Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
J Pediatr Gastroenterol Nutr. 2013 Sep;57(3):298-304. doi: 10.1097/MPG.0b013e318298020a.
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.
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.
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).
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.
与幽门螺杆菌感染相关的结节性胃炎（NG）在儿童中较为常见，被认为是良性的，无临床意义。本研究通过内镜和胃黏膜相关淋巴组织（MALT）的组织学分析，阐明了 NG 在 H pylori 感染儿童内镜下的意义。
在 758 例行内镜检查的儿童中，有 80 例被确定为 H pylori 感染。这些患者根据胃结节内镜严重程度分为 3 组。评估 MALT 的组织病理分级和 CD3、CD20、细胞角蛋白和 Ki-67 的免疫组化。
在内镜下，80 例患者中有 38 例胃窦部存在严重 NG，27 例存在轻度 NG，15 例无 NG。3 组间 H pylori 密度和淋巴细胞浸润程度不同（P=0.022 和 P=0.025）。胃淋巴浸润的组织学分级在 47 例（58.8%）中为 1 级，在 21 例（26.3%）中为 2 级，在 7 例（8.8%）中为 3 级，在 4 例（5.1%）中为 4-5 级。NG 程度、H pylori 密度、中性粒细胞活性和胃窦炎评分随 MALT 分级而变化（P=0.003、P=0.042、P=0.028 和 P=0.006）。
本研究表明，NG 可能是儿童 H pylori 感染的一种重要胃表现，提示胃 MALT。在 H pylori 感染的儿童中，当胃窦部出现严重 NG 时，进行彻底的组织学检查可能有助于评估胃 MALT。
