Assessment of relationship between non-invasive activity markers and histopathological findings in children with Helicobacter pylori positive and negative gastritis

AIM: The aim of this study is to evaluate the relationship between histopathological findings of gastric biopsies and serum levels of neopterin (NP), neutrophil gelatinase associated lipokalin (NGAL) and other acute phase reactants in children who admitted with dyspeptic complaints and who underwent endoscopy and to further evaluate the effect of Helicobacter pylori (H. pylori) on these parameters.PATIENTS AND METHODS: The patients (n: 36) who underwent upper gastrointestinal endoscopy with the indication of dyspepsia between April 2012 and June 2012 in Dokuz Eylül University Hospital, Department of Pediatric Gastroenterology, Nutrition and Metabolism and finally diagnosed as gastritis by endoscopic and histopathological findings were enrolled in the study. Age and sex match 37 healthy children were included as control group. The patients were divided into subgroups according to severity of gastritis and existence of H. pylori after being classified according to Sydney classification by histopathological examination. There were 7 patients in the non-inflammatory group, 15 patients in the mild gastritis group, 5 patients in the moderate gastritis group and 9 patients in the severe gastritis group. H. pylori was detected in 7 patients. The physical examinations of the patients were performed and weight, height and weight for height were recorded. The serum NP levels were measured by high performance liquid chromatography (HPLC) and plasma NGAL levels by Biosite Triage Meter Pro device that works with the principle of fluoresance immune measurement. The groups were compared in regards of histopathological findings and H. pylori existence with serum levels of NP, NGAL, C-reaktif protein, erythrocyte sedimentation rate, platelet count, leukocyte count and mean platelet volume.RESULTS: There was not a significant difference between the patients with gastritis and controls regarding neopterin (3.58 ± 1.13 nmol/L and 3.47 ± 1.13 nmol/L, respectively) and NGAL (102.41 ± 47.65 ng/mL and 83.32 ± 28.35 ng/mL, respectively) levels. The Helicobacter pylori positivity and the severity of gastritis were shown to have no impact on neopterin levels. The levels of NGAL were significantly higher in H. pylori positive patient group (146.71 ± 62.23 ng/mL) than both H. pylori negative patient group (91.72 ± 37.40 ng/mL, p= 0.012) and healthy controls (83.32 ± 28.35 ng/mL, p= 0.004). The NGAL levels of patients with moderate and severe gastritis were significantly higher than both controls and patient group without inflammation. The platelet counts of patients with histopathologically mild, moderate and severe gastritis were significantly higher than the patients without inflammation (265.06 ± 58.71, 374.20 ± 67.24, 290.77 ± 50.79, 248.14 ± 62.11 x10³/µL, respectively). There was a significant positive corelation between severity of gastritis and NGAL levels and platelet count.CONCLUSION: The serum NP and NGAL levels show no difference between children with gastritis and healthy controls. However, the existence of H. pylori and severity of gastritis increase the serum NGAL levels. Further studies are required that will investigate the impact of gastric inflammation on systemic inflammatory markers and elicit the underlying mechanisms.Key words: Gastritis, child, H. pylori, platelet, neopterin, neutrophil gelatinase associated lipokalin (NGAL)