Duodenogastric reflux does not influence Helicobacter pylori colonization in children

Aims: Duodenogastric reflux (DGR) and Helicobacter pylori (H. pylori) infection are two common etiologies implicated in gastric mucosal injury during childhood. However, their interplay remains poorly understood. This study aimed to investigate the relationship between DGR and H.pylori colonization through comprehensive endoscopic and histopathological evaluation in a pediatric cohort. Methods: In this retrospective study, the medical records of 698 children who underwent esophagogastroduodenoscopy between January 2024 and March 2025 were reviewed. Patients were classified into DGR and non-DGR groups, based on the presence or absence of bile residues in the stomach during endoscopy. Histopathological assessments were conducted using the modified Sydney classification to evaluate H.pylori presence and density. Demographic, endoscopic, and histological parameters were compared across groups. Results: DGR was identified in 21.6% of patients and was significantly associated with older age and female sex (p<0.001 and p=0.017, respectively). However, no significant differences were observed between the DGR and non-DGR groups regarding the frequency or density of H.pylori colonization (p=0.647 and p=0.731). Both DGR and H.pylori positivity were independently associated with increased endoscopic abnormalities (p<0.001 for both) and gastric mucosal inflammation (p=0.047, and p<0.001 respectively). Conclusions: DGR and H.pylori infection independently contribute to gastric mucosal pathology in children. However, DGR does not appear to influence H.pylori colonization significantly. These findings underscore the need for further prospective and molecular studies to elucidate the mechanistic interactions between bile reflux and H.pylori in pediatric populations.