Abstract:

Objective　To raise awareness of Helicobacter pylori (Hp) gastritis in children by the investigation of clinical characteristics and endoscopic manifestations in these children. Methods　A total of 1 028 children who underwent gastroscopy and were confirmed with chronic gastritis in Shenzhen Children's Hospital from 2020 to 2022 were selected; they were 1-18 years old. According to the results of immunohistochemistry, the children were divided into an Hp-positive group and an Hp-negative group. The clinical data were collected. χ² test and Fisher's exact test were used to analyze the clinical manifestations and endoscopic features. Results　Among the 1 028 children, there were 216 children in the Hp-positive group and 812 children in the Hp-negative group; the overall prevalence of Hp infection in this investigation was 21.01%. The incidences of mucosal micronodules, mucosal swelling, and poor contraction of pyloric canal in the Hp-positive group were higher than those in the Hp-negative group [75.46% (163/216) vs. 6.15% (50/812), 83.79% (181/216) vs. 44.70% (363/812), and 4.62% (10/216) vs. 1.10% (9/812)], with statistical differences between the two groups (all P<0.05). The detection rates of activity +, chronic inflammation reaction ++, and lymphoid follicles in the Hp-positive group were significantly higher than those in the Hp-negative group [12.50% (27/216) vs. 0.74% (6/812), 7.87% (17/216) vs. 0.49% (4/812), and 24.53% (53/216) vs. 6.28% (51/812)], with statistical differences between the two groups (all P<0.05). There were no statistical differences in the incidences of abdominal pain, abdominal distension, nausea/hiccups, vomit, and anorexia between two groups the (all P>0.05). Conclusions　More Hp-positive children are found with micronodular changes, poor contraction of pyloric canal, and mucosal swelling under endoscope, with no specific clinical findings. Hp infection mainly reflect gastric mucosal activity and chronic inflammation. Lymphoid follicle is the histopathological feature. Gastric mucosa atrophy and intestinal metaplasia are rare in children.

Key words:

Children, Helicobacter pylori gastritis, Clinical findings, Endoscopic manifestations

摘要：

目的　通过对比研究分析儿童幽门螺杆菌（Hp）胃炎的临床表现及镜下特点，以提高对该疾病的认识。方法　选取2020至2022年在深圳市儿童医院行胃镜检查并诊断为慢性胃炎的患儿1 028例，年龄范围1～18岁，性别不限。根据免疫组化结果分为Hp阳性、Hp阴性两组，收集临床数据，分析其临床表现、镜下特点。采用χ²检验、Fisher确切概率。结果　1 028例慢性胃炎患儿病例中，Hp阳性组216例，Hp阴性组812例，Hp阳性患儿比例为21.01%。Hp阳性组患儿黏膜微小结节发生率为75.46%（163/216），黏膜水肿发生率为83.79%（181/216），幽门收缩不良发生率为4.62%（10/216），均显著高于Hp阴性组［6.15%（50/812）、44.70%（363/812）、1.10%（9/812）］，两组比较差异均有统计学意义（均P<0.05）；Hp阳性组患儿活动性+检出率为12.50%（27/216），慢性炎性反应++检出率为7.87%（17/216），淋巴小结检出率24.53%（53/216），均显著高于Hp阴性组［0.74%（6/812）、0.49%（4/812）、6.28%（51/812）］，两组比较差异均有统计学意义（均P<0.05）；腹痛、腹胀、恶心/呃逆、呕吐、食欲减退等临床表现两组差异均无统计学意义（均P>0.05）。结论　儿童Hp胃炎内镜下特征表现多为微小结节形成、幽门口收缩不良、水肿，但是无特异性临床表现，Hp感染主要反映胃黏膜的活动性及慢性炎症程度，淋巴小结为病理组织学特征，胃黏膜萎缩及肠化生儿童患者少见或者罕见。

关键词:

儿童, 幽门螺杆菌胃炎, 临床表现, 内镜特征