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1664 Gastric Intestinal Metaplasia in Pediatric Patients: A Metaplastic Process or an Incidental Finding?
Abstract   Open access   Peer reviewed

1664 Gastric Intestinal Metaplasia in Pediatric Patients: A Metaplastic Process or an Incidental Finding?

Muhammad Shaheen and Iván González
Laboratory investigation, Vol.105(3 Supplement), 103908
03/2025
DOI: 10.1016/j.labinv.2024.103908
url
https://doi.org/10.1016/j.labinv.2024.103908View
Published (Version of record) Open Access

Abstract

Background Gastric intestinal metaplasia (GIM) is defined by the presence of goblet cells within the gastric epithelium with or without Paneth cells. In the adult population, GIM is considered as a preneoplastic lesion hence recent guidelines advocate for endoscopic surveillance for patients with GIM. In children, the clinical significance of GIM remains uncertain. We hypothesize that GIM in pediatric patients is not a preneoplastic lesion and in most cases represent and incidental finding of no clinical significance. Design A retrospective search for GIM in pediatric patients was performed in our database from 1/2000 to 12/2021. Results A total of 162 patients with GIM were identified (incidence of 0.6%), presenting with a median age of 14 years (range: 1–18 years) and with female predominance (58%). The biopsies had a median number of 2 (range: 1–5) fragments with most of them containing antral mucosa (96%) for examination and oxyntic mucosa being available in 52% of the cases. According to the extent of involvement, GIM was considered as focal (81%), multifocal (17%) and diffuse (2%), and in most cases the GIM was present only in the antral mucosa (96%). Paneth cells were seen in 32% of the GIM cases. In most cases some degree of chronic gastritis was seen (79%) but most of them were considered as mild (69%), and an acute chronic gastritis was seen in 9% of the cases. The pattern of gastritis was considered as a superficial infiltrate in 91% of the cases and importantly an oxyntic only gastritis was present in only 3 (2%) cases and none of the case show a base predominant infiltrate. Lymphoid aggregates were present in 27% of the cases. Helicobacter pylori-like organisms were identified in 3 (2%) cases. In none of the cases dysplasia was identified and more importantly none of the cases develop a neoplastic lesion during follow-up. Conclusions Contrary to its adult counterpart, GIM in children is likely an incidental finding and in only a minority of the cases associated with a Helicobacter pylori infection. Importantly, no cases were associated with dysplasia. Our single center experience suggests that GIM in children has an uncertain clinical significant posing the question if indeed they represent a true metaplastic process.

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