Pancreatic metaplasia of the gastric mucosa in pediatric patients.

Antropyloric and intestinal-type metaplasia of gastric columnar epithelial cells occurs commonly in the setting of atrophic gastritis in both adults and pediatric patients. Pancreatic metaplasia of gastric mucosa, although less common, has been reported in a variety of clinical conditions in adult patients, but not in the pediatric population. Objectives: The aim of this retrospective review was to characterize the clinical and pathological findings in pediatric patients found to have histological and immunohistochemical evidence of pancreatic metaplasia of the gastric mucosa in biopsies taken at the time of upper endoscopy. Methods: Patients with histological evidence of pancreatic metaplasia of the gastric mucosa were prospectively identified. Their individual medical records were then reviewed for presenting symptoms, pertinent laboratory data, gross findings on endoscopy, radiological features, diagnosis, and subsequent therapy. Results: Of the six children (ages, 8-18 yr; mean, 13.0 yr), with pancreatic metaplasia of the gastric mucosa, two children each had gastroesophageal reflux disease and chronic abdominal pain, whereas one child had a duodenal ulcer and one child had nodular gastritis. Iron deficiency anemia was present in four of six patients; three of four patients with this finding presented with hematemesis. All biopsies were negative for Helicobacter pylori. Conclusions: Whereas pancreatic metaplasia of the gastric mucosa is strongly associated with chronic atrophic gastritis in adults, its occurrence in children who do not have atrophic gastritis raises the possibility that it may be a developmental phenomenon of gastric mucosal differentiation. The clinical significance of this finding remains to be determined; and its association with iron deficiency in children requires further study.