Authors: K.K. Prasad ([email protected]), B.R. Thapa, A.K. Sharma, S. Lal, and C.K. Nain
Department of Superspeciality of Gastroenterology, Post-Graduate Institute of
Medical Education and Research, Chandigarh 160 012, India
Endoscopic nodular antritis in children is described to have a high correlation with Helicobater pylori infection.
The study was carried out to investigate the accuracy of using antral nodularity as a marker for H. pylori infection in children.
This prospective study included 468 children in whom upper digestive endoscopy was performed for gastrointestinal symptoms between 6 June 2003 and 14 October 2005, and gastric antral mucosal biopsy was taken. Sixty-seven children were diagnosed as having endoscopic nodular antritis and were included in the study. Nodular antritis was defined as antral gastritis with endoscopic findings characterized by a miliary pattern and prominent lymphoid follicles in biopsy specimens. Demographics, clinical characteristics, endoscopic features, and pathologic features were recorded. H. pylori were recognized in gastric biopsy on H&E sections; a modified Giemsa stain was performed in biopsy suspicious for H. pylori. The results were expressed as number and percentage or mean+SE. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Comparisons of quantitative measurements were also performed with Student's t test. Informed parental written consent was obtained prior to participation in the study.
The prevalence of nodular antritis in children was 14.3% (67 of 468) and consisted of 31 (46.3%) of 67 males and 36 (53.7%) of 67 females. Age of children ranged from 3 to 18 years (mean age 9.2+0.4 years). The prevalence of nodular antritis increased gradually with age. Twenty-six (38.8%) of the 67 children with endoscopic nodular antritis had recurrent abdominal pain. H. pylori infection was identified in 68 (14.5%) of the 468 children. Endoscopic nodular antritis had a poor accuracy rate to determine H. pylori infection (sensitivity40.3%; positive predictive value-39.7%) and was observed in 27 (39.7%)of the 68 H. pylori-positive patients and in 40 (10%) of 400 H. pylori-negative patients.
Endoscopic nodular antritis is a poor predictor for H. pylori infection in children. During endoscopy, gastric biopsies should always be obtained in children to establish the presence of H. pylori infection. The prevalence of H. pylori infection in the present study was 14.5%, which reflects that H. pylori infection is a common health problem in India.