Am J Gastroenterol 2010;105:493-8.
7. 7- Weinberg AG.The significance of small intestinal epithelium in gastric antral biopsies in children. Pediatr Dev Pathol 2012;15(2):101-6.
8. 8- Schaeppi MG, Mougenot J, Belli DC. Upper Gastrointestinal Endoscopy. In: Walker WA,Goulet O, Kleinman RE, Sherman PM,Shneider BL,Sanderson IR (eds). Pediatric Gastrointestinal Disease,4th ed. BC Decker 2004:1674-702.

9. 9- Pimentel-Nunes P, Libânio D, Lage J, Abrantes D, Coimbra M, Esposito G, et al. A multicenter prospective study of the real-time use of narrow-band imaging in the diagnosis of premalignant gastric conditions and lesions. Endoscopy 2016;48:723-30.
10. 10- Esposito G, Primentel-Nunes P, Angeletti S, Castro R, Libânio D, Galli G, et al. Endoscopic grading of gastric intestinal metaplasia (EGGIM): a multicenter validation study. Endoscopy 2019;51(6):515-21.
11. 11- Rugge M, Fassan M, Pizzi M, et al. Operative link for gastritis assessment vs operative link on intestinal metaplasia assessment. World J Gastroenterol 2011;17:4596–601.
12. 12- Akbulut UE, Sağ E, Çakır M. Özefagogastroduodenoskopi yapılmış çocuklarda özefagus patolojilerinin değerlendirilmesi. Türkiye Çocuk Hast Derg 2017;11;9-14.
13. 13- Camacho-Gomez SM, Bernieh A, Saad AG, Tipnis. NA. Non- Helicobacter pylori Gastric Intestinal Metaplasia in Children: A Series of Cases and Review of the Literature. Case Rep Gastrointest Med 2018;2018:5930415.
14. 14- Geling Li , David R Kelly, Elizabeth Mroczek-Musulman, Kai Wang , Leona Council , Lei Zhao. Gastric Antral Mucosal Changes in Children With Intestinal Metaplasia. Pediatr Dev Pathol 2022;25(5):511-7.
15. 15- Weinberg AG.The significance of small intestinal epithelium in gastric antral biopsies in children. Pediatr Dev Pathol 2012;15(2):101-6.
16. 16- Correa P. The biological model of gastric carcinogenesis. IARC Sci Pub 2004;157:301-10.
17. 17- Wyatt JI. Histopathology of gastroduodenal inflamation: The impact of helicobacter pylori. Histopathology 1995;26:1-15.
18. 18- Rugge M, Di Mario F, Cassaro M, Baffa R, Farinati F, Rubio J.Jr, Ninfo V. Pathology of the gastric antrum and body associated with Helicobacter pylori infection in non-ulcerous patients: is the bacterium a promoter of intestinal metaplasia ? Histopathology 1993;22:9-15.
19. 19- Villarreal-Calderon R, Luevano-Gonzales A, Aragon-Flores M, Zhu H, Yuan Y, Xiang Q, et al. Antral atrophy, intestinal metaplasia, and preneoplastic markers in Mexican children with Helicobacter pylori-positive and Helicobacter pylori-negative gastritis. Ann Diagn Pathol 2014;18(3):129-35.
20. 20-Nai GA, Parizi ACG, Barbosa RL. Association between Helicobacter pylori concentration and the combining frequeny of histopathological findings in gastric biopsies and specimens. Arq Gastroenterol 2007;44(3):240-8.
21. 21- Kalach N, Zrinjka M, Bontems P, Kori M, Homan M, Cabral J, et al. Systematic Review and Meta-analysis of Histological Gastric Biopsy Aspects According to the Updated Sydney System in Children. J Pediatr Gastroenterol Nutr 2022;74(1):13-9.
22. 22- Dinis-Ribeiro M, Kuipers EJ. How to Manage a Patient With Gastric Intestinal Metaplasia: An International Perspective. Gastroenterology 2020;158(6):1534-7.