Very early and early nutrition in children with pancreatitis-A randomised trial.

OBJECTIVES: The aim of our study was to assess the impact of the very early introduction of refeeding on the course of acute pancreatitis (AP) in children. Additionally, we evaluated the effect of nutrition on inflammatory markers, including cytokines. METHODS: This prospective randomised study was conducted in three university hospitals in Poland. Patients, aged 1-18 years with AP, were randomised into two groups: A-refeeding within 24 h of hospital admission (very early), and B-refeeding at least 24 h after admission (early nutrition). The severity of AP was assessed after 48 h. The serum concentrations of four cytokines (tumour necrosis factor α [TNFα], interleukin-1ß [IL-1ß], interleukin-6 [IL-6] and interleukin-8 [IL-8]) and C-reactive protein, as well as the activity of amylase, lipase and aminotransferases, were measured during the first 3 days of hospitalisation. RESULTS: A total of 94 children were recruited to participate in the study. The statistical analysis included 75 patients with mild pancreatitis: 42-group A and 33-group B. The two groups did not differ in the length of hospitalisation (p = 0.22), AP symptoms or results of laboratory tests. Analysis of cytokine levels was conducted for 64 children: 38-group A and 26-group B. We did not find a difference in concentrations of the measured cytokines, except for IL-1ß on the third day of hospitalisation (p = 0.01). CONCLUSIONS: The time of initiation of oral nutrition within 24 h (very early) or after 24 h (early) from the beginning of hospitalisation had no impact on the length of hospitalisation, concentrations of TNF-α, IL-1ß, IL-6 and IL-8, activity of amylase and lipase or occurrence of symptoms in children with mild AP.

Macrophage-Stimulating 1 Polymorphism rs3197999 in Pediatric Patients with Inflammatory Bowel Disease.

Background and Objectives: Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), often necessitates long-term treatment and hospitalizations and also may require surgery. The macrophage-stimulating 1 (MST1) rs3197999 polymorphism is strongly associated with the risk of IBD but its exact clinical correlates remain under investigation. We aimed to characterize the relationships between the MST1 rs3197999 genotype and the clinical characteristics in children and adolescents with IBD within a multi-center cross-sectional study. Materials and Methods: Clinical data included serum C-reactive protein (CRP), albumin, activity indices (PUCAI, PCDAI), anthropometric data, pharmacotherapy details, surgery, and disease severity. Genotyping for rs3197999 was carried out using TaqMan hydrolysis probes. Results: The study included 367 pediatric patients, 197 with Crohn's disease (CD) (40.6% female; a median age of 15.2 years [interquartile range 13.2-17.0]) and 170 with ulcerative colitis (UC) (45.8% female; a median age of 15.1 years [11.6-16.8]). No significant relationships were found between MST1 genotypes and age upon first biologic use, time from diagnosis to biological therapy introduction, PUCAI, PCDAI, or hospitalizations for IBD flares. However, in IBD, the height Z-score at the worst flare was negatively associated with the CC genotype (p = 0.016; CC: -0.4 [-1.2-0.4], CT: -0.1 [-0.7-0.8], TT: 0.0 [-1.2-0.7)]). The TT genotype was associated with higher C-reactive protein upon diagnosis (p = 0.023; CC: 4.3 mg/dL [0.7-21.8], CT 5.3 mg/dL [1.3-17.9], TT 12.2 mg/dL [3.0-32.9]). Conclusions: This study identified links between MST1 rs3197999 and the clinical characteristics of pediatric IBD: height Z-score and CRP. Further studies of the associations between genetics and the course of IBD are still warranted, with a focus on more extensive phenotyping.

Comparison of Anorectal Function as Measured with High-Resolution and High-Definition Anorectal Manometry.

INTRODUCTION: Anorectal manometry (ARM) provides comprehensive assessment of pressure activity in the rectum and anal canal. Absolute pressure values might depend on the catheter used. OBJECTIVE: Our aim was to compare the results obtained by different anorectal catheters in children with functional anorectal disorders. METHODS: Children diagnosed with functional defecation disorders based on the Rome IV criteria were prospectively enrolled. ARM was performed in the supine position successively using 2 different probes in each patient in random order. Resting, squeeze pressures, and bear-down maneuver variables obtained by high-resolution (2-dimensional [2D]) and high-definition (3-dimensional [3D]) catheters were compared. RESULTS: We prospectively included 100 children {mean age 7.5 [standard deviation (SD) ± 4.3] years; 62 boys}. Mean resting pressures were significantly higher when measured with the 3D than with the 2D catheter (71 [SD ± 19.4] vs. 65 [SD ± 20.1] mm Hg, respectively; p = 0.000). Intrarectal pressure measured by 3D and 2D catheters was similar (35 vs. 39 mm Hg, respectively; p = 0.761), but the percent of anal relaxation appeared to be higher for the 3D than for the 2D probe (12 vs. 5%, respectively; p = 0.002). Dyssynergic defecation (DD) was diagnosed in 41/71 patients (57.7%) using the 3D probe and in 51/71 children (71.8%) using the 2D probe (p = 0.044). Cohen's kappa showed only fair agreement between the catheters (κ = 0.40) in diagnosis of DD. CONCLUSIONS: Our study demonstrated significantly different values of pressures obtained with different types of catheters. Normal ranges for conventional manometry cannot be applied to high-resolution systems, and results obtained by different types of manometry cannot be compared without adjustments (NCT02812823).

C-Reactive Protein/Albumin Ratio at Diagnosis of Pediatric Inflammatory Bowel Disease: A Retrospective Multi-Center Study.

BACKGROUND This study aimed to evaluate the C-reactive protein-to-albumin (CRP/albumin) ratio at diagnosis of pediatric inflammatory bowel disease (IBD). MATERIAL AND METHODS Serum CRP/albumin ratio was calculated for patients with Crohn's disease (CD; n=186) and ulcerative colitis (UC; n=159) aged 3-18 years. RESULTS Patients with CD differed in CRP/albumin ratio at diagnosis in groups with quiescent, mild, moderate, and severe disease (P=0.011). CRP/albumin ratio at diagnosis was significant in differentiating patients with severe CD from quiescent disease at diagnosis (area under the curve (AUC)=0.94, odds ratio (OR)=63.4, 95% confidence interval (CI) 7.1-569.1, P<0.0001). CRP/albumin ratio at diagnosis could moderately differentiate penetrating from non-penetrating disease behavior in CD at diagnosis (AUC=0.73, OR=6.3, 95% CI 2.0-19.3, P<0.001). Furthermore, CRP/albumin ratio at diagnosis weakly differentiated IBD patients in need of biological treatment in a step-up procedure (AUC=0.58, OR=2.1, 95% CI 1.3-3.4, P=0.022) and in need of surgery (AUC=0.63, OR=3.1, 95% CI 1.4-7.2, P=0.006). For the IBD, CRP/albumin ratio at diagnosis was weakly correlated with age at first immunosuppressive treatment (rho=0.20, P=0.018), time from diagnosis to first biological treatment (rho=-0.37, P<0.001), days spent in hospital (rho=0.26, P=0.007), number of severe relapses (rho=0.31, P=0.001), and Pediatric Crohn's Disease Activity Index (rho=0.38, P=0.002). CONCLUSIONS The present findings add to previous studies carried out in adult patients and show that the CRP/albumin ratio at diagnosis was not significantly associated with the course of either CD or UC in children. However, CRP/albumin ratio could differentiate patients with severe CD from those with quiescent disease.

Immune Response to Vaccination in Children and Young People With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.

OBJECTIVES: The aim of this systematic review and meta-analysis was to assess immune response to vaccination in children and young people with inflammatory bowel disease (IBD). In patients with IBDs, both the disease itself and its treatment can affect the vaccine response. METHODS: Medical databases were searched for relevant studies and statistical analysis was performed. As a result, 20 publications were included in the study, 9 of which met the criteria for the meta-analysis. RESULTS: The immune response to vaccination was better in healthy subjects (odds ratio = 0.73, 95% confidence interval = 0.45-1.17) and patients without immunosuppressive treatment (odds ratio  = 0.65, 95% confidence interval = 0.41-1.03), but did not reach statistical significance. CONCLUSIONS: Immunogenicity of vaccinations in children and young people with IBD is not significantly lower than it is in healthy ones. Immune response to vaccination in this group of patients is also not significantly lower in patients on immunosuppressive therapy than in those without it.

Immune response to hepatitis B vaccination in pediatric patients with inflammatory bowel disease.

AIM OF THE STUDY: To evaluate the immune response rate in children with inflammatory bowel disease (IBD) who received the full hepatitis B vaccination course in infancy. We also evaluated rates of response to booster doses. MATERIAL AND METHODS: Participants were 1- to 18-year-old children with IBD, who received 3 doses of the hepatitis B vaccine in infancy. The study subjects were on no immunosuppressive therapy, on immunomodulators, on biological therapy, or received combo therapy. Anti-hepatitis B surface antibody (anti-HBs) level ≥ 10 mIU/ml was considered to be seroprotective. Patients with anti-HBs level < 10 mIU/ml received 1 or 3 doses of hepatitis B vaccine, and their post-vaccination anti-HBs levels were evaluated. RESULTS: In total, we included 157 subjects, with a median age of 14.5 years. Anti-HBs levels ≥ 10 mIU/ml were found in 84/157 (53.5%) patients and were not associated with age (p = 0.3), sex (p = 0.7), or IBD type (p = 0.9). There was no significant difference in the rate of seroconversion between IBD patients treated with no immunosuppressive drugs, immunomodulators, biologicals, and combo therapy (30.4% vs. 39.3% vs. 2.7% vs. 7.1%, respectively, p = 0.3). After the first and third dose of booster vaccine, anti-HBs levels ≥ 10 mIU/ml were as follows: 92% and 100%, respectively. CONCLUSIONS: The immune response in children with IBD, who received the full series of hepatitis B vaccinations in infancy was inadequate and did not depend on the type of therapy. The booster dose(s) of vaccine could help to protect this group of patients from hepatitis B virus.

Inflammatory bowel disease is associated with increased gut-to-blood penetration of short-chain fatty acids: A new, non-invasive marker of a functional intestinal lesion.

NEW FINDINGS: What is the central question of this study? 'Leaky gut' has been found in intestinal and extra-intestinal diseases. However, functional evaluation of intestinal permeability is not widely used as a diagnostic marker, possibly owing to significant limitations of currently used permeability assays. There is an unmet need for development of a new, non-invasive test to assess intestinal function. What is the main finding and its importance? We show that an increased blood-to-stool ratio of the concentration of gut bacteria-produced short-chain fatty acids may be used as a marker of gut permeability. Our findings lay the groundwork for establishing a new, non-invasive, risk-free diagnostic tool in diseases associated with intestinal barrier malfunction, such as inflammatory bowel disease. ABSTRACT: Intestinal diseases, such as inflammatory bowel disease (IBD), are characterized by an impaired gut-blood barrier commonly referred to as 'leaky gut'. Therefore, functional evaluation of the gut-blood barrier is a promising diagnostic marker. We hypothesized that short-chain fatty acids (SCFAs) produced by gut bacteria might serve as a marker in IBD. Animal experiments were performed on male Sprague-Dawley rats with acetic acid-induced colitis and in sham control animals. The gut-blood barrier permeability was determined by assessing the ratios of the following: (i) portal blood concentration of SCFAs (Cp ) to faecal concentration of SCFAs (Cf ); (ii) systemic blood concentration of SCFAs (Cs ) to faecal concentration of SCFAs (Cf ); and (iii) Cp and Cs of fluorescein isothiocyanate (FITC)-dextran administered into the colon. As a clinical study, we evaluated Cs , Cf and the Cs /Cf ratio of SCFAs in six paediatric patients with IBD, assessed as mild/moderate/severe by the Paediatric Ulcerative Colitis Activity Index (PUCAI) and the Paediatric Crohn's Disease Activity Index (PCDAI) at the time of sample collection, and nine age-matched healthy control subjects. Rats with histologically confirmed IBD had significantly increased ratios of Cp /Cf and Cs /Cf for SCFAs. This was positively correlated with the plasma FITC-dextran concentration. Likewise, IBD patients showed a significantly higher Cs /Cf ratio for SCFAs, including acetic, valeric, isocaproic, caproic and propionic acids, in comparison to control subjects. In conclusion, in the rats and in paediatric patients with IBD we found an increased blood-to-stool ratio of SCFAs, suggesting an increased gut-to-blood penetration of SCFAs. These findings pave the way for a new, non-invasive diagnostic tool in IBD and other diseases accompanied by intestinal barrier malfunction.

Dietary Fiber Intake in Children With Inflammatory Bowel Disease.

OBJECTIVES: The aim of the study was to estimate intake of total dietary fiber, and its soluble and insoluble fractions, by children with inflammatory bowel disease (IBD) in comparison with healthy controls. METHODS: This was a prospective controlled study on children with IBD. Food consumption data were collected by using the 3-day diet record. For intake of soluble and insoluble fibers author's questionnaire was used. RESULTS: The study included 50 children with IBD (80% in clinical remission) and 50 healthy controls. There were no statistically significant differences in age, weight, height, and BMI percentiles between both groups. The mean disease duration was 3.5 ±â€Š2.5 years. The daily median dietary fiber intake in patients was 15.3 ±â€Š4.2 g, whereas controls consumed about 14.1 ±â€Š3.6 g/day; differences were not statistically significant. The median intake of soluble fiber in the study group was 5.0 g/day and in controls 4.7 g/day, whereas the intake of insoluble fractions was 10.2 versus 9.7 g/day, respectively. The total fiber intake significantly increased with age and it was higher among boys in each age group. The boys better achieved adequate intake recommendations (P = 0.003). Both, children with IBD and healthy controls, did not meet the adequate intake recommendations. CONCLUSIONS: Intake of fiber in patients with IBD and healthy controls was comparable; however, in both groups, it was lower than recommended.

Clear Liquid Versus Low-fibre Diet in Bowel Cleansing for Colonoscopy in Children: A Randomized Trial.

OBJECTIVES: In light of a paucity of data on the role of diet in colonoscopy preparation in paediatric population, the present study was designed to compare the effectiveness of clear liquid and low-fibre diets for breakfast and lunch on the day preceding colonoscopy in children. METHODS: This prospective, randomised trial was conducted at the Department of Paediatric Gastroenterology and Nutrition in Warsaw, Poland. Eligible patients, referred for colonoscopies, were 6 to 18 years old. Patients were randomly divided into 2 groups: the first received a clear liquid diet and the second a low-fibre diet on the day before colonoscopy. In the afternoon, all participants were asked to drink polyethylene glycol with electrolytes at a dose of 66 mL/kg to a maximum of 4 L. The effectiveness of bowel cleansing was measured using the Boston Bowel Preparation Scale (BBPS). The preparation tolerance was assessed by parents and children using a visual analogue scale. Adverse effects were reported. RESULTS: In total, 184 patients were enrolled. Of those, 96 received the clear liquid diet and 88-the low-fibre diet. The mean age of both groups was 15 years. There were no differences between the 2 study groups in age, weight, and sex, as well as in total BBPS score (BBPS ≥ 5 96.6% vs 95.1%, P = 0.5). The frequency of adverse effects was similar in both groups; nausea was the most common (P = 0.8). CONCLUSIONS: Clear liquid and low-fibre diets administered to children the day before colonoscopy demonstrated similar bowel cleansing effectiveness.

A Two-Week Fecal Microbiota Transplantation Course in Pediatric Patients with Inflammatory Bowel Disease.

Dysbiosis plays a major role in the etiology of inflammatory bowel disease (IBD). Fecal microbiota transplantation (FMT) is a new promising option for IBD treatment. We aimed to assess the effectiveness of a two-week FMT course in children with IBD. Ten patients, 10-17 years of age with moderate to severe IBD received a course of eight doses of freshly prepared FMT via a naso-duodenal tube or gastroscopy. All of the patients had pancolitis. There were eight cases of ulcerative colitis (UC) and two of Crohn's disease (CD). Disease activity was evaluated using the Pediatric UC Activity Index (PUCAI) and Pediatric CD Activity Index (PCDAI) for UC and CD, respectively, CRP, and fecal calprotectin on the day before the first infusion and then on the day before the next course of FMT. Clinical response, defined as a decrease of 15 points in either index, was observed in 9/10 patients (seven UC and two CD). Clinical remission, defined as a PCDAI score ≤ 10 and PUCAI score < 10 measured at the same time point, was observed in 3/8 UC patients and 2/2 CD patients. Side effects observed were self-limiting and benign. We conclude that a short, intensive course of FMT has a beneficial effect on UC and CD colitis. FMT was well-tolerated and safe. Nonetheless, an optimal protocol of FMT administration is crucial for treatment efficacy.

Induction Therapy With Biosimilar Infliximab in Children With Crohn Disease.

INTRODUCTION: In most European countries, an infliximab biosimilar (CT-P13) is currently in common use. In vitro and in vivo studies have proved a high similarity between CT-P13 and the reference infliximab. CT-P13 was licensed for use in patients with Crohn disease (CD) based on the extrapolation of data from preclinical studies and clinical trials in rheumatology indications. The aim of this study was to assess the similarity between CT-P13 and the originator infliximab in induction therapy in CD paediatric patients. METHODS: Thirty-six CD paediatric patients from 3 Polish academic centres who started biological therapy with CT-P13 were enrolled in this prospective, observational study. Patients received 3 induction doses (5 mg/kg) of CT-P13 at weeks 0, 2, 6. Assessment was performed before the first infusion and at week 14. RESULTS: Overall 34/36 (94.4%) patients completed induction therapy with CT-P13. A clinical response or remission after 3 initial doses was achieved in 31/36 (86%) and 24/36 (67%) of patients, respectively. Clinically and statistically significant decreases in Paediatric Crohn's Disease Activity Index, C-reactive protein, and erythrocyte sedimentation rate were observed in the responders group. An allergic reaction during infusion, which led to treatment discontinuation, was observed in one case. CONCLUSIONS: Induction therapy with CT-P13 in children with CD is effective. The profile appears similar to that reported for the reference infliximab. No unexpected adverse events occurred.

Computed Tomography (CT) Angiography in Pre-Embolization Assessment of Location of Gastrointestinal Bleeding in Paediatric Patient with Granulomatosis with Polyangiitis (Wegener's Granulomatosis) - Case Report.

BACKGROUND: Acute gastrointestinal bleeding is an emergency with a high morbidity and mortality. Early diagnosis and appropriate intervention can be lifesaving and can prevent long-term complications. CASE REPORT: In this case report, we discuss and illustrate the role of CT angiography in the evaluation of acute, active gastrointestinal haemorrhage and show its usefulness prior to embolization. We describe a 15-year-old girl with granulomatosis with polyangiitis, formerly known as Wegener's granulomatosis. CONCLUSIONS: An accurate pre-embolization assessment of bleeding with CT angiography shortens the total diagnostic time, which results in prompt and more effective endovascular treatment.We describe the clinical presentation of our patient and present diagnostic and interventional radiologic findings.

Values From Three-dimensional High-resolution Anorectal Manometry Analysis of Children Without Lower Gastrointestinal Symptoms.

BACKGROUND & AIMS: Three-dimensional high-resolution anorectal manometry (3DHRAM) provides a topographic image of pressure along the anal canal. We aimed to determine normal 3DHRAM values in children. METHODS: We performed a prospective study of 61 children (34 male; mean age, 8.28 years) without any symptoms arising from the lower gastrointestinal tract who were evaluated at the Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Poland. Manometry procedures were performed by using a rigid probe without medication. Pressure within the anal canal and 3D images of sphincters were measured. If possible, squeeze pressure and thresholds of sensation were evaluated. The population was divided into age groups of <5 years, 5-8 years, 9-12 years, and older than 12 years. RESULTS: The mean resting and squeeze sphincter pressures were 83 ± 23 mm Hg and 191 ± 64 mm Hg, respectively. The mean length of the anal canal was 2.62 ± 0.68 cm and correlated with age (r = 0.49, P < .0001). The mean rectal balloon volume to elicit rectoanal inhibitory reflex was 15.7 ± 10.9 cm(3). The first sensation, urge, and discomfort were observed at balloon volumes of 24.4 ± 23.98 cm(3), 45.9 ± 34.55 cm(3), and 91.6 ± 50.17 cm(3), respectively. The mean resting pressure of the puborectalis muscle was 69 ± 14 mm Hg, whereas the mean squeeze pressure was 124 ± 33 mm Hg. There was no statistically significant difference in pressure parameters between age groups. We observed a positive correlation between age and balloon volume needed to elicit discomfort (r = 0.49, P < .001). CONCLUSIONS: In a prospective study, we determined normal values from 3DHRAM analysis of children without symptoms arising from the lower gastrointestinal tract. There were no significant differences in pressure results between children of different sexes or ages. ClinicalTrials.gov number: NCT02236507.

Serotype-Specific Pneumococcal Status prior to PCV 13 Administration in Children and Adolescents with Inflammatory Bowel Disease.

The aim of this study was to evaluate the serotype-specific pneumococcal status of children and adolescents with inflammatory bowel disease (IBD) who were naïve to pneumococcal vaccination before administering the 13-valent pneumococcal conjugate vaccine (PCV 13). This was an open, prospective study on children and adolescents aged 5-18 years who had IBD and were naïve to pneumococcal vaccination. A single dose of PCV 13 was administered to each patient. The geometric mean concentrations (GMCs) were measured for all 13 serotypes. A total of 122 subjects completed the study. Prevaccination GMCs ranged from 0.55 µg/ml (serotype 4) to 4.26 µg/mI (serotype 19A). Prior to the administration of PCV 13, high GMCs were detected in older children and adolescents who had IBD and were naïve to pneumococcal vaccination.

Inhaled corticosteroids do not reduce initial high activity of matrix metalloproteinase (MMP)-9 in exhaled breath condensates of children with asthma exacerbation: a proof of concept study.

Inhaled corticosteroids (ICS) are the key component of asthma treatment. However, it is unclear whether they could control the activity and level of matrix metalloproteinase (MMP)-9, which is an important factor in asthma-associated inflammation and airway remodeling. Therefore, the aim of this proof of concept study was to analyze the influence of increased doses of ICS on MMP-9 in exhaled breath condensates (EBC) of patients with allergic asthma exacerbation. Apart from MMP-9, the assessment concerned selected inflammation markers - exhaled nitric oxide (eNO) and cytokines (IL-8 and TNF). The study involved a small group (n = 4) of individuals with asthma exacerbation. The intervention concerned increased doses of ICS with ß-mimetics for 4 weeks. In addition to clinical evaluation, eNO measurements and EBC collections were done before and after 4 weeks of intense ICS treatment. The biochemical assessment of EBC concerned MMP-9, IL-8 and TNF. The data were compared to results of healthy controls (n = 6). The initial levels of eNO, MMP-9 and TNF in EBC were higher in the asthma group than in controls. In all subjects IL-8 levels were below the detection limit. After 4 weeks of ICS treatment in all patients we observed improvement of clinical and laboratory parameters. Interestingly, despite reduction of eNO and TNF, the activity of MMP-9/EBC remained on the initial level. Practical relevance of our results is limited by a small group. Nevertheless, our data suggest that ICS, although sufficient to control symptoms and inflammatory markers, may be ineffective to reduce MMP-9/EBC activity in asthma exacerbation and, possibly, airway remodeling.

Lack of evidence for an unmet need to treat Clostridium difficile infection in infants aged <2 years: expert recommendations on how to address this issue.

The role of Clostridium difficile in causing disease in infants is unclear, and the existence of C. difficile infection (CDI) in this population is controversial. As part of the drug licensing process for new CDI therapies, a pediatric investigation plan is required to define studies in infants aged <2 years. This assumes an unmet medical need, even though clinical trials in this age group may not be feasible. Three pharmaceutical companies developing CDI treatments came together to seek advice from a panel of experts. Our unanimous opinion is that the existence of CDI is questionable in infants, and if it exists, is rare. There is therefore no unmet need for CDI treatment in this population. Interventional studies are not feasible with the current level of knowledge, and studies should be limited to noninterventional studies or open-label pharmacokinetic and safety studies to better define CDI in infants.

Value of Antral Nodularity for the Diagnosis of Helicobacter pylori Infection in Children.

BACKGROUND: The aim of this study was to confirm the role of antral nodularity in the diagnosis of Helicobacter pylori (H. pylori) infection in children. MATERIAL AND METHODS: This prospective study included 107 children (58 male; 54.2%), between the ages of 3 and 18 years, infected with H. pylori, which was confirmed if the patient had at least 2 of 4 positive test results (urea breath test, urease test in gastric biopsy, histopathology - positive hematoxylin and eosin and Giemsa staining, and/or monoclonal stool ELISA test - Amplified IDEIA™ Hp StAR™). The control group consisted of 234 children with abdominal pain, of similar age, in whom urease test in gastric tissue and histopathology were negative. In both groups, photographs of the gastric antrum taken during endoscopy were evaluated for nodularity by 3 independent endoscopists, blinded to the results of other tests. Sensitivity, specificity, and negative and positive predictive value of nodularity were assessed. Indication for upper endoscopy was chronic abdominal pain not considered to be functional. RESULTS: There were no statistical differences between groups regarding sex (chi-square test with Yates's correction: p=0.8763) or age (mean ±SD) 11.77±3.49 and 12.43±3.32, study and control groups, respectively (Mann-Whitney test: p=0.1352). The sensitivity of the presence of nodularity as an indication of H. pylori infection was 91.6% and specificity was 91%. PPV of gastric nodularity was 81% and NPV was 96%. CONCLUSIONS: Antral nodularity is reliable test. Physicians could start treatment of H. pylori infection whenever gastric nodularity is observed and the urease test result is positive, without waiting for histopathology results.