Some Features of Intestinal Metaplasia in Children

Abstract

Background and aims: Intestinal metaplasia(IM) of stomach mucosa in children is rare problem. Aim of the study is to apply the criteria used in adults for diagnostic and control of IM in pediatric cohort. Patients and methods: From 2011 to 2015 endoscopy with NBI was performed on 1860 children. Endoscopic studies were performed using high-definition (HD) resolution equipment with electronic magnification and/or standard-definition (SD) resolution with optical magnification using Exera II and III by Olympus (Tokyo, Japan) systems. Narrow band imaging (NBI) was used for illumination. Two groups were founded. The main group included 24 children with morphologically verify intestinal metaplasia (IM) and 65 children were included in the control group. Patients in the main group have precision biopsy from IM area. The main and the control group also underwent multiple non-targeted biopsies in accordance with OLGA criteria. H. pylori was defined in two ways - morphologically and С13 breath test. Evaluation of pepsinogens I and II, gastrin-17 levels in blood was performed in group with IM also. Results: The sensitivity and specificity of high-resolution endoscopy with NBI for the detection of intestinal metaplasia (IM) foci were 100% (85.18-100.00) and 98.59% (92.40-99.96), respectively. “Light blue crests” – was leading endoscopic symptom of IM. In 23 of 24 cases, the zone of IM was localised in the pre-pyloric zone, with trend to stomach angle. In the group with IM, H.pylori were detected in 2 cases (8.3%), and in the control group, in 35 cases (53.8%). The relative risk of detection of H. pylori in the presence of IM was 0.0774 (0.0112-0.5341), and the Odds ratio was 0.0373 (0.0047-0.2926). The pepsinogen I and pepsinogen II levels were significantly higher in the control group (P< 0.01). The ratio of the pepsinogen I and pepsinogen II levels was reliably different in these groups. There were no reliable differences in the gastrin 17 levels. Conclusions: Endoscopy with NBI for detecting of intestinal metaplasia is a universal diagnosis tool for this type of pathology. The incidence of intestinal metaplasia in the main group was 1.29%. The visualised foci of intestinal metaplasia in children are mainly associated with the pylorus and have a vector of propagation towards the lesser gastric curvature. The probability of identifying the association of Helicobacter pylori in children with intestinal metaplasia is very low. Keywords: Intestinal Metaplasia; High-Resolution Endoscopy with NBI Illumination; Contamination of Gastric Mucosa With H. Pylori; Diagnostics; Children;