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Endoscopic and Histologic Analysis of Gastric Mucosa-Associated Lymphoid Tissue in Children With Helicobacter pylori Infection

Yang, Hye Ran*; Choi, Hyoung Soo*; Paik, Jin Ho; Lee, Hye Seung

Journal of Pediatric Gastroenterology and Nutrition: September 2013 - Volume 57 - Issue 3 - p 298–304
doi: 10.1097/MPG.0b013e318298020a
Original Articles: Gastroenterology

Objectives: Nodular gastritis (NG) associated with Helicobacter pylori infection can occur commonly in childhood and is regarded to be benign without clinical significance. This study includes endoscopic and histologic analysis of gastric mucosa-associated lymphoid tissue (MALT) to clarify the significance of NG on endoscopy in H pylori–infected children.

Methods: Of the 758 children who underwent endoscopy, 80 were identified as having H pylori infection. These patients were divided into 3 groups based on endoscopic severity of gastric nodularity. Histopathologic grading of MALT and immunohistochemistry of CD3, CD20, cytokeratin, and Ki-67 were evaluated.

Results: On endoscopy, severe NG was observed in the antrum of 38 of the 80 subjects, mild NG in 27, and an absence of NG in 15. Density of H pylori and lymphocyte infiltration differed among the 3 groups (P = 0.022 and P = 0.025, respectively). Histological grading for gastric lymphoid infiltrates was compatible with grade 1 in 47 (58.8%), grade 2 in 21 (26.3%), grade 3 in 7 (8.8%), and grade 4–5 in 4 (5.1%) in the antrum. Degree of NG, density of H pylori, neutrophil activity, and gastritis score in the antrum varied with MALT grades (P = 0.003, P = 0.042, P = 0.028, and P = 0.006, respectively).

Conclusions: Our study suggests NG may present as a significant gastric manifestation of childhood H pylori infection that indicates gastric MALT. Thorough histologic investigation may be useful in the evaluation of gastric MALT in children infected with H pylori that manifests as severe NG in the antrum.

*Department of Pediatrics

Department of Pathology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.

Address correspondence and reprint requests to Hye Ran Yang, MD, PhD, Department of Pediatrics, Seoul National University Bundang Hospital, 82, Gumi-ro 173, Bundang-gu, Seongnam-si, Gyeonggi-do 463–707, Korea (e-mail:

Received 19 December, 2012

Accepted 15 April, 2013

This study was funded by a grant (No. 02–2008–009) from the Seoul National University Bundang Hospital, Seongnam, South Korea.

The authors report no conflicts of interests.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,