{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T02:13:14Z","timestamp":1775787194557,"version":"3.50.1"},"reference-count":30,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,3,20]],"date-time":"2022-03-20T00:00:00Z","timestamp":1647734400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["MOST 105\u20102314\u2010B\u2010006\u2010062\u2010MY2"],"award-info":[{"award-number":["MOST 105\u20102314\u2010B\u2010006\u2010062\u2010MY2"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Helicobacter"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p><jats:italic>Helicobacter pylori<\/jats:italic> infection is the leading cause of peptic ulcer and chronic gastritis and may initiate gastric carcinogenesis following the Correa cascade. Another lineage of metaplasia, spasmolytic peptide\u2010expressing metaplasia (SPEM) has recently been found to be an alternative precursor to gastric cancer. To date, few reports have investigated gastric precancerous lesions among children with <jats:italic>H.\u00a0pylori<\/jats:italic> infection. This study aimed to evaluate the histopathological pattern of <jats:italic>H.\u00a0pylori<\/jats:italic> atrophic gastritis in children and the extent of precancerous lesions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>This study enrolled pediatric patients with <jats:italic>H.\u00a0pylori<\/jats:italic> infection from 1998 to 2019. During esophagogastroduodenoscopy examinations, biopsy fragments were collected from the gastric antrum and corpus for rapid urease test, culture, and histology evaluation. The presence and degree of chronic inflammation, activity of gastritis, <jats:italic>H.\u00a0pylori<\/jats:italic> density, atrophy, and intestinal metaplasia (IM) were assessed according to the modified Updated Sydney System. Trefoil factor 2 (TFF2) immunohistochemistry was also performed to assess SPEM in the gastric tissues collected from each case using rabbit anti\u2010human TFF2 antibodies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 92 children with <jats:italic>H.\u00a0pylori<\/jats:italic> infection and adequate gastric mucosa biopsies were enrolled. Esophagogastroduodenoscopy showed that 39 (42.4%) had duodenal ulcers, 11 (12.0%) had gastric ulcers, 41 (44.6%) had gastritis, and 1 (1.1%) had negative findings. Mild\u2010to\u2010moderate IM was identified in 4 patients (4.3%). SPEM was found in 8 patients (8.7%) with a significantly higher incidence among female patients (15.8% vs. 8.7%, <jats:italic>p\u00a0<\/jats:italic>=\u00a0.031). Gastric glandular atrophy presented in 28 patients (30.4%), and high\u2010grade atrophy was more common in female patients (3.2% vs. 1.9%, <jats:italic>p\u00a0=<\/jats:italic>\u00a0.031).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The prevalence rates of atrophic gastritis in the children with <jats:italic>H.\u00a0pylori<\/jats:italic> infection were 30.4% for gastric glandular atrophy, 4.3% for IM and 8.7% for SPEM. SPEM and high\u2010grade atrophy were more common in female patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hel.12885","type":"journal-article","created":{"date-parts":[[2022,3,20]],"date-time":"2022-03-20T20:23:41Z","timestamp":1647807821000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Atrophic gastritis in <i>Helicobacter pylori<\/i>\u2010infected children"],"prefix":"10.1111","volume":"27","author":[{"given":"Hsuan","family":"Hsieh","sequence":"first","affiliation":[{"name":"Departments of Pediatrics Medical College National Cheng Kung University Hospital National Cheng Kung University  Tainan Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsiao\u2010Bai","family":"Yang","sequence":"additional","affiliation":[{"name":"Departments of Pathology Medical College National Cheng Kung University Hospital National Cheng Kung University  Tainan Taiwan"},{"name":"Department of Pathology 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