The mucosal microbiota in a young child with severe non-Helicobacter gastritis

http://tag.sagepub.com 749 A 34-month-old boy of Caribbean/Hispanic descent, born abroad and raised in a Houston suburb, following 2 weeks in the Caribbean presented with new-onset painless gagging and vomiting multiple times per day. The emesis contained clear or partially digested food with an occasional bloody tinge. Physical examination and a barium swallow were unremarkable, and trials of ranitidine and proton-pump inhibitor (PPI) were unsuccessful. Esophagogastroduodenoscopy under general anesthesia (Figure 1a–f) revealed mild erythema throughout the distal esophagus, corpus, antrum, and fundus, with prominent antral nodularity and friability. Mild edema was present in the duodenal folds. Biopsies from the fundus (Figure 1g–h) and corpus revealed oxyntic-predominant chronic active gastritis with increased eosinophils. Antral biopsies (Figure 1i–j) revealed severe chronic active gastritis. The esophagus was unremarkable, and duodenal biopsies revealed patchy mild chronic inflammation. Gastrin was focally absent on immunostaining, and there was no evidence of granulomata, giant cells, viral inclusions, or Helicobacter pylori.