Features of the endoscopic picture of the upper gastrointestinal tract in Helicobacter pylori-infected patients of different ages

The aim. To evaluate the features of the endoscopic picture of the upper gastrointestinal tract (GI tract) in Helicobacter pylori-infected patients of different ages.

Materials and methods. The study involved 126 adult patients aged 18 to 76 years (mean age 44.75±15.05 years) and 19 children aged 9 to 17 years (mean age 14.26±2.68 years) infected with H. pylori. All subjects underwent gastroscopy with an assessment of inflammatory and atrophic changes in the mucous membrane of the upper gastrointestinal tract, cardia insufficiency, sliding hernia of the esophageal orifice of the diaphragm (HE), duodenogastric reflux (DGR), as well as the presence of H. pylori (rapid urease test). Statistical data processing was carried out using the SPSS Statistics 27.0.1 program.

 Results. According to the endocropic data, in adult patients, signs of catarrhal esophagitis were detected in the esophagus: in 32.7% of cases, esophageal erosion was detected in 4.8% of the examined patients, HE occurred in 15.6%, and cardia insufficiency – in 23.3% of patients. When visualizing the gastric mucosa, its atrophy and hyperemia were observed in 8.8% and 77.9% of cases, respectively, erosive changes were detected in 2.8% of patients. Endoscopic signs of atrophy of the mucous membrane of the antrum of the stomach occurred in 34.0%, hyperemia – in 85.5%, and erosive changes – in 10.95% of the examined, DGR was observed in 8% of cases, pyloric deformity was detected in 13.5% of patients. Pathology of the mucous membrane of the duodenal bulb (duodenum) was noted in 89.9% of cases: signs of mucosal atrophy were detected in 2%, hyperemia in 79%, erosion in 21% of the examined, ulcerative defects of the mucosa were detected in 44% of patients: ulcer on the anterior wall – 47.8%, on the posterior wall – 25.4%, along the upper wall – 16.4%, ulcer of unspecified localization – 10.5%, two or more ulcers were detected in 9% of cases. According to the endoscopic data, the following changes in the esophagus were detected in children: 31.5% of patients showed signs of HE, cardia insufficiency and catarrhal esophagitis – in 57.9% and 15.8% of patients, respectively. When visualizing the mucous membrane of the stomach body, it was revealed: in 10.5% of cases – atrophic changes, in 63.2% of cases – signs of hyperemia. Hyperemia of the mucous membrane of the antrum of the stomach occurred in 100% of children. The frequency of detection of DGR was 42.1% of cases. Hyperemia of the mucous membrane of the BPC bulb was present in 84.2% of cases. No other changes were observed. A comparative analysis of the frequency of detection of gastrointestinal pathology in adults and children found that patients infected with H. pylori in childhood and adolescence are more likely to have cardia insufficiency (p<0.0001) and DHR (p<0.001). At the same time, the detection of erosions and ulcers of the mucous membrane of the BPC bulb was higher in patients over 18 years of age (p=0.023 and p<0.001, respectively).

Conclusion. The age-related features of the endoscopic picture in patients infected with H. pylori are characterized by a predisposition of children and adolescents to impaired motility of the digestive tube, and adults to erosive and ulcerative changes, which may be a consequence of higher acid production. The fairly frequent detection of endoscopic signs of atrophy of the gastric mucosa dictates the need for histological examination in this category of patients using the OLGA system to establish the degree and stage of pathological changes, determine management tactics and follow-up of patients.

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