Introduction:

In Asian countries, Helicobacter pylori (H. pylori) infection is considered a risk factor for progression to gastric cancer in children. In the West, there is no consensus and a tendency toward non eradication.

Objective:

To identify endoscopic risk characteristics for cancer in Helicobacter pylori-inducible gastritis in pediatrics and their association with family history.

Materials and method:

Comparative, non randomized, prospective, cross-sectional study (January 2020-March 2025). Variables: age, sex, endoscopic findings, Kyoto classification, and gastritis severity. Group A: presence of family history of H. pylori gastritis or gastric cancer, group B: absence.

Results:

225 patients, group A: 85 (37.78%), 8.61 years ± 3.45 (range: 2-16), female 56.47%, H. pylori gastritis in mother 43/85 (50.59%) and maternal grandmother 23/85 (27.06%); gastric cancer in grandparents 5/85 (5.88%). Group B: 140 (62.22%), 8.78 years ± 3.59 (range: 2-15), female 51.43%. Moderate gastritis was predominant in both groups A and B: 54.11% and 55%, severity of gastritis and history, p=0.1184. Kyoto score, group A: ≤2 in 47.06% and 2-3 in 42.35% indicating Hp infection; ≥4 was found in 10.59% indicating risk of gastric cancer. Group B: ≤2 and 2-3 points recorded in 62.14% and 37.86% respectively. A difference between groups p=0.0000. The risk of progression to gastric cancer was higher in group A with the presence of intestinal metaplasia (p=0.0237), thickened folds (p=0.0039), and severe redness (p=0.0012) compared to group B. There were no differences between groups: gastric atrophy (p=0.7167) and nodularity (p=0.9777).

Conclusions:

Endoscopic risk lesions in children and adolescents were associated with a family history of chronic H. pylori gastritis or gastric cancer; the Kyoto classification was useful. There is a need to prioritize eradication and a follow-up program.