The following is a summary of “Gastric Intestinal Metaplasia in Children: Natural History and Clinicopathological Correlation,” published in the September 2023 issue of Pediatrics by Mansuri, et al.
Gastric intestinal metaplasia (GIM) is where intestinal-type epithelium replaces normal gastric epithelium. GIM is considered a preneoplastic lesion for gastric adenocarcinoma in adults and is often associated with Helicobacter pylori (H. pylori) infection. However, the significance of GIM in pediatric gastric biopsies has yet to be well understood.
The retrospective study analyzed pediatric patients with GIM identified in gastric biopsies at Boston Children’s Hospital between January 2013 and July 2019. Demographic, clinical, endoscopic, and histologic data were collected and compared to a control cohort of age and sex-matched individuals without GIM. A specialized pathologist carefully examined the gastric biopsies. GIM was classified as complete or incomplete based on the presence or absence of Paneth cells and limited or extensive based on its distribution in the antrum (lower part of the stomach) or both the antrum and corpus (the main part of the stomach).
Among the 38 patients with GIM, 18 were male (47%), and the mean age at detection was 12.5 years, ranging from 1 to 18 years. Chronic gastritis was the most common associated histological finding (47%). Complete GIM was observed in 50% (19/38) of cases, and GIM was limited in 92% (22/24) cases. Only 2 patients were positive for H. pylori infection. Two patients still had GIM during repeat esophagogastroduodenoscopy (out of 12 follow-up cases). No instances of dysplasia (precancerous changes) or carcinoma (cancer) were identified. The use of proton-pump inhibitors and chronic gastritis were more common in patients with GIM compared to the control group (P = 0.02).
In most children with GIM, the condition was associated with low-risk histological subtypes (complete or limited), and there was rare co-occurrence with H. pylori gastritis in this cohort. Further studies involving multiple centers were needed to better understand outcomes and risk factors in children with GIM.