Srovnání epidemiologicko-klinických projevů a chronické gastritidy způsobené infekcí H. pylori v dětském věku ve dvou geograficky odlišných populacích (Česká republika, Francie)

Comparison of Epidemiological and Clinical Symptoms and Chronic Gastritis in HelicobacterPylori Infected Children in Two Geographically Different Populations (Czech Republic, France)

Background:
H. pylori infection can be acquired in early childhood. There are not enough data on the natural outcome and long-term implications of H. pylori infection in childhood. It cannot be ruled out, however, that in different geographical conditions the outcome of H. pylori infection can be quite different. There are few data to knoty if this is so also in children. Authors conducted a study to compare epidemiological data, clinical symptoms, endoscopic and histological changes in H. pylori - infected children in two different geographical populations, Lille, the northern part of France and Plzeň, western part of the Czech Republic.Patients and methods: A total of 45 H. pylori - infected children (30 Czech children and 15 French children), range 10 - 16 years, were enrolled in this study. All had completed the follow-up protocol (a questionnaire, Epi info software) that comprised clinical symptoms, epidemiological data, endoscopic fmdings (OMED) and histological examination. Gastric samples were analyzed for histological changes by two experienced pathologist (E.M.L.) and (J.K.) by a double blind method. The histological changes were classified according to the 5ydney classification.Results: There were no statistical differences between both H. pylori infected groups of children for age, sex, socioeconomic background and symptoms. However, there was a significant difference (p < 0.0001) between patients concerning common clinical symptoms (fever, fatigue). The macroscopic picture of gastritis was not different in children, the frequency of nodular gastritis was not different in French children (60%) compared to Czech patients (53.3% ). No differences between patients were seen as regards levels of the density of gastric mucosal colonization with H. pylori, polynuclear cell infiltration, glandular atrophy and intestinal metaplasia. There were progressive intlammatory changes in the cohort of Czech children compared to French children in antral mucosal histology. The frequency of lymphoid folicules was significantly higher (p < 0.02), mononuclear cell infiltration was more intense in Czech patients than in French patients (p < 0.001). There was also a statistical difference in the severity of diffuse inflammatory mucosal changes (p < 0.05).Conclusion: Authors demonstrated that H. pylori infected Czech children seem to have a more severe inflammation of the gastric antrum than H. pylori infected French children as shown by an increase in the density of antral mononuclear cells. These findings confirm that the gastritis score can be significantly different in two comparable geographically different paediatric populations and these differences can play a very important role in the long-term outcome of H. pylori infection in humans.

Key words:
Helicobacter pylori, children, gastritis, geographical differences