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Snyder, John D.1; Gold, Benjamin D.2; Chen, Yunn-Yi3; Czinn, Steven4; Perrin, James M.5
1Pediatrics, UCSF, San Francisco, CA; 2Pediatrics, Emory, Atlanta, GA; 3Pathology, UCSF, San Francisco, CA; 4Pediatrics, Case Western University, Cleveland, OH; 5Pediatrics, Children's Hospital, Boston, MA.
Previous studies have shown poor correlation between signs and symptoms of abdominal pain and the presence of H. pylori in children. However, these studies were carried out before the development of validated pediatric GI symptom assessment instruments (SAI). We evaluated the predictive value of a second generation SAI to determine the presence and severity of gastritis and correlation with H. pylori infection.
We enrolled symptomatic children who required endoscopy (EGD) and biopsy. Before EGD, an SAI (0-5 severity scale) was completed by the child and/or their parent. A GI pathologist evaluated each biopsy specimen using the updated Sydney System. H. pylori was diagnosed by histology and a rapid diagnostic urease test.
49 children were evaluated over a 2-year period. Gastritis was found in 21 patients (43%), including 4 (8%) with H. pylori. Moderate or severe gastritis was found in 38% of those with inflammation, including all 4 with H. pylori. SAI findings are summarized in the Table 1. The severity of chest pain, burping and regurgitation in the H. pylori patients was more than twice that of the other 2 groups. However, the small cohort size to date precludes determination of statistically significant differences.
Our preliminary data indicate that the SAI may be useful in distinguishing children with H. pylori infection from those with no gastritis or those with non-H. pylori inflammation. Enrollment to obtain a sufficiently powered patient population is ongoing.Table 1
© 2006 Lippincott Williams & Wilkins, Inc.
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