Helicobacter pylori and Meckel's diverticula

Background: Helicobacter pylori is known to infect only gastric mucosa and is strongly associated with gastroduodenal ulceration. The authors studied whether H. pylori colonizes the gastric mucosa of Meckel's diverticula, and determined its relationship to "gastritis" and bleeding. Methods: A 10-year retrospective review identified 45 children with Meckel' s diverticulum. Hematoxylin-eosin and Diff-Quik stains were used to assess the presence and severity of gastritis, and to highlight organisms in the r esected diverticula. Cases with organisms were then studied with antibodies specific for H. pylori using immunoperoxidase methods. Results: Twenty-eight children, 7 months to 12.6 years of age, had lower ga strointestinal hemorrhage caused by Meckel's diverticulum and had positive radionuclide scans. All had acid-secreting mucosa in their diverticula, and ulceration. "Chronic gastritis" and eosinophilia were constant findings; " acute gastritis" was present in four patients. Twenty specimens exhibited l ymphoid follicles in the gastric mucosa. Seventeen patients: with Meckel's diverticula (age range, 1 month-14.7 years) who presented with acute abdomi nal pain associated with intussusception were used for comparison. Acid-sec reting gastric mucosa was seen in four patients. H. pylori was identified i n only one of the 45 patients; this patient had ulceration and moderate "ac ute gastritis." Conclusions: H. pylori does not colonize a substantial number of children w ho have ulcerated and bleeding Meckel's diverticulum in the presence of aci d-secreting mucosa. Although H. pylori is a notable cause of ulceration, th e authors confirm that ulceration is possible in its absence, and alternati ve mechanisms of ulceration are important. The presence of lymphoid follicl es in Meckel's diverticula, unlike gastric biopsies, is not associated with H. pylori.