title: Endoscopic and histologic analysis of gastric mucosa-associated lymphoid tissue in children with Helicobacter pylori infection.
abstract: OBJECTIVE
  Nodular gastritis (NG) associated with Helicobacter pylori infection can occur commonly in childhood and is regarded to be benign without clinical significance. This study includes endoscopic and histologic analysis of gastric mucosa-associated lymphoid tissue (MALT) to clarify the significance of NG on endoscopy in H pylori-infected children.
  
  
  METHODS
  Of the 758 children who underwent endoscopy, 80 were identified as having H pylori infection. These patients were divided into 3 groups based on endoscopic severity of gastric nodularity. Histopathologic grading of MALT and immunohistochemistry of CD3, CD20, cytokeratin, and Ki-67 were evaluated.
  
  
  RESULTS
  On endoscopy, severe NG was observed in the antrum of 38 of the 80 subjects, mild NG in 27, and an absence of NG in 15. Density of H pylori and lymphocyte infiltration differed among the 3 groups (P=0.022 and P=0.025, respectively). Histological grading for gastric lymphoid infiltrates was compatible with grade 1 in 47 (58.8%), grade 2 in 21 (26.3%), grade 3 in 7 (8.8%), and grade 4-5 in 4 (5.1%) in the antrum. Degree of NG, density of H pylori, neutrophil activity, and gastritis score in the antrum varied with MALT grades (P=0.003, P=0.042, P=0.028, and P=0.006, respectively).
  
  
  CONCLUSIONS
  Our study suggests NG may present as a significant gastric manifestation of childhood H pylori infection that indicates gastric MALT. Thorough histologic investigation may be useful in the evaluation of gastric MALT in children infected with H pylori that manifests as severe NG in the antrum.
authors: Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, Korea. hryang@snubh.org
authors: Hye Ran
authors: HR
authors: Yang
authors: Hyoung Soo
authors: HS
authors: Choi
authors: Jin Ho
authors: JH
authors: Paik
authors: Hye Seung
authors: HS
authors: Lee
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005753:Gastric Mucosa / Q000276:immunology / Q000378:metabolism / Q000382:microbiology / Q000473:pathology*; D005756:Gastritis / Q000209:etiology / Q000378:metabolism / Q000382:microbiology*; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications / Q000378:metabolism / Q000382:microbiology / Q000473:pathology*; D016480:Helicobacter pylori; D006801:Humans; D018928:Immunity, Mucosal; D008214:Lymphocytes / Q000378:metabolism*; D008221:Lymphoid Tissue / Q000473:pathology*; D018442:Lymphoma, B-Cell, Marginal Zone / Q000209:etiology / Q000378:metabolism / Q000382:microbiology / Q000473:pathology*; D008297:Male; D009504:Neutrophils / Q000378:metabolism; D012720:Severity of Illness Index; D013270:Stomach / Q000382:microbiology / Q000473:pathology