Increased gastric juice leukotriene B4, C4 and E4 concentrations in children with Helicobacter pylori colonization

During recent years, the role of inflammatory lipid mediators in the pathophysiology of Helicobacter pylori (H. pylori) infections has been investigated in several studies. The concentrations of leukotrienes (LTs) in gastric juice from H. pylori positive (n = 13) and negative (n = 18) children with recurrent abdominal pain were studies in order to determine whether these lipid inflammatory mediators are involved in local and systemic biological actions. Gastric juice samples and biopsy specimens of mucosa were obtained endoscopically from 31 patients with recurrent abdominal pain for assessment of LTs and histopathological examination. In this study, all children with recurrent abdominal pain were investigated by rapid urease test and histological assessment for H. pylori colonization. Leukotriene levels were measured by high performance liquid chromatography (HPLC) and radioimmunoassay (RIA) in gastric juice samples. Gastric juice LTB4, LTC4, and LT4 levels were significantly higher in patients with H. pylori colonization than in children without H. pylori colonization. These results indicate that increased gastric content of proinflammatory mediators (LTB4, LTC4, and LT4) may be related to the pathogenesis of H. pylori-associated gastritis.     

Correlation between Helicobacter pylori infection and vitamin C levels in whole blood,plasma, and gastric juice,and the pH of gastric juice in Korean children

BACKGROUND: It is well known that chronic gastritis induced by Helicobacter pylori may be associated with hypochlorhydria and may also be accompanied by low levels of vitamin C in plasma and gastric juice in adults. This study investigates the relationship between H. pylori infection and vitamin C levels in the blood, plasma and gastric juice and the gastric juice pH of Korean children. METHODS: During a 5-year period, multiple gastric antral biopsies were taken from 452 children who underwent gastroduodenoscopy. The biopsy specimen was inoculated into phenol red buffered urea broth and incubated for 48 hours to detect color changes. The histopathologic findings were evaluated using the Sydney System. Concentrations of vitamin C in whole blood, plasma, and gastric juice aspirate were measured using the 2,4-dinitrophenylhydrazine method. RESULTS: Four hundred fifty-two patients (228 boys, 224 girls) aged 1 to 15 years were enrolled in this study. H. pylori was detected in 112 patients (24.8%) using histology, whereas it was found in 204 patients (45.1%) using the urease test. One hundred seven patients (23.7%) had active gastritis, and 421 patients (93.1%) had chronic gastritis. Vitamin C levels in whole blood, plasma, and gastric juice exhibited significant negative correlation with the age of patients, the histologic density of H. pylori, the degree of active and chronic gastritis, and the severity of H. pylori infection (based on urease positivity and histologic density of H. pylori). Gastric juice pH was correlated with the degree of chronic gastritis and was significantly higher in urease-positive patients. CONCLUSIONS: The data demonstrate that vitamin C levels in whole blood, plasma, and gastric juice and the gastric juice pH in Korean children are closely related to the severity of H. pylori infection and the histologic changes in the stomach. These data suggest that vitamin C may play a role in determining infection and progression, and vitamin C supplementation may be an important axis for the management of H. pylori infection in children.     

Testing for serum IgG antibodies to Helicobacter pylori cytotoxin-associated protein detects children with higher grades of gastric inflammation.

BACKGROUND: Little information is available about the relationships between Helicobacter pylori cytotoxin-associated protein (CagA) and clinicopathologic features in children. The purpose of this study was to test whether determining serum IgG antibodies to CagA is a useful tool for detecting more severe disease. METHODS: One hundred twenty-seven consecutive children (age range, 0.75-17.8 years; median, 9.4 years) referred for gastroscopy were included in the study. Antral and corpus biopsies were taken for gastric histology and H. pylori detection. Major symptoms and endoscopic findings were recorded. A serum sample was drawn from each child and assayed for IgG antibodies CagA by a commercial enzyme-linked immunosorbent assay. RESULTS: Sixty-three (50%) children had no evidence of H. pylori infection, 28 (22%) were H. pylori positive/CagA positive, and 36 (28%) were H. pylori positive/CagA negative. There were no differences in clinical diagnosis and occurrence of any predominant symptom according to H. pylori and CagA status. Findings of antral nodularity were more frequent (p = 0.003) in H. pylori-positive/CagA-positive children than in H. pylori-positive/CagA-negative children. The gastritis score was significantly higher in H. pylori-positive/CagA-positive children than in H. pylori-positive/CagA-negative children (5.7 +/- 1.9 vs. 3.8 +/- 1.6, respectively; p = 0.0003), either in the antral (p = 0.0002) or in the corpus (p = 0.001) mucosa. Inflammation (p = 0.0001) and activity (p = 0.0001) scores were both higher in H. pylori-positive/CagA-positive children than in H. pylori-positive/CagA-negative children, but the H. pylori density score was not significantly different (p = NS). In no case was normal gastric mucosa found in H. pylori-positive/ CagA-positive children. Lymphocytic gastritis (p = 0.0008) and lymphoid follicles (p = 0.000003) were a more frequent finding in H. pylori-positive children than in H. pylori negative children, irrespective of CagA status. CONCLUSION: Testing for serum IgG to CagA detects higher grades of gastric inflammation among children with H. pylori infection. It may be useful in targeting H. pylori-positive/ CagA-positive children for antimicrobial therapy while reducing the need for endoscopy and gastric biopsy.     

Helicobacter pylori - dependent intragastric urea biodegradation in children: Diagnostic and pathogenetic importance

Abstract The objective of the present work was to study the relationship between intragastric urea hydrolysis generated by Helicobacter pylori urease and acid-peptic disease in childhood. Intragastric urease activity was examined by urea and ammonia concentration measurement in gastric juice in 91 children with upper abdominal complaints. Helicobacter pylori infection was detected from 70 (76.9%) of 91 patients, including all of the 15 subjects with peptic ulcer disease. Helicobacter pylori -related gastritis in children was associated with a decrease of urea and an increase of ammonia in gastric juice ( P < 0.001) in comparison with H. pylori-negative children. The gastritis score was correlated with the concentrations of urea and ammonia in the gastric juice of patients infected with H. pylori. There was a significant correlation between the histologically detected dissemination of organisms and gastric ammonia levels. Similar results were obtained concerning correlation between gastric juice ammonia and anti- H. pylori specific immunoglobulin G versus highly purified antigen of H. pylori containing urease. Present findings prove that H. pylori plays an essential role in the pathogenesis of gastritis and that ammonia is one of the main pathogenic factors of acid-peptic disease.     

Helicobacter pylori antigens in stool specimens of gastritis children before and after treatment

BACKGROUND: Various testing methods are successfully applied to the diagnosis of Helicobacter pylori infection, but noninvasive techniques are still needed for therapeutic monitoring, especially in children. In the search for new noninvasive techniques for the diagnosis of H. pylori infection, the authors evaluated an enzyme immunoassay for the detection of H. pylori antigen in stool (HpSA). METHODS: The authors studied 62 H. pylori-positive children with chronic gastritis and 45 control subjects. H. pylori infection was diagnosed using cultures and histology of gastric biopsy specimens and a stool antigen test before treatment (clarithromycin, amoxicillin, omeprazole for 7 days) and 4 weeks to 6 weeks after treatment. RESULTS: Before therapy, antigen in stool was detected in 55 of 62 H. pylori-positive patients, which indicates that the sensitivity of the HpSA test was 88.7%. Of the 45 control subjects (with negative culture and histology results), 43 had negative results for H. pylori in the stool test (specificity, 95.5%). After completion of therapy, eradication was obtained (and confirmed by culture and histology) in 53 of the 62 H. pylori-positive children (85.5%). Four weeks to 6 weeks after eradication therapy, the sensitivity, specificity, positive predictive value, and negative predictive value of the stool antigen (HpSA) test were 88.9%, 96.2%, 80%, and 98%, respectively. CONCLUSIONS: The accuracy of the HpSA test for the detection of H. pylori in human stool 4 weeks to 6 weeks after treatment is comparable with the accuracy of the culture results. The stool antigen (HpSA) test was found to be a useful method for posttreatment eradication testing of infection in children.     

Gastric histopathology, iron status and iron deficiency anemia in children with Helicobacter pylori infection

OBJECTIVES: Helicobacter pylori has been established as a major cause of gastritis and peptic ulcer disease in adults and children. H. pylori infection may also have a role in the development of some extra-gastrointestinal diseases, including iron deficiency anemia. The aim of this study is to investigate H. pylori-related changes in gastric physiology and histology and the relationship of these changes to iron deficiency anemia in children. METHODS: Fifty-two patients with gastrointestinal complaints were studied. Hematologic parameters, 3-day vitamin C and iron consumption, serum gastrin levels, and gastric juice ascorbic acid levels were compared in patients with and without H. pylori infection. Dietary intake of vitamin C and iron, serum gastrin, gastric juice ascorbic acid content, and gastric histology were compared in patients with H. pylori infection and anemia and in patients with H pylori infection and no anemia. The CagA status of the H. pylori organisms was evaluated. RESULTS: Twenty-eight of 52 patients had H. pylori. Thirty-one patients had iron deficiency anemia. H. pylori infection was associated with low serum iron levels. H. pylori gastritis was associated with a decrease in the gastric juice ascorbic acid level. Infection with CagA-positive strains was associated with a greater decrease in gastric juice ascorbic acid than infection with CagA-negative strains. However, the gastric juice ascorbic acid levels of patients with H. pylori and anemia were not different from those of non-anemic patients with H. pylori. Among patients with H. pylori infection, pangastritis was twice as common in those with anemia than in those without anemia. CONCLUSIONS: H. pylori infection was associated with a decrease in gastric juice ascorbic acid concentration, and this effect was more pronounced in patients with the CagA-positive strain. Pangastritis was more common in patients whose H. pylori.infection was accompanied by anemia.     

Gastric emptying of solids in children with H. pylori-positive and H. pylori-negative non-ulcer dyspepsia

OBJECTIVE: There is currently no data available in children on possible relationships among Helicobacter pylori, gastric motility and gastric inflammation. This is a prospective study of gastric emptying (GE) in symptomatic children with and without H. pylori who met symptom-based criteria for non-ulcer dyspepsia (NUD). METHODS: 47 consecutive dyspeptic patients (23 males; age range, 7 to 18 years) were enrolled. All patients had extensive negative diagnostic investigations. Scintigraphic solid-phase gastric emptying was assessed. RESULTS: 21 H. pylori-positive and 26 H. pylori-negative patients were identified with non-ulcer dyspepsia. The groups were not different in clinical symptoms except that pain related to feeding was more frequent in infected children (P < 0.03). Nodular antral gastritis was found more frequently in the H. pylori positive group (P < 0.0001). The gastritis score was more severe in H. pylori infected than H. pylori negative patients in both fundic and body mucosa (P < 0.001). Within the H. pylori-positive NUD group, the mean half-time GE of a solid meal was significantly accelerated compared to the non-infected group (P < 0.05). There was no difference in the intragastric food distribution and curves of gastric emptying of both groups. A significant relationship was found between the degree of gastric body inflammation gastric emptying, but not antral inflammation. Gastric emptying rate did not differ by sex or age of the subjects in either group. CONCLUSIONS: In dyspeptic children with H. pylori, gastric emptying of a solid was significantly accelerated compared with symptomatic H. pylori uninfected patients. This suggests that H. pylori is able to induce gastric emptying acceleration. Our findings add more information on H. pylori infection and gastroduodenal disease.     

Cytokines in the gastric mucosa of children with Helicobacter pylori infection

AIM: Few studies have looked at the cytokine profile in gastric mucosa in children with Helicobacter pylori infection. This study investigated cytokines and their effects on histological abnormalities in the gastric mucosa of children with H. pylori infection. METHODS: The levels of interferon-gamma (IFN-gamma), interleukin-4 (IL-4) and IL-8 proteins were measured in biopsy specimens from the gastric antrum and corpus of children with H. pylori infection, and related to inflammatory cell infiltrations. RESULTS: The antral and corporal mucosal levels of IFN-gamma and IL-8 proteins were significantly higher in children with H. pylori infection than in uninfected children, but there was no such difference in the levels of IL-4 protein. The antral mucosal level of IL-8 protein was significantly higher than the corporal mucosal level of IL-8 protein in the infected children. Inflammatory cell infiltration was significantly higher in the infected children than in the uninfected children, but there were no significant correlations between mucosal cytokine levels and inflammatory cell infiltrations. CONCLUSION: The results suggest that the predominant Th1 cytokine response and enhanced IL-8 production in the mucosa may be involved in the gastric inflammation seen in children infected with H. pylori, as well as in adult patients.     

幽门螺杆菌感染与儿童胃炎关系探讨

为进一步研究幽门螺杆菌（Helicobacter pylori,H.pylori)感染与儿童胃炎的关系，对我科1998年至2000年间500例3岁－15岁儿童胃镜活检组织进行组织学和H.pylori观察，按Sydney胃炎标准对病变分级，分析和探讨H.pylori感染与儿童胃炎发展变化的关系。结果表明：40.4%的儿童胃炎与H.pylori感染有关；而且炎症的程度、淋巴滤泡的形成、嗜酸细胞增多及幽门腺萎缩明显高于无H.pylori感染的儿童胃炎。提示上海地区儿童胃炎有很高的H.pylori感染率，H.pylori感染与儿童胃炎关系密切，儿童H.pylori胃炎的胃粘膜病理变化比非H.pylori感染者严重。     

Parietal cell antibodies and Helicobacter pylori in children

BACKGROUND: Gastric autoantibodies are common in Helicobacter pylori-infected adults, and the presence of these antibodies is associated with atrophic gastritis. The role of H. pylori in the autoimmune type of atrophic gastritis is unresolved, and it is not known at what stage the autoantibodies appear in serum during H. pylori infection. Therefore, we screened children with and without H. pylori infection for gastric parietal cell antibodies. METHODS: Seventy-one children with H. pylori infection verified by examination of gastric biopsy specimens (mean age, 9.4 years), 8 children with positive serology but negative histology for H. pylori (mean age, 11.6 years), and 130 children with negative serology for H. pylori (mean age, 7.7 years) were screened for the presence of gastric parietal cell antibodies in serum by indirect immunofluorescence. In addition, 61 children with celiac disease (mean age, 7.1 years) were screened for gastric parietal cell antibodies and H. pylori antibodies. RESULTS: None of the children with H. pylori infection had gastric parietal cell antibodies in serum. Only three positive parietal cell antibody reactions were found: a 14-year-old boy with positive serology for H. pylori but no other signs of infection (titer 5000), a 14-year-old girl with tuberculosis (titer 1250, seronegative for H. pylori) and a 10-year-old girl with insulin-dependent diabetes mellitus (titer 6250, seronegative for H. pylori). CONCLUSIONS: Although gastric autoantibodies are often found in adults with chronic H. pylori gastritis, it seems that H. pylori-infected children are not positive for gastric parietal cell antibodies. It remains to be studied in which H. pylori infections and at what stages gastric autoantibodies appear.     

Immunohistochemical detection of Helicobacter pylori infection in gastric biopsies of urea breath test-positive and -negative pediatric patients

Helicobacter pylori (H. pylori) is a common cause of gastritis in both children and adults, and its incidence increases every year. The aims of this study were to evaluate the histopathologic features of H. pylori gastritis and to compare immunohistochemical with histochemical [hematoxylin-eosin (HE) and Giemsa] staining of gastric biopsy specimens for the detection of H. pylori infection from urea breath test (UBT) (-) and UBT (+) children. Seventy-eight gastric biopsies from pediatric patients who were administered UBT were included in this study. Gastric biopsy specimens were evaluated histopathologically and graded according to the Sydney system. HE, Giemsa and immunohistochemical staining was performed for the identification of H. pylori. The frequency of H. pylori gastritis was higher in the antrum than corpus. All biopsies with H. pylori colonization showed chronic inflammation with activity. By using immunohistochemical method, coccoid forms of H. pylori and spiral bacteria with low density were observed easily. With histochemical staining, 1/10 (10%) UBT (-) biopsies were H. pylori (+), while with immunohistochemical staining, 3 of the biopsies from UBT (-) patients were found to be H. pylori (+). Biopsies from 65 of 78 (83.3%) UBT (+) patients were H. pylori (+) with histochemical staining, but only 53 of these biopsies were found to be H. pylori (+) immunohistochemically. We conclude that immunohistochemical staining is more specific than histochemical staining and UBT for the detection of H. pylori infection.     

Inhaled corticosteroid therapy reduces cytokine levels in sputum from very preterm infants with chronic lung disease

Aim: To evaluate the effects of inhaled corticosteroid therapy and high-frequency oscillatory ventilation (oscillation) on preterm infants with chronic lung disease (CLD).
Methods: Ten infants with CLD who received inhaled corticosteroid therapy were enrolled. Week 1 was defined as the first week of therapy. The concentrations of interleukin (IL)-8, tumour necrosis factor-α (TNF-α), IL-1β, IL-6, IL-10 and IL-12p70 in serial sputum specimens from the infants were determined using a cytometric bead array.
Results: The sputum concentrations of IL-8 obtained from the infants during week 3–4 were significantly lower than those obtained before therapy and during week 1–2. The sputum concentrations of TNF-α, IL-6 and IL-10 during week 3–4 were significantly lower than the concetrations during week 1–2. The ratio of IL-8 levels during week 1–2 to those before therapy in infants who received oscillation (n = 4) was significantly lower than in those who received intermittent mandatory ventilation (n = 6).
Conclusion: Inhaled corticosteroids may be associated with a decrease in pro-inflammatory cytokine levels in sputum from infants with CLD from 2 weeks after the start of therapy. Our further investigations suggest that therapy with oscillation modulated airway inflammation earlier than therapy with intermittent mandatory ventilation.     

上海地区部分儿童幽门螺杆菌cagA、vacA、iceA基因型别分析

目的：了解上海部分地区儿童感染幽门螺杆菌（Hp）的cagA、vacA、iceA的基因亚型,探讨其与儿童上消化道疾病的关系。方法：收集2007年5月至2008年1月在我院行胃镜检查确诊Hp感染59例患者的胃黏膜组织,分别进行聚合酶链反应（PCR）检测cagA、vacA和iceA基因;病理检查胃窦黏膜炎症程度;酶联免疫吸附试验（ELISA）检测胃窦黏膜IFN-γ 和IL-4的含量。结果：cagA基因单独检出率为65%（37/57）,vacAs1/m1单独检出率为19%（11/57）,vacAs1/m2单独检出率为40%（23/57）,iceA1单独检出率为63%（36/57）,iceA2单独检出率为19%（11/57）,9%（5/57）的菌株iceA1 和iceA2均阳性。不同基因型菌株在慢性胃炎和消化性溃疡中的检出率差异无统计学意义（P>0.05）。不同基因型菌株与胃窦黏膜炎症的严重程度无关（P>0.05）。不同基因型菌株感染的胃窦黏膜IFN-γ、IL-4的含量差异亦无统计学意义（P>0.05）。结论：cagA/vacAs1/m2/iceA1为上海部分地区儿童中Hp的优势基因型。除了菌株因素外,宿主基因多态性、环境因素对于疾病的发生、发展也发挥了重要作用。［中国当代儿科杂志,2010,12（4）：267-271］     

Endoscopic nodular gastritis: an endoscopic indicator of high-grade bacterial colonization and severe gastritis in children with Helicobacter pylori

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.     

儿童幽门螺杆菌感染与HLA-DQB1等位基因遗传多态性研究

目的　研究HLA -DQB1基因位点上是否存在幽门螺杆菌(H .pylori)感染及其相关胃炎的易感基因或抵抗基因,从免疫遗传角度探讨H .pylori感染后临床结局多样性的可能发生机制。方法　对1 999年9月至2 0 0 0年7月上海第二医科大学附属瑞金医院收治的1 3 3例慢性胃炎及80名健康儿童(对照组) ,进行H .pylori检测,应用PCR SSO杂交方法确定其HLA -DQB1等位基因型别。结果　80名对照组儿童中H .pylori阳性3 3名,H .pylori阴性47名;1 3 3例慢性胃炎患儿中,H .pylori阳性85例,H .pylori阴性48例。DQB1 0 3 0 3 2等位基因频率在血清学H .pylori阳性者中低于血清学H .pylori阴性的健康儿童( 1 0 . 61 %vs 2 5. 53 % ,P <0 . 0 5)。DQB1 0 60 2等位基因频率在H .pylori阳性胃炎患儿低于H .pylori阴性胃炎患儿( 4 . 71 %vs 1 2 . 50 % ,P <0 . 0 5)。结论　DQB1 0 3 0 3 2对H .pylori感染可能具有抵抗保护作用,DQB1 0 60 2缺乏可能是H .pylori相关性胃炎发生的宿主遗传因素。     

Characteristics and prevalence of Helicobacter heilmannii infection in children undergoing upper gastrointestinal endoscopy.

BACKGROUND: Helicobacter heilmannii, described in 1983 as a new cause of chronic gastritis, has been reported rarely in children. The purpose of this study was to determine the clinical characteristics and the prevalence of H. heilmannii infection, in comparison with Helicobacter pylori infection in children undergoing upper digestive endoscopy. METHODS: Diagnosis of H. heilmannii was based on its morphologic characteristics in gastric biopsy specimens (two from the antrum, one from the fundus), whereas H. pylori infection was defined by histology and/or culture (one specimen from the antrum, one from the fundus). Respective prevalences of H. heilmannii and H. pylori were calculated in 518 patients studied prospectively who underwent systematic biopsies. RESULTS: The prevalence of H. pylori was 8.9% (46/518) and increased with age (from 2% before 3 years of age to 18% after 10 years). On the contrary, the prevalence of H. heilmannii infection was low, 0.4% (2/518), and no different from that published in adults. After completion of the study period, a third H. heilmannii-infected child was diagnosed. Characteristics of H. heilmannii infection could be studied in these three children 5, 9, and 14 years old. Two of three had abdominal pain and one had dysphagia. Nodular gastritis was observed at endoscopy in two children. H. heilmannii chronic active gastritis (n = 3) was localized in the antrum, associated with an interstitial infiltrate, and could not be distinguished from H. pylori gastritis (n = 46). CONCLUSION: Clinical characteristics, endoscopic features and gastric histopathology did not allow H. heilmannii to be distinguished from H. pylori gastritis in our pediatric population. H. heilmannii infection should be considered and carefully looked for during histologic examination of gastric specimens in cases of H. pylori-negative gastritis.     

��ͯ�����ݸ˾����ݶ��ػ�����о�

目的探讨儿童幽门螺杆菌vacA基因型并分析各基因亚型与胃十二指肠疾病的关系。方法对80例H·pylori感染的儿童,采用PCR法扩增胃黏膜vacA基因亚型。结果南宁儿童H·pylorivacA基因型有s1a/m1和s1a/m2两种组合,基因频率分别为3·75%、66·25%。vacA基因各亚型在慢性浅表性胃炎及消化性溃疡中的检出率差异无显著性(P>0·05)。结论s1a/m2为南宁地区儿童幽门螺杆菌的vacA优势基因型。部分患儿同时感染多株不同vacA基因型H·pylori。vacA基因各亚型不能作为南宁地区儿童H·pylori菌株毒力强弱的指标。     

Can pre-neoplastic lesions be detected in gastric biopsies of children with Helicobacter pylori infection?

BACKGROUND: Active gastritis, gastric mucosal atrophy and intestinal metaplasia are lesions associated with Helicobacter pylori infection. Atrophy and intestinal metaplasia are only seen in adults. OBJECTIVES: We describe pediatric patients with atrophy and metaplasia, and compare the inflammatory response in these patients to controls. METHODS: As part of a multicenter study of pediatric H. pylori infection, gastric biopsy specimens obtained during diagnostic upper endoscopy of 19 H. pylori-infected children and 45 uninfected controls were reviewed and graded by using the updated Sydney system. The inflammatory response was characterized using immunohistochemistry for T lymphocytes, B lymphocytes, and macrophages, and TUNEL assay for apoptosis. RESULTS: Histology of H. pylori-infected and control biopsy specimens showed active gastritis in 32% and 2% respectively (P = 0.002). Mild intestinal metaplasia was found in 4 H. pylori-infected children, in two of whom it appeared to be accompanied by atrophy. Specimens from patients with H. pylori infection contained increased numbers of B lymphocytes in lymphoid nodules, and apoptosis in the superficial epithelium and inflammatory cells. T lymphocytes and macrophages appeared in similar numbers in specimens from controls and infected patients. CONCLUSIONS: We describe intestinal metaplasia associated with H. pylori infection in children. Since atrophy usually precedes intestinal metaplasia in adults, we suggest that atrophy exists in children. High numbers of B lymphocytes and apoptosis in the surface epithelium are seen in patients with H. pylori infection and may be related to the development of atrophy and intestinal metaplasia.