Cohen M C, Cueto Rúa E, Balcarce N, Quijano G, Drut R
Department of Pathology, Hospital de Niños Superiora Sor María Ludovica, La Plata, Argentina.
Acta Gastroenterol Latinoam. 2001;31(5):411-6.
Atrophic gastritis has not been described in children in the setting of Helicobacter Pylori infection.
Gastric biopsies of six children (7 to 11 years old) with history of HpCG and recent therapeutic eradication of H. Pylori, were reviewed. In the 6 H. Pylori was documented with histology, culture, direct visualization and/or serology before treatment. Cases were compared with five biopsies of age-matched patients showing none of the above-mentioned clinical data. All the biopsies were formalin-fixed, paraffin embedded and stained with hematoxilin-eosin, Masson trichrome and reticulin stain.
The biopsies of the six treated patients showed variable-in-size stellate-shaped spots of glandular loss replaced by dense connective tissue with few inflammatory cells. The fibrous tissue showed a central area of scarring and radially oriented spikes extending to adjacent interglandular tissue, more evident with the Masson trichrome stain. Density of inflammatory cells in the lamina propria was variable. H. Pylori organisms were consistently absent. On the reticulin stain the atrophic areas showed coarser and compacted reticulin. Stellate scars were not present in the five controls.
Small foci with fibrous scars may be found in children with long standing HpCG, perhaps as an early sequel of it. We hypothesize that if the chronic gastritis-gastric atrophy process is a continuum, these stellate scars may be representing the very beginning of the multifocal atrophic gastritis usually seen in adult patients.
萎缩性胃炎在儿童幽门螺杆菌感染的情况下尚未见报道。
回顾了6名患有幽门螺杆菌感染（HpCG）且近期接受过幽门螺杆菌治疗性根除的儿童（7至11岁）的胃活检标本。在这6例中，治疗前通过组织学、培养、直接观察和/或血清学证实存在幽门螺杆菌。将这些病例与5例年龄匹配的患者的活检标本进行比较，这些对照患者没有上述任何临床资料。所有活检标本均用福尔马林固定、石蜡包埋，并用苏木精-伊红、Masson三色染色和网状纤维染色。
6例接受治疗患者的活检标本显示大小不一的星状腺体缺失区域，被致密结缔组织取代，炎症细胞较少。纤维组织显示中央有瘢痕形成区域，并有呈放射状延伸至相邻腺间组织的棘状突起，Masson三色染色更明显。固有层炎症细胞密度各不相同。始终未发现幽门螺杆菌。在网状纤维染色中，萎缩区域显示网状纤维更粗且紧密。5例对照中未发现星状瘢痕。
长期患有HpCG的儿童可能会出现有纤维瘢痕的小病灶，这可能是其早期后遗症。我们推测，如果慢性胃炎-胃萎缩过程是一个连续过程，这些星状瘢痕可能代表了成年患者中常见的多灶性萎缩性胃炎的最初阶段。
