Systematic Review and Meta-analysis of Histological Gastric Biopsy Aspects According to the Updated Sydney System in Children.

Ender Pehlivanoglu, Stephane Verdun, Mathilde Delebarre, Colette Creusy, Pierre Gosset, Pedro Urruzuno, Vaidotas Urbonas, Meltem Ugras, Marta Tavares, Eleftheria Roma, Rogalidou Maria, Francesca Rea, Josette Raymond, Nicolas Kalach, Alexandra Papadopoulou, Francis Megraud, Simona Faraci, Maria Luz Cilleruelo, Sonny Chong, Thomas Casswall, José Cabral, Matjaz Homan, Michal Kori, Patrick Bontems, Zrinjka Misak

Journal: Journal of pediatric gastroenterology and nutrition 2022;74(1):13-19

PMID: 34338237

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Abstract

OBJECTIVES

A descriptive and comparative study of gastric histological aspects according to the updated Sydney classification (USC), obtained from Helicobacter pylori-positive versus H pylori-negative children referred for upper gastrointestinal endoscopy.

METHODS

The Prisma method was used to perform a systematic review and meta-analysis. Selection criteria were based on following key words USC, H pylori, children, endoscopy, or biopsy. Publication biases were assessed according to the Newcastle-Ottawa Scale, and a meta-regression analysis was done. The study was registered on the PROSPERO platform.

RESULTS

Between 1994 and 2017, 1238 references were found; 97 studies were retained for the systematic review with a total number of 25,867 children; 75 studies were selected for the meta-analysis concerning 5990 H pylori-infected and 17,782 uninfected children.H pylori-positive versus H pylori-negative children, according to the USC, showed significantly higher relative risk for gastric antral and corpus chronic inflammation, presence of neutrophils, and of lymphoid follicles, and gastric mucosa atrophy, whereas, intestinal metaplasia showed a significantly higher RR only in antral biopsies. The meta-regression analysis showed that H pylori-positive versus H pylori-negative children had significantly higher risk only for corpus activity according to age, recurrent abdominal pain, and geographical area of low H pylori prevalence.

CONCLUSIONS

H pylori infection in children was associated with higher relative risk for gastric antral and corpus chronic inflammation, presence of neutrophils, lymphoid follicles, and rare gastric mucosa atrophy, whereas, rare intestinal metaplasia was only significantly higher in the antral area.

Address: Pediatric Clinic, Saint Vincent de Paul Hospital, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Catholic University of Lille, Lille, France.; Department of Pediatrics, Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia.; Department of Gastroenterology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Belgium.; Kaplan Medical Center, Pediatric Gastroenterology Unit, Rehovot, Israel.; Department of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, University Children's Hospital Ljubljana, Ljubljana, Slovenia.; Hospital of Dona Estefania, CHLC, Pediatric Gastroenterology Unit, Lisbon, Portugal.; Karolinska University Hospital, Department of Pediatrics, Stockholm, Sweden.; Queen Mary's Hospital for children Epsom & St Helier NHS Trust Carshalton, Surrey, United Kingdom.; Hospital Universitario Puerta de Hierro-Majadahonda, Pediatric Gastroenterology Unit, Madrid, Spain.; Bambino Gesù Children's Hospital, Digestive Endoscopy and Surgery Unit, Rome, Italy.; INSERM U1053, University of Bordeaux, & National Reference Centre for Campylobacter and Helicobacter, Hospital Pellegrin, Bordeaux, France.; Division of Gastroenterology & Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia Children's Hospital, Athens, Greece.; Department of Child Health & Nutrition, Istanbul Kent University, Istanbul, Turkey.; Microbiology Department, Cochin Hospital, Assistances Publiques des Hôpitaux de Paris (AP-HP), University René Descartes Paris V, Paris, France.; Mitera Children's Hospital Athens, Greece.; Unidade de Gastrenterologia Pediátrica do Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal.; Yeditepe University Medical Faculty, Department of Pediatrics, Gastroenterology, Hepatology and Nutrition, Ataşehir, Istanbul, Turkey.; Vilnius University Clinic of Children's Diseases, Vilnius, Lithuania.; Hospital Universitario Doce de Octubre, Servicio de Pediatria, Madrid, Spain.; Pathology Department, Saint Vincent de Paul Hospital, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Catholic University of Lille.; Department of Medical Research, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Lille Catholic Hospital, Lille, France.

DOI: 10.1097/MPG.0000000000003259

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MeSH Terms: Biopsy, Child, Gastric Mucosa, Gastritis, Gastroscopy, Helicobacter Infections, Helicobacter pylori, Humans, Metaplasia