@article {Gormally513, author = {S M Gormally and B M Kierce and L E Daly and B Bourke and R Carroll and M T Durnin and B Drumm}, title = {Gastric metaplasia and duodenal ulcer disease in children infected by Helicobacter pylori.}, volume = {38}, number = {4}, pages = {513--517}, year = {1996}, doi = {10.1136/gut.38.4.513}, publisher = {BMJ Publishing Group}, abstract = {BACKGROUND--Helicobacter pylori infection of the gastric mucosa is vital in the pathogenesis of duodenal ulcer disease. H pylori will only colonise gastric epithelium and its association with duodenal disease is therefore not easily explained. AIMS--To determine if gastric metaplasia in the duodenum increases the risk of duodenal ulcer disease in children infected with H pylori. PATIENTS--All children undergoing upper endoscopy over a 20 month period in a children{\textquoteright}s hospital in Ireland. METHODS--Two biopsy specimens were obtained from the antral mucosa and two from the first part of the duodenum. One antral biopsy specimen was used in a rapid urease test (Clo Test). Biopsy sections were stained with haematoxylin and eosin and also with cresyl violet for identification of H pylori. Periodic acid Schiff (PAS) stain was performed to identify areas of gastric metaplasia. RESULTS--Gastric and duodenal biopsy specimens were obtained from 148 patients (M:F 1:2:1). Twenty five children (17\%) had H pylori positive gastritis. Thirty four children (23\%) had gastric metaplasia in the duodenum. Nine per cent of children under the age of 8 years had gastric metaplasia compared with 38\% in those 12 years of age or over (p \< 0.005). Seven children had duodenal ulcer disease. Gastric metaplasia was present in six of seven (86\%) children with duodenal ulcer disease compared with 28 of 141 (20\%) without ulceration (p \< 0.001). While both H pylori and gastric metaplasia were each significant risk factors for duodenal ulcer disease, the combined presence of both factors was associated with a pronounced increase in duodenal ulcer disease. Duodenal ulcer disease occurred in over 50\% of children with both H pylori infection and gastric metaplasia. In contrast duodenal disease did not occur in children (0 of 100) when both were absent. CONCLUSION--The presence of gastric metaplasia in the duodenum is the major risk factor for duodenal ulcer disease in patients colonised by H pylori.}, issn = {0017-5749}, URL = {https://gut.bmj.com/content/38/4/513}, eprint = {https://gut.bmj.com/content/38/4/513.full.pdf}, journal = {Gut} }