Course and diagnostic significance of nodular gastritis in children with Helicobacter pylori infection.

The purpose of this study was to evaluate the clinical and histological fea tures of nodular gastritis (NG), its relationships with Helicobacter pylori infection, and its course after H. pylori eradication. Patients and method s: 270 children who underwent outpatient upper gastrointestinal endoscopy a t the Saint-Vincent-de-Paul Teaching Hospital in Paris, France, were studie d prospectively; 22 were mentally-disabled children living in institutions. Antral biopsy specimens were obtained during endoscopy. Patients with a po sitive biopsy for H. pylori by culture and/or histology were classified as H. pylori-positive. A clinical evaluation and a repeat endoscopy with biops y collection were done one month after completion of a course of amoxicilli n, metronidazole, and lansoprazole. Results. NG was documented in 55 childr en overall (20%), including 12 institutionalized children (12/22, 55%), and in 43 noninstitutionalized children (43/248, 17%). The main reason for end oscopy was vomiting (55%) versus abdominal pain (49%) in these two subgroup s, respectively. In all 55 cases of NG, histology showed predominantly lymp hocytic gastritis with a follicular architecture. Among the 43 noninstituti onalited patients with NG, 37 were H. pylori-positive and six were H. pylor i-negative (P<0.05). All 12 institutionalized patients with NG were H. pylo ri-positive. Of the H. pylori-positive NG patients, 25 noninstitutionalized and six institutionalized subjects received amoxicillin, metronidazole, an d lansoprazole. At reevaluation, 20 noninstitutionalized patients were H. p ylori-negative; four of these 20 and three of the five H. pylori-positive p atients had persistent NG. Among the six institutionalized patients who wer e given therapy, three converted to H. pylori-negative, and one of these th ree had persistent NG. Conclusion. H. pylori infection is common in childre n with NG. However, this association seems to be nonspecific, since some ca ses of NG resolve prior to H. pylori eradication, whereas others persist de spite H. pylori eradication.