title: Peptic ulcer disease in Helicobacter pylori-infected children: clinical findings and mucosal immune response.
abstract: OBJECTIVE
  Peptic ulcer disease (PUD) is highly prevalent among adults but less common in children. Helicobacter pylori infection, the main cause of PUD, is, however, acquired extremely early in life. The aim of the study was to analyze clinical characteristics of children with PUD in a country with a high prevalence of the disease and to evaluate which host factors could determine this clinical outcome.
  
  
  METHODS
  Children referred for upper gastrointestinal (GI) endoscopy with suspicion of peptic diseases were included prospectively during an 8-year period. Antral biopsies were performed to determine H pylori presence and mucosal cytokines profile.
  
  
  RESULTS
  A total of 307 children between 3 and 18 years old were enrolled. Of the total, 237 children (46% boys) with complete data were included. H pylori infection was confirmed in 133 (56.1%) participants. Duodenal ulcer (DU) was diagnosed in 32 patients (13.5%); among them 29 were infected with H pylori (90.6%). Infected children had a nodular appearance of the gastric mucosa more often than noninfected children. Noninfected children had fewer lymphoid follicles and less inflammatory infiltrate than infected children. Only mucosal polymorphonuclear cell infiltration was more intense in DU-infected children as compared with non-DU-infected children. DU-infected children had higher levels of mucosal interferon-γ than noninfected and non-DU-infected patients. Non-DU-infected children had also higher levels of mucosal interleukin-10 than noninfected patients (P < 0.05).
  
  
  CONCLUSIONS
  PUD in children, especially DU, is strongly associated with H pylori infection in developing countries. There is no distinctive clinical presentation of children with PUD. T-helper cytokine balance may influence clinical outcomes in children.
authors: *Department of Pediatric Gastroenterology and Nutrition †Department of Pathology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors: Caroll
authors: C
authors: Hernández
authors: Carolina
authors: C
authors: Serrano
authors: Helly
authors: H
authors: Einisman
authors: Andrea
authors: A
authors: Villagrán
authors: Alfredo
authors: A
authors: Peña
authors: Ignacio
authors: I
authors: Duarte
authors: Javiera
authors: J
authors: Torres
authors: Francisca
authors: F
authors: Riera
authors: Paul R
authors: PR
authors: Harris
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000032:analysis; D004381:Duodenal Ulcer / Q000276:immunology / Q000382:microbiology; D005260:Female; D005753:Gastric Mucosa / Q000276:immunology* / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000276:immunology*; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D018928:Immunity, Mucosal; D008297:Male; D009504:Neutrophils / Q000473:pathology; D010437:Peptic Ulcer / Q000276:immunology* / Q000382:microbiology*
chemical_list: D016207:Cytokines