Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2022; 28(28): 3682-3694
Published online Jul 28, 2022. doi: 10.3748/wjg.v28.i28.3682
Gastric mucosal precancerous lesions in Helicobacter pylori-infected pediatric patients in central China: A single-center, retrospective investigation
Miao Yu, Jing Ma, Xiao-Xia Song, Qiao-Qiao Shao, Xue-Chun Yu, Muhammad Noman Khan, Ya-Bin Qi, Ruo-Bing Hu, Pei-Ru Wei, Wei Xiao, Bai-Ling Jia, Yan-Bo Cheng, Ling-Fei Kong, Chuan-Liang Chen, Song-Ze Ding
Miao Yu, Jing Ma, Qiao-Qiao Shao, Xue-Chun Yu, Muhammad Noman Khan, Ya-Bin Qi, Ruo-Bing Hu, Pei-Ru Wei, Wei Xiao, Bai-Ling Jia, Song-Ze Ding, Department of Gastroenterology and Hepatology, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou 450003, Henan Province, China
Xiao-Xia Song, Ling-Fei Kong, Department of Pathology, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou 450003, Henan Province, China
Yan-Bo Cheng, Department of Pediatrics, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou 450003, Henan Province, China
Chuan-Liang Chen, Department of Medical Imaging, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou 450003, Henan Province, China
Author contributions: Yu M, Cheng YB, Jia BL, Kong LF, Chen CL and Ding SZ designed the research; Yu M, Song XX, Ma J, Shao QQ, Yu XC, Khan MN, Qi YB, Hu RB, Wei PR and Xiao W collected the clinical data and performed the experiments; Yu M analyzed the data; Yu M and Ding SZ wrote the paper; Ding SZ revised the article; all authors approved the final version of the manuscript.
Supported by the National Natural Science Foundation of China, No. U1604174; Henan Provincial Government-Health and Family Planning Commission, No. 20170123 and No. SBGJ202002004; and Henan Provincial Government-Health and Family Planning Commission Research Innovative Talents Project, No. 51282.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of People’s Hospital of Zhengzhou University (2019-KY-No. 10).
Informed consent statement: The study was performed retrospectively. Patients were not required to give informed consent for the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare that there are no conflicts of interests related to this work.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Song-Ze Ding, MD, PhD, Professor, Department of Gastroenterology and Hepatology, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, No. 7 Weiwu Road, Jinshui District, Zhengzhou 450003, Henan Province, China. dingsongze@hotmail.com
Received: January 9, 2022
Peer-review started: January 9, 2022
First decision: March 8, 2022
Revised: April 2, 2022
Accepted: June 21, 2022
Article in press: June 21, 2022
Published online: July 28, 2022
Processing time: 198 Days and 10.7 Hours
Abstract
BACKGROUND

Helicobacter pylori (H. pylori) infects about 50% of the world population and is the major cause of chronic gastritis, peptic ulcers, and gastric cancer. Chronic H. pylori infection induces gastric mucosal precancerous lesions mostly in adulthood, and it is debatable whether these pathological conditions can occur in childhood and adolescents as well. Since this is a critical issue to determine if intervention should be offered for this population group, we investigated the gastric mucosal precancerous lesions in pediatric patients in an area in central China with a high prevalence of H. pylori and gastric cancer.

AIM

To investigate the relationship of H. pylori infection and gastric mucosal precancerous lesions in children and adolescents in central China.

METHODS

We screened 4258 ward-admitted children and adolescent patients with upper gastrointestinal symptoms, and finally enrolled 1015 pediatric patients with H. pylori infection and endoscopic and histological data. H. pylori infection status was determined by rapid urease test and histopathological examination. Both clinical and pathological data were collected and analyzed retrospectively. Occurrence of gastric mucosal precancerous lesions, inflammatory activity and degree of inflammatory cell infiltration between H. pylori-positive and -negative groups were compared.

RESULTS

Among the 1015 eligible children and adolescents, the overall H. pylori infection rate was 84.14% (854/1015). The infection rate increased with age. The incidence of gastric mucosal precancerous lesions in H. pylori-infected children was 4.33% (37/854), which included atrophic gastritis (17 cases), intestinal metaplasia (11 cases) and dysplasia (9 cases). In H. pylori-negative patients, only 1 atrophic gastritis case [0.62%, (1/161)] was found (P < 0.05). Active inflammation in H. pylori-infected patients was significantly higher than that in non-infected patients, and the H. pylori-infected group showed more severe lymphocyte and neutrophil granulocyte infiltration (P < 0.001). In addition, endoscopy revealed that the most common findings in H. pylori-positive patients were antral nodularity, but in H. pylori-negative patients only superficial gastritis was observed.

CONCLUSION

In children and adolescents, gastric mucosal precancerous lesions occurred in 4.33% of H. pylori-infected patients in central China. These cases included atrophic gastritis, intestinal metaplasia, and dysplasia. The data revealed an obvious critical issue requiring future investigation and intervention for this population group.

Keywords: Helicobacter pylori, Gastric cancer, Precancerous lesions, Inflammation, Children and adolescents

Core Tip: Helicobacter pylori (H. pylori) infection induces gastric mucosal precancerous lesions mostly in adulthood. Whether these lesions can also occur in children and adolescents remains controversial. Our study showed that in a region in central China with a high prevalence of H. pylori and gastric cancer, the incidence of gastric mucosal precancerous lesions was 4.33% among H. pylori-infected children and adolescents, which is significantly higher than the non-infected pediatric patients. The precancerous lesions included atrophic gastritis, intestinal metaplasia, and dysplasia. These data provide an alarming alert and call for further investigation and intervention for this population group.