PANCREATIC METAPLASIA OF THE GASTRIC-MUCOSA IN PEDIATRIC-PATIENTS

Antropyloric and intestinal-type metaplasia of gastric columnar epithe lial cells occurs commonly in the setting of atrophic gastritis in bot h adults and pediatric patients. Pancreatic metaplasia of gastric muco sa, although less common, has been reported in a variety of clinical c onditions in adult patients, but not in the pediatric population. Obje ctives: The aim of this retrospective review was to characterize the c linical and pathological findings in pediatric patients found to have histological and immunohistochemical evidence of pancreatic metaplasia of the gastric mucosa in biopsies taken at the time of upper endoscop y. Methods: Patients with histological evidence of pancreatic metaplas ia of the gastric mucosa were prospectively identified. Their individu al medical records were then reviewed for presenting symptoms, pertine nt laboratory data, gross findings on endoscopy, radiological features , diagnosis, and subsequent therapy. Results: Of the six children (age s, 8-18 yr; mean, 13.0 yr), with pancreatic metaplasia of the gastric mucosa, two children each had gastroesophageal reflux disease and chro nic abdominal pain, whereas one child had a duodenal ulcer and one chi ld had nodular gastritis. Iron deficiency anemia was present in four o f six patients; three of four patients with this finding presented wit h hematemesis. All biopsies were negative for Helicobacter pylori. Con clusions: Whereas pancreatic metaplasia of the gastric mucosa is stron gly associated with chronic atrophic gastritis in adults, its occurren ce in children who do not have atrophic gastritis raises the possibili ty that it may be a developmental phenomenon of gastric mucosal differ entiation. The clinical significance of this finding remains to be det ermined; and its association with iron deficiency in children requires further study.