Distribution of Helicobacter pylori organisms in the stomachs of children with H. pylori infection

Histology has been recognized as the gold standard for the diagnosis of Helicobacter pylori (Hp) infection in children. For ethical reasons, the number of mucosal biopsies obtained during endoscopic procedures is limited in the pediatric population. The aim of this study was to identify the optimal location where Hp organisms are colonized. Children who were scheduled for upper endoscopic procedures were prospectively recruited for the study. At least 2 mucosal biopsy samples were obtained from the following anatomic locations: greater curvature (mid-fundus [B3], mid-body [B1], and mid-antrum [A1] and lesser curvature mid-body [B2], incisura angularis [A3], and mid-antrum [A2]). In addition, a biopsy sample for a rapid urease test was obtained. The biopsy samples were stained with hematoxylin and eosin and Giemsa for the detection of inflammation and Hp colonization. The degree of mucosal inflammation and Hp colonization was assessed. The study group comprised 206 children, of whom 16 (8%) were positive for Hp infection. Hp colonization was significantly greater in the antral locations (A1, A2, and A3) than the body locations (B1, B2, and B3) (P <.001). The degree of mucosal inflammation correlated with the presence of Hp organisms, Hp density, and antral location. The mid-antrum location (A2) was superior for the detection of Hp organisms. The antrum, especially mid-antrum, at the lesser curvature is the best location in which to detect Hp organisms in children who have not recently used antibiotics or proton pump inhibitor medications.