Antral nodularity identifies children infected with Helicobacter pylori with higher grades of gastric inflammation

Background: The endoscopic pattern of antral nodularity is a peculiar findi ng in children with Helicobacter pylori infection. The aim of this study wa s to determine whether this finding is related to more severe gastritis. Methods: One hundred seventy-four consecutive children (median age 8.7 year s) referred for gastroscopy were studied. Biopsy specimens from the antrum and body of the stomach were taken to assess H pylori status, gastritis sco re, and lymphoid follicles, Clinical diagnosis, major symptoms and endoscop ic findings were recorded. Results: Eighty-four (48%) children (median age 10.5 years) had evidence of H pylori infection. The endoscopic pattern of antral nodularity was found only in children infected with H pylori (34/84, 40.5% vs. 0/90, 0%, p < 0.0 001; 100% specificity, 40.5% sensitivity). Among all children infected with H pylori, the gastritis score was higher (p < 0.0001) in those with antral nodularity (n = 34) than in those without (n = 50). Completely normal gast ric mucosal histology was never found in children infected with H pylori wi th antral nodularity. The presence and number of lymphoid follicles was str ongly related to the finding of antral nodularity (p < 0.01). Conclusions: The endoscopic pattern of antral nodularity identifies childre n with H pylori infection, severe gastritis, and increased lymphoid follicl es.