title: Antral nodularity and positive CagA serology are distinct and relevant markers of severe gastric inflammation in children with Helicobacter pylori infection.
abstract: BACKGROUND
  The aim of this study was to assess whether the endoscopic finding of antral nodularity and serum IgG antibodies to CagA are associated with higher grades of gastric inflammation.
  
  
  METHODS
  The comprehensive data of two previously published trials were reanalysed. One hundred and fifty-three children (median age 9.5 years) who underwent gastroscopy were included. Biopsy specimens from the antrum and corpus were taken to assess Helicobacter pylori status, gastritis score and lymphoid follicles. During endoscopy, antral nodularity was noted. Serum samples were assayed for IgG antibodies to CagA.
  
  
  RESULTS
  The presence of antral nodularity (nod+) and positive CagA serology (CagA+) were each found in 32 of the 77 (41.5%) children who had evidence of H. pylori infection. Cross tabulation showed that 20 children (26%) were nod+/CagA+, 12 (15.5%) nod+/CagA-, 12 (15.5%) nod-/CagA+ and 33 (43%) nod-/CagA-. Gastritis score was significantly lower in nod-/CagA- children than in nod+/CagA- (p =.004), nod-/CagA+ (p =.002) and nod+/CagA+ (p <.001), both in the antrum and corpus. Completely normal gastric histology was only found in the nod-/CagA- subgroup of H. pylori-infected children (eight of 33, 24%). Regression analysis showed that antral nodularity and positive CagA serology were related to severe gastric inflammation independently of each other and age. Separate analysis showed that inflammation (p <.001), activity (p <.001) and H. pylori density (p =.002) scores were significantly lower in nod-/CagA- children compared with nod+/CagA+ children. The number of lymphoid follicles in the gastric mucosa was related to antral nodularity (p =.003) and positive CagA serology (p =.043), independently of each other.
  
  
  CONCLUSIONS
  Antral nodularity and positive CagA serology are distinct and relevant markers of severe gastric inflammation in children with H. pylori infection. The lack of both findings in the same child reflects low-grade or no gastritis.
authors.affiliation: Dipartimento di Medicina Sperimentale e Clinica, Cattedra di Gastroenterologia, Università di Catanzaro 'Magna Graecia', Catanzaro, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Luzza
authors.forename: Licia
authors.initials: L
authors.lastname: Pensabene
authors.forename: Maria
authors.initials: M
authors.lastname: Imeneo
authors.forename: Maria
authors.initials: M
authors.lastname: Mancuso
authors.forename: Laura
authors.initials: L
authors.lastname: Giancotti
authors.forename: Anna M
authors.initials: AM
authors.lastname: La Vecchia
authors.forename: Maria C
authors.initials: MC
authors.lastname: Costa
authors.forename: Pietro
authors.initials: P
authors.lastname: Strisciuglio
authors.forename: Francesco
authors.initials: F
authors.lastname: Pallone
mesh_terms: D000293:Adolescent; D000907:Antibodies, Bacterial / Q000097:blood*; D000942:Antigens, Bacterial; D001426:Bacterial Proteins / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005756:Gastritis / Q000382:microbiology / Q000473:pathology*; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000382:microbiology / Q000473:pathology; D016480:Helicobacter pylori / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D011706:Pyloric Antrum / Q000382:microbiology / Q000473:pathology*
chemical_list: D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D001426:Bacterial Proteins; C080866:cagA protein, Helicobacter pylori