Dyspeptic syndrome and infection by Helicobacter pylori exhibit histopathologic correlation when observed in adolescents
Keywords:adolescents, dyspeptic symptoms, Helicobacer pylori, histopathologic findings.
Objective: Chronic gastritis is a histological entity and is primarily associated with Helicobacter pylori infection. The main reason for controversy is the lack of correlation between dyspeptic symptoms and histopathologic changes. The purpose of this study was to compare histological findings with dyspeptic symptoms in adolescents. Methods: Adolescents aged 10 to 19 years old with dyspeptic symptoms were referred to upper endoscopy. A protocol was systematically submitted to all patients prior to endoscopy. Histopathologic examination was performed on biopsy specimens. H. pylori infection was detected by rapid urease test and histology. Results: A total of 162 consecutive outpatients with dyspeptic complaints and indication for endoscopy were entered in the database of this study. The mean age of the sample was 16 years old; There were 120 females (74%) and 42 males (26%). Helicobacter pylori were present in 123 patients (75.9%) with a Pearsonâ€™s coefficient of 0.7 (infection versus symptoms). The frequency of gastritis in the antrum and incisura angularis was significantly higher in subjects who had epigastric pain (p=0,004). Superficial gastritis was 2 times more frequent among subjects who had epigastric pain than those who do not presented (p=0,012).Â Severe gastritis was significantly more frequent among those who had epigastric pain (p=0,016). There was no correlation between gastritis and other dyspeptic symptoms. Conclusion: This study shows that there is a correlation between epigastric pain and superficial gastritis of greater intensity and infection by H. pylori. There is no correlation between epigastric pain and intestinal metaplasia in adolescents. Gastritis of the antrum and incisura angularis showed a correlation to regurgitation. Gastritis was not associated to other dyspeptic symptoms.Â
Lauwers GY. Gastritis: Beyond Helicobacter pylori. Int J Surg Pathol, 2010; Supplement to 18(3) 28Sâ€“32S.
Sepulveda AR, Patil M. Practical Approach to the Pathologic Diagnosis of Gastritis. Arch Pathol Lab Med, 2008; 132: sp.
Yakoob MY, Hussainy AS. Chronic Gastritis and Helicobacter pylori: A Histopathological Study of Gastric Mucosae Biopsies. Journal of the College of Physicians and Surgeons Pakistan, 2010; 20 (11): 773-775.
Elseweidy MM, Taha MM, Younis NN, Ibrahim KS, Hamouda HA, Eldosouky MA, Soliman H. Gastritis Induced by Helicobacter pylori Infection in Experimental Rats. Dig Dis Sci, 2010; 55:2770â€“2777.
DÃ®rnu R, Secureanu FA, Neamtu C,Totolici BD, Pop OT, Mitrut P, MÄƒlÄƒescu DG, MogoantÄƒ L. Chronic gastritis with intestinal metaplasia: clinic-statistical, histological and immunohistochemical study. Rom J Morphol Embryol, 2012; 53(2):293â€“297.
RedÃ©en S, Petersson F, Kechagias S, Mardh E, Borch K. Natural history of chronic gastritis in a population-based cohort. Scand J Gastroenterol, 2010; 45: 540â€“549.
Tan VPY, Wong BCY. Helicobacter pylori and gastritis: Untangling a complex relationship 27 years on. J Gastroen Hepatol, 2011; 26 (Suppl. 1): 42â€“45.
Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. Am. J. Surg. Pathol, 1996; 20(10): 1161-1181.
IARC â€“ Working group. IARC working group on the evaluation of carcinogenic risks to humans: some industrial chemicals Lyon, 15â€“22 February 1994. IARC. Monogr Eval Carcinog Risks Hum. 1994;60:1-560.
EkstrÃ¶m AM, Held M, Hansson LE, Engstand L, NyrÃ©n O. Helicobacter pylori in gastric cancer established by CagA immunoblot as a marker of past infection. Gastroenterology. 2001; 12:784-91.
Bornschein J, Selgrad M, Warnecke M, Kuester D, Wex T, Malertheiner P. H. pylori infection is a key risk factor for proximal gastric cancer. Dig Dis Sci.2010; 55: 3124-31.
Correa, P. A Human Model of Gastric Carcinogenesis.Cancer Res, 1988;48:3554-3560.
Genta RM, Wentzell LM, Hamner J. Linphoid follicles in Helicobacter pylori infection: frequency, distribution and response to triple therapy. Hum. Pathol, 1993; 24:577-583.
Langner M, Machado RS, Patricio FRS, Kawakami E. Evaluation of gastric histology in children and adolescents with Helicobacter pylori gastritis using the update Sydney System. Arq Gastroenterol, 2009; 46(4):328-33.
Turkay C, Erbayrak M, Bavbek N, Yendunya S, Eraslane, Kasapolu B. Helicobacter pylori and histopathological findings in patients with dyspepsia. Turk J Gastroenterol, 2011; 22 (2): 122-127.
Tanko MN, Manasseh AN, Echejoh GO, Mandong BM, Malu AO, Okeke EM; Ladep N, Agaba EI. Relation between Helicobacter pylori, inflammatory (neutrophil) activity, chronic gastritis, gastric atrophy and intestinal metaplasia. Nigerian Journal of Clinical Practice, 2008; ll (3):270-274.
Tinelli C, Zagari M, Bazzoli F. Upper gastrointestinal histopathological findings in children and adolescents with nonulcer dyspepsia with Helicobacter pylori infection. J Pediatr Gastroenterol Nutr, 2012; 55 (5): 523-9.
De Giacomo C, Valdambrini V, Lizzoli F, Gissi A, Palestra M. A Population-Based Survey on Gastrointestinal Tract Symptoms and Helicobacter pylori Infection in Children and Adolescents. Helicobacter, 2002; 7(6):356-63.
Perri F, Festa V, Grossi E, Garbagna N, Leandro G, Andriulli A. Dyspepsia and Helicobacter pylori infection: a prospective multicentre observational study. Dig Liver Dis, 2003; 35(3):157-164.
Lopez Gaston A, Andrusch A, Catuogno P. Functional Dyspepsia and infection by Helicobacter pylori: a causal relation does not exist. Acta Gastroenterol Latinoam, 2003; 33:13-21.
Sarnelli G, Cuomo R, Janssens J, Tack J. Symptom patterns and pathophysiological mechanisms in dyspeptic patients with and without Helicobacter pylori. Dig Dis Sci, 2003 ; 48(12):2229-2236.
Bode G, Brenner H, Adler G, Rothenbacher D. Helicobacter pylori infection, intake of analgesics or anti-inflammatory medication, and personal factors in relation to dyspeptic symptoms in patients of a general practitioner. Br J Gen Pract, 2000; 50(457): 615-6199.
Reshetnikov OV, Kurilovich SA, Tereshonok IN, Denisova DV, Zav'ialova LG, Krivenchuk NA, Zimina Iiu, Granberg C, HÃ¤ivÃ¤ VM. Dyspepsia and gastroesophageal reflux in adolescents. Ter Ark, 2002; 74 (2):9-13.
Marzio L, Cappello G, Ballone E. Evaluation of dyspeptic symptoms in patients with and without Helicobacter pylori infection and normal upper gastrointestinal endoscopy. Dig Liver Dis, 2003; 35(3):138-142.
Kalach N, Mention K, Guimber D, Michaud L, Spyckerelle C, Gottrand F. Helicobacter pylori infection is not associated with specific symptoms in nonulcer-dyspeptic children. Pediatrics, 2005. 115 : 17-21.
Shmuely H, Obure S, Passaro DJ, Abuksis G, Yahav J, Fraser G, Pitlik S, Niv Y. Dyspepsia symptoms and Helicobacter pylori infection, Nakuru, Kenya. Emerg Infect Dis 2003; 9(9):1103-1107.
Zhao B, Zhao J, Cheng WF, Shi WJ, Liu W, Pan XL, Zhang GX. Efficacy of Helicobacter pylori Eradication Therapy on Functional Dyspepsia: A Meta-Analysis of Randomized Controlled Studies With 12-Month Follow-up. J. Clin. Gastroenterol, 2014;48(3):241-7.
Moayyedi P, Soo S, Deeks J, Forman D, Mason J, Innes M. Systematic review and economic evaluation of Helicobacter pylori eradication treatment for nonÂ¬ulcer dyspepsia. BMJ, 2000;321:659â€“64.
Moayyedi P, Deeks J, Talley NJ, Delaney B, Forman D. An Update of the Cochrane Systematic Review of Helicobacter pylori Eradication Therapy in Nonulcer Dyspepsia: Resolving the Discrepancy between Systematic Reviews. Am J Gastroenterol, 2003; 98:2621-2626.
Delaney B, Ford AC, Forman D, Moayyedi P, Qume M. WITHDRAWN: Initial management strategies for dyspepsia. Cochrane Database Syst Rev, 2009 7(4): CD001961.
Moayyedi P, Soo S, Deeks JJ, Delaney B, Harris A, Innes M, Oakes R, Wilson S, Roalfe A, Bennett C, Forman D. WITHDRAWN: Eradication of Helicobacter pylori for non-ulcer dyspepsia. Cochrane Database Syst Rev, 2011; 16(2): CD002096.
Dupont C, Benhamou PH, Kalach N, Raymond J. Helicobacter pylori infection in children. Rev Prat, 2000,50(13):1437-1441.
Sedlackova M, Malaty H, Volf V, FrÃ¼hauf P, Marx D, Soucek A, Graham DY. Helicobacter pylori infection in a group of symptomatic and asymptomatic children and adolescents in the Czech Republic. Cas Lek Cesk, 2005; 142(2): 102-105.
Rivera P, Carranza A, Hernandez-Chavarria F. Helicobacter pylori in children in Hospital Nacional de Ninos, San Jose de Costa Rica. Acta Gastroenterol Latinoam, 2003;33(3):159-163.
Bala G, Czerwionka-Szaflarska M. Long term analysis of chronic gastritis with Helicobacter pylori infection in children and teenagers with chronic abdominal pain. Med Wieku Rozwoj, 2004; 8:86-96.
Turkkan E, Uslan I, Acartuk G, Topak N, Kahraman A, Dilek FM, Akcan Y, Karaman O, Colbay M, Yuksel S. Does Helicobacter pylori-induced infl ammation of gastric mucosa determine the severity of symptoms in functional dyspepsia? J Gastroenterol, 2009; 44:66â€“70.
Mysorekar VV, Chitralekha, Dandekar P, Prakash BS. Antral histopathological changes in acid peptic disease associated with Helicobacter pylori. Indian J Pathol Microbiol, 1999; v.42, n.4, p.427-434.
Wang J, Xu L, Shi R, Huang X, Li SWH, Huang Z, Zhang G. Gastric Atrophy and Intestinal Metaplasia before and after Helicobacter pylori Eradication: A Meta-Analysis. Digestion, 2011;83:253â€“260.
Malfertheiner P. Gastric Atrophy Reversible or Irreversible after Helicobacter pylori eradication â€“ An Open Question. Digestion, 2011;83:250â€“252.
Fang JY, Liu WZ, Shi Y, Ge ZZ, Xiao SD. Consensus on chronic gastritis in China â€“ Second National Consensus Meeting on Chronic Gastritis (14â€“16 September 2006 Shanghai, China). J Dig Dis, 2007; 8; 107â€“119.
Egan BJ, Holmes K, Oâ€™Connor JH, Oâ€™Morain CA. Helicobacter pylori Gastritis, the Unifying Concept for Gastric Diseases. Helicobacter, 2010; 12 (Suppl. 2): 39â€“44.
Sipponen P. Chronic Gastritis in Former Times and Now. Helicobacter, 2010;12 (Suppl. 2): 16â€“21.
Telaranta-Keerie A, Kara R, Paloheimo L, Harkonen M, Sipponen P. Prevalence of undiagnosed advanced atrophic corpus gastritis in Finland: an observational study among 4,256 volunteers without specific complaints. Scand J Gastroenterol, 2010; 45: 1036â€“1041.
Adamu MAA, Weck MN, Gao L, Brenner H. Incidence of chronic atrophic gastritis: systematic review and meta-analysis of follow-up studies Eur J Epidemiol, (2010) 25:439â€“448.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under aÂ Creative Commons Attribution LicenseÂ that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeÂ The Effect of Open AccessÂ and Benefits of Publishing Open Access).