Inflammatory changes of the gastric mucosa and serum concentration of chosen growth factors in children.

PURPOSE: To assess whether there is a correlation between the severity of gastritis and concentration of chosen growth factors in the serum of children infected with H. pylori. MATERIAL AND METHODS: The study included 64 children of whom 50% (Group I) were infected with H. pylori and had gastritis; 18.7% (Group II) of the examined children had a positive titre of IgG against H. pylori and normal gastric mucosa. Controls (Group III) comprised 31.3%. The gastric mucosa was evaluated histopathologically according to the Sydney System. The serum concentrations of growth factors: EGF, TGF-alpha, VEGF, were determined using ELISA. RESULTS: Mean concentrations of the growth factors were also the highest in Group I compared to Group II and Group III (EGF - 137.3+/-10.4 pg/mL, TGF-alpha - 0.4+/-1.2 pg/mL, VEGF - 146.8 pg/mL). Analysis of correlations between growth factors and the severity of gastritis as well as the activity of antral gastric mucosa inflammation proved that mean EGF concentration in H. pylori infected children was the highest (149.5+/-84.8 pg/mL) in severe gastritis, whereas mean concentrations of TGF-alpha (2.0+/-4.3 pg/mL) and of VEGF (148.1+/-92.6 pg/mL) were the highest in moderate gastritis. Mean concentrations of EGF (155.1+/-116.4 pg/mL) and of VEGF (156.0+/-118.9 pg/mL) were the highest in high activity antral gastritis, whereas the mean concentration of TGF-alpha was the highest (2.0+/-4.2 pg/ml) in moderate activity gastritis. CONCLUSIONS: In the children with H. pylori infection, serum concentrations of EGF, TGF-alpha, VEGF were the highest in moderate and severe antral gastritis.

The EGFR expression in gastric mucosa of children infected with Helicobacter pylori.

PURPOSE: Epidermal growth factor receptor (EGFR) modulates balance between proliferation and apoptosis in gastric mucosa of the gastrointestinal tract. The aim of the study was to evaluate immunohistochemically the EGFR expression in epithelial and gland cells of antral mucosa in children infected with Helicobacter pylori (H. pylori). MATERIAL/METHODS: The study included 44 children, aged from 5 to 18 years (mean age 13+/-3.4 years) with dyspeptic symptoms, of whom 30 (68.2%) children were infected with H. pylori, 14 (31.8%) children constituted controls. Endoscopic and histopathological assessment of antral mucosa samples was performed according to the Sydney System. Samples taken from gastroscopy were prepared to evaluate EGFR expression in epithelial and gland cells of antrum mucosa according to the manual of a detection kit of EnVision+System-HRP (DAKO). RESULTS: In children H. pylori infected, the EGFR expression in epithelial cells of antral mucosa equaled on average 82.5+/-15 cells/mm2 and ranged from 45.0 to 98.0 cells/mm2 as well as differed statistically significantly when compared to controls (10.2+/-5.0 cells/mm2) (p<0.001). In children with H. pylori infection, the EGFR expression in gland cells of antral mucosa ranged from 2.0 to 85.0 cells/mm2 (mean 25.7+/-22.6 cells/mm2); was lower and differed statistically significantly from controls (54.2 +/- 29.6 cells/mm2) (p<0.001). In children H. pylori infected, there was a statistically significant difference (p<0.001) between the EGFR expression in epithelial and in gland cells of antral mucosa. CONCLUSION: The increased EGFR expression in epithelial cells in comparison with gland cells of antral mucosa in children with H. pylori infection may suggest its role in regeneration processes of gastric mucosa.

Familial and social conditions of alcohol drinking in children and adolescents.

PURPOSE: The aim of the study was to evaluate the frequency of alcoholic beverage use among children and young people of Bialystok city and to assess the influence of familial and environmental factors on this phenomenon. MATERIAL AND METHODS: The study included 894 pupils in the city of Bialystok. An anonymous questionnaire, prepared in the Department of Pediatric Nursery of the Medical University of Bialystok was used in the study. RESULTS: The examinations revealed that alcohol use among adolescents of Bialystok increases with the increasing age of pupils (33.2%--the first grade of middle school, 63.4%--the third grade of middle school, and 79.9%--the second grade of high school). The first experience with alcohol took place in the 5-10 age bracket, but the greatest alcohol initiation (35% of young people) was reported in the 10-15 age bracket; 16% of children were not capable of establishing proper relations with their parents. The examined pupils observed destructive behavior most frequently among their friends (38%) and in people with whom they had no direct contact (36.8%). Adolescents were revealed to use alcohol for company (21.6%), due to lack of safety feeling (18.4%), and the ability of free time organizing (23.4%). CONCLUSION: 1. Alcohol use by children and adolescents from the city of Bialystok increases with the age and the biggest alcohol initiation takes place in the age of 10-15 brackets. 2. Familial and social conditioning/factors influence alcohol use by children and adolescents.

Mucosal gastrin cells and serum gastrin levels in children with Helicobacter pylori infection.

PURPOSE: Impaired control of gastric juice secretion is observed in chronic gastritis due to Helicobacter pylori (H. pylori) infection. G cells are stimulated by such cytokines as tumor necrosis factor (TNF-alpha), interferon gamma (IFN-gamma) and interleukin-8 (IL-8). The number of D cells producing somatostatin decreases simultaneously. An increase in gastrin levels could also depend on alkalization in G cell environment caused by bacterial urease. The aim of the study was to evaluate G cell counts in the antrum and gastrin levels in the serum of children with H. pylori infection and after bacterium eradication. MATERIAL AND METHODS: The study was performed in 106 patients. Children were divided into 3 groups with regard to the presence and course of H. pylori infection. Fifty nine children (55.7%) had chronic gastritis in the course of H. pylori infection with a positive titre of antibodies in IgG class against H. pylori; 29 children (27.3%) with past H. pylori infection, without bacterium colonization and gastritis but with a positive titre of antibodies in IgG class against H. pylori; 18 children (17%) with functional disorders of the gastrointestinal tract but without H. pylori infection. RESULTS: The quantitative analysis of gastrin cells in the antral mucosa of children performed by immunohistochemical method showed the highest gastrin cell count in group I with H. pylori infection (112.1 +/- 58.9 cell/mm2) and in group II with past H. pylori infection (105.3 +/- 73.1 cell/mm2). The serum gastrin level (92.9 +/- 41.6 microU/ml) was the highest in children with H. pylori infection. In controls, it was 70.0 +/- 15.3 microU/ml and could be compared to the results of children with past H. pylori infection. CONCLUSIONS: 1. The H. pylori infection plays a significant role in the stimulation of G cells increase and gastrin release in the blood serum in children. 2. The eradication of H. pylori infection is probably a main factor in gastric secretion down-regulation during gastritis in children.

Helicobacter pylori eradication as prevention against chronic peptic ulcer disease in children.

The changes caused by Helicobacter pylori are a slow, progressing inflammatory process developing from several to dozen years. H. pylori infection leads to an inflammatory response in the gastric mucosa with granulocyte infiltrates in an acute form of the inflammation, and lymphocytes, plasmatic, macrophages and eosinophils in a chronic form inducing the development of gastric and duodenal ulcers and gastric cancer in some patients. The frequency and the type of morphological changes in the gastric mucosa were analyzed in children with positive IgG against H. pylori and the incidence of gastric and duodenal ulcers in family members of children examined was evaluated in our study. Gastritis was reported in 68.8% of children with positive IgG against H. pylori. Gastric ulcer was confirmed in 37.1% of families of children included in the study. Duodenal ulcers were found in 22.9% of families. The results obtained, indicate the usefulness of long-term observation and clinical follow-up of children with chronic gastritis of H. pylori ethiology taking into consideration bacterium eradication as prophylaxis of peptic ulceration.

Educational and nursing problems of parents of children with stoma.

In children, it is usually one of the stages of treatment of lower alimentary congenital defects. Such patients require long-term professional medical and nursing attention as well as solicitous care of the parents at home. The aim of the study was the analysis of educational and nursing problems that are faced by parents of children with stoma, the influence of a nurse on the quality of their care, and determination of nurse educational assignment in preparing the parents for the care at home. The study was performed in the group of 30 parents of children, 0-2 years old, with lower alimentary congenital defects who had intestinal stoma inserted in 2003. The questionnaire revealed that the main causes of the stoma were Hirschsprung disease (40%), anal atresia (37%), perianal fistula, intestinal perforation and necrosis (10% each). All responders stated that the knowledge acquired in the ward was of great help while nursing a child at home. The results showed that above 80% of parents had the opportunity to change the stomal sacks by themselves, once or more times, in the presence of medical staff. Skin changes (33%) were the most common complications in case of stoma, which could encounter for inappropriate care. Other complications included hemorrhage (20%), prolapse (13%), and stoma narrowing (10%).

The knowledge of pedagogic students on suicidal behaviors in adolescents.

Suicide, taking one's own life, seems to be in contradiction with the will to live. However, it is not so obvious, as there is not the same patterns of behavior for all people. People differ from one another as far as reactions, behavior, and actions are concerned. Some are mobilized, others are discouraged by failures. It is often thought that suicidal behavior occurs due to a mental disorder. The purpose of the study was to check the knowledge of IV-year-students of Pedagogy and Psychology of The University in Bialystok concerning suicidal behavior. Danger of suicidal phenomenon among young people was also to be noticed and discussed. The examination was conducted in the group of 50 students of the IV year of Pedagogy and Psychology of The University in Bialystok in 2002. Students, 21-25 years of age, comprised the most numerous group. Women were the majority (84%) while men were 16%. The examination tool was the questionnaire of 29 open and closed questions. The analysis of the results points to the fact that making a decision of suicide is a result of long reflections expanded in time. Personal and family problems are most common causes of suicidal behavior given by the responders. Social isolation and bad mental condition were behaviors indicating the will to commit suicide. Lonely people, chronically ill, emotionally immature and the young people were those of the high risk groups. According to the examined students, pain connected with physical suffering may influence suicidal behavior.

Cytotoxic lymphocytes (CD8+) in the antrum mucosa in children with chronic Helicobacter pylori-related inflammation before and after bacteria eradication.

The authors assessed the expression of cytotoxic CD8 lymphocytes in the antrum mucosa of children with chronic Helicobacter pylori-related inflammation, before and after bacteria eradication. Biopsy specimens of gastric mucosa were evaluated in specimens, collected from 59 H. pylori-positive patients (Group I), 29 patients after H. pylori infection (Group II) and 18 H. pylori-negative children (Group III). The obtained specimens were assessed for infection and inflammation and the expression of CD8+ lymphocytes was estimated, using monoclonal antibodies. The number of CD8+ lymphocytes in the mucosa was counted. The results of the study showed an increase in the expression of CD8+ lymphocytes in children with H. pylori infection, in comparison to the values in children after bacteria eradication. The increased expression of CD8+ lymphocytes correlated with the severity degree of antrum gastritis.

Helicobacter pylori infection and mast cells of the antrum mucosa.

The studies aimed at evaluating mast cells in inflammatory infiltration of gastric mucosa in children with H. pylori infection, as well as in those after the infection eradication. Biopsy specimens of gastric mucosa were evaluated, the specimens collected from 59 H. pylori-positive patients (Group I), 29 patients after H. pylori infection (Group II) and 18 H. pylori-negative children (Group III). The specimens were assessed for infection and inflammation and stained with anti-human mast cell tryptase to count mucosal mast cells. The evaluations of histopathological changes in the antrum mucosa of the children were performed, according to Sydney's Classification. In morphometric evaluation, slight differences were found in the numbers of mast cells among Groups: I, II and III of the examined children (the number of mastocytes being: 86.4, 81.4 and 70.2 cells/mm2 of specimen, respectively).

B (CD20+) lymphocytes in the antrum mucosa of children with Helicobacter pylori infection.

The aim of the study was to estimate the expression of CD20+ lymphocytes in the antrum mucosa in children, infected with Helicobacter pylori and after bacteria eradication. Biopsy specimens of gastric mucosa were the specimens, collected from 59 H. pylori-positive patients (Group I), 29 patients after H. pylori infection (Group II) and 18 H. pylori-negative children (Group III). The collected specimens were assessed for infection and inflammation and the expression of CD20+ lymphocytes was estimated, using mice monoclonal antibodies. The expression of CD20+ lymphocytes in the inflammatory infiltrate of the antrum mucosa correlated with the severity of gastritis, found in children with Helicobacter pylori infection and was the highest in comparison with the group of children after H. pylori eradication.

Memory cells in the antral mucosa of children with Helicobacter pylori infection.

A total of 106 patients, included in the study, were divided into three groups with regard to Helicobacter pylori infection. Endoscopy and histopathological examination of the stomach, based on the Sydney's System, were performed in all the children. CD45RA and CD45RO cells were identified by means of specific antibodies in the inflammatory infiltrate of the antral mucosa. An increased expression of CD45RO and CD45RA lymphocytes was reported, basing on the results of the study.

Macrophages of the antral mucosa in children with Helicobacter pylori infection and after eradication.

Our study included 59 children, aged 12.2 +/- 4.6 years, with Helicobacter pylori infection and 29 children, aged 11.0 +/- 4.2 years, with past H. pylori infection after spontaneous eradication with positive IgG antibodies against H. pylori and with functional disorders of the gastrointestinal tract, without H. pylori infection, with normal IgG concentration against H. pylori. All biopsy specimens from each of the study groups were stained by an immunohistochemical method for the evaluation of CD68+ macrophages in the antral mucosa. Histopathological changes in the antral mucosa of children with Helicobacter pylori are characterized by an increased infiltrate of macrophages, dependent on the severity grade of inflammation.

Peripheral blood lymphocyte population in children infected with Helicobacter pylori.

PURPOSE: Helicobacter pylori infection in children is associated with a chronic inflammatory process of gastric and duodenal mucosa, which may have a various clinical course ranging from asymptomatic and chronic inflammatory condition to gastric ulceration. The immune system may contribute especially to chronic gastric mucosa inflammation. The aim of our study was to assess the levels of peripheral blood T (CD3+, CD4+, CD8+) and B lymphocyte subpopulation (CD19+) in children with Helicobacter pylori infection and to evaluate their relation to degree of antrum mucosa inflammation. MATERIAL AND METHODS: The study was performed in 32 children aged 7-18 years, hospitalized due to dyspeptic symptoms. The endoscopic examination of upper gastrointestinal tract was performed and gastric and duodenal mucosa was estimated in all patients. The endoscopic and histological evaluation of gastric mucosa was performed according to the Sydney System [4]. The urease test (CLO-test-H. pylori) was made to estimate the severity of the infection. RESULTS: Moderate antrum mucosa inflammation was found in 41.2% of the examined. The highest percentage of children (58.8%) presented marked inflammation. No mild inflammation was found in children examined. CONCLUSIONS: No correlation was found between lymphocyte levels and the degree of the inflammatory changes in antrum mucosa. The evaluation of peripheral blood lymphocytes performed in children with Helicobacter pylori infection suggests that T lymphocytes may play a predominant role in this infection.

Comparative evaluation of gastric mucosa morphological changes in children and adults with positive IgG antibodies to Helicobacter pylori.

PURPOSE: Helicobacter pylori colonization of gastric epithelium causes a local and systemic, cellular and humoral immune response. Despite this immune response involvement in the infection, its elimination from the organism does not take place and the process usually becomes chronic. The purpose of the study was to establish the prevalence of gastric mucosa inflammation in children and adults with serum positive anti-Helicobacter pylori antibodies IgG. MATERIAL AND METHODS: The study included 171 patients comprising 109 (63.7%) children and 62 (36.3%) adults with IgG positive titre against Helicobacter pylori, who were qualified to the study basing on epidemiological examinations estimating the prevalence of Helicobacter pylori infection in the population of north-eastern Poland living in the country, town and city. All patients reported dyspeptic symptoms. The evaluation was performed basing on the morphological (endoscopy) and histopathological examinations estimating the changes in gastric mucosa of these patients. RESULTS: The evaluation of antrum and corpus gastric mucosa proved normal gastric mucosa in 34 children (31.1%) and 10 adults (16.1%) with positive IgG antibodies against Helicobacter pylori. The evaluation of the severity showed the predominance of moderate inflammation within corpus in children (37.6%) and marked inflammation in adults (45.1%). CONCLUSIONS: The concentration of IgG antibodies against Helicobacter pylori in both groups was highest in patients with marked antrum gastric mucosa inflammation.

[Endoscopic evaluation of upper gastrointestinal tract mucosa in children with food hypersensitivity]. / Ocena endoskopowa blony sluzowej górnego odcinka przewodu pokarmowego u dzieci z nadwrazliwoscia pokarmowa.

The authors compared clinical symptoms with morphological and endoscopic picture of upper gastrointestinal tract mucosa in 48 children at pre-school and school age with established food allergy.

[Production of gastrointestinal mucosa cytokines in Helicobacter pylori infection]. / Produkcja cytokin blony sluzowej przewodu pokarmowego w zakazeniu Helicobacter pylori.

The authors determined the role of cytokines in the pathogenesis of gastric mucous membrane inflammation in patients with H. pylori infection. Cytokines play an important role in the pathogenesis of mucous inflammation in secretory and gastromotoric disorders.

[Lymphocytic response of gastric and duodenal mucosa in Helicobacter pylori infection in children]. / Odpowiedz limfocytarna blony sluzowej zoladka i dwunastnicy w zakazeniu Helicobacter pylori u dzieci.

The authors evaluated morphologically gastric and duodenal mucosa in H. pylori infection in children. Fenotypic evaluation of T lymphocytes carried out in patients showed the increase in number of these cells in gastric antrum and corpus mucosa in comparison with controls according to the level of mucosal inflammation. B lymphocytes in inflamed gastric mucosa were dispersed as lamina propria infiltrates or in clusters (lymph nodules).

[Mast cell of upper gastrointestinal tract mucosa and Helicobacter pylori infection in children]. / Komórka tuczna blony sluzowej górnego odcinka przewodu pokarmowego a zakazenie Helicobacter pylori u dzieci.

Using histological, immunohistochemical and electron microscopic examinations of gastric and duodenal mucosa the authors showed the increase in the number of mast cells with ultrastructural changes characteristic of their degranulation in H. pylori infected children. The damage of various intensification in glandular and covering epithelial cells and the inflammatory response were also proved. The results suggest the role of mastocytes in the inflammation of gastric and duodenal mucosa in H. pylori infected children.

Evaluation of selected cytokines and mononuclear cell infiltration in gastric mucosa of children with food allergy.

The authors performed simultaneous evaluation of histological changes in gastric and duodenal mucosa, phenotypic evaluation of mononuclear cells infiltration and the levels of selected cytokines of gastric mucosa in children with diagnosed food allergy. It was determined that IL-4, IL-5, IL-10 and TNF-alpha were produced locally within alimentary tract mucosa; they may play pathogenic role in food hypersensitivity in children. Increase in the number of T lymphocytes (CD3+, CD8+) and B lymphocytes (CD20+) as well as mastocytes with positive reaction to Mast Cell Tryptase-Mastocyte antibody was also observed in gastric and duodenal mucosa of these patients.

[Helicobacter pylori as supposed factor of uveitis in children: a case report]. / Helicobacter pylori jako domniemany czynnik zapalen blony naczyniowej u dzieci--opis przypadku.

MATERIAL: A case of a 14-year-old boy with recurrent idiopathic bilateral uveitis. METHODS: Detection of Helicobacter pylori infection basing on endoscopic examination of upper alimentary tract and eradication of this factor using specific therapy leading to extinction of active uveitis in both eyes. RESULTS: Helicobacter pylori may be the etiological agent of uveitis in children with unknown reason of the disease.