Endoscopic findings of Helicobacter pylori gastritis in children and young adults based on the Kyoto classification of gastritis and age-associated changes

Background and Aim: We aimed to evaluate endoscopic findings of Helicobacter pylori (H. pylori)-positive children and young adults based on the Kyoto classification, and to examine if there are age-associated changes in H. pylori-positive gastritis. Methods: H. pylori-positive patients under 40 years old who underwent upper gastrointestinal endoscopy from 1 April 2009 to 15 February 2017 were included. Subjects were classified into the Pediatric (<20 years) and Young adult groups (20-39 years). The patients' endoscopic photographs were retrospectively re-evaluated based on the Kyoto classification. We compared endoscopic findings between the two groups and examined alterations in the findings of H. pylori-associated gastritis in 5-year age groups. Results: Forty-three and 163 subjects were classified into the Pediatric and Young adult groups, respectively. In the Pediatric group, nodularity was seen in the majority (93.0%); other endoscopic findings in order of decreasing frequency included mucosal swelling (32.6%), spotty redness (25.6%), diffuse redness (18.6%), and atrophy (9.3%). In the Young adult group, endoscopic findings included atrophy (66.9%), mucosal swelling (49.7%), spotty redness (39.3%), nodularity (31.9%), and diffuse redness (30.3%). The difference in prevalence of nodularity or atrophy between the two groups reached statistical significance (P < 0.0001 each). The rate of nodularity decreased with increasing age in the Young adult group. The rate of atrophy was 33% in young adult patients aged 20-24, and the rate increased to >65% in patients over age 25. Conclusion: H. pylori-positive children had endoscopic findings besides nodularity based on the Kyoto classification. The prevalence of atrophy increased in patients over age 20.