title: Endoscopic nodular gastritis: an endoscopic indicator of high-grade bacterial colonization and severe gastritis in children with Helicobacter pylori.
abstract: OBJECTIVE
  To investigate the significance of endoscopic nodular gastritis associated with Helicobacter pylori infection.
  
  
  METHODS
  This prospective study included 185 children (50.8% boys) aged 1 to 12 years (mean, 6.9 +/- 3.0 years) who underwent upper intestinal endoscopy during evaluation of chronic abdominal pain. The authors assessed the endoscopic appearance of the stomach, noting those patients with endoscopic nodular gastritis. Urease activity of gastric mucosal biopsies was measured. With histologic examination, the presence and density of H. pylori organisms, the presence of follicular gastritis, the nature of inflammation, and the gastritis activity grade and overall gastritis score were assessed.
  
  
  RESULTS
  H. pylori infection was identified in 50 children (27%). Endoscopic nodular gastritis was significantly associated with active chronic gastritis and follicular gastritis. Nodularity in the stomach showed a high specificity (98.5%) and positive predictive value (91.7%) for the diagnosis of H. pylori infection and was observed in 22 of 50 (44%) H. pylori-positive patients and in 2 of 135 (1.5%) H. pylori-negative patients. A significant association was observed between older age and the prevalence of this finding (P< 0.001). There was a significant increase in endoscopic nodular gastritis with increased H. pylori density and a positive correlation (Pearson coefficient = 0.97) with increased gastritis score on histologic examination. Increase in gastritis score was dependent on increased H. pylori density in patients with gastric nodularity; this finding was independent of age.
  
  
  CONCLUSIONS
  Endoscopic findings of antral nodularity in children suggest the presence of H. pylori infection and follicular gastritis and may identify cases of severe gastritis and marked bacterial colonization.
authors.affiliation: Pediatric Gastroenterology Unit, Hospital da Criança Conceição, Federal Department of Health, Universidade Federal do Rio Grande do Sul, Ildefonso Simões Lopes 201/02, 91330-180 Porto Alegre, RS, Brazil. mgbahu@uol.com.br
authors.forename: Maria da Graça Soares
authors.initials: Mda G
authors.lastname: Bahú
authors.forename: Themis Reverbel
authors.initials: TR
authors.lastname: da Silveira
authors.forename: Ismael
authors.initials: I
authors.lastname: Maguilnick
authors.forename: Jane
authors.initials: J
authors.lastname: Ulbrich-Kulczynski
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000367:Age Factors; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005756:Gastritis / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D005773:Gastroscopy / Q000379:methods*; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D016480:Helicobacter pylori / Q000472:pathogenicity; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013270:Stomach / Q000382:microbiology / Q000473:pathology*