Utilization of Hematological Markers to Distinguish Bile Reflux Gastritis From Helicobacter pylori-Associated Gastritis in Pediatric Patients

Gastritis is a frequent pediatric disease and is associated with significant morbidity, nutritional compromise and reduction in the quality of life. Among the etiologies, Helicobacter pylori (H. pylori) gastritis and bile reflux gastritis (BRG) are most frequent though clinically indistinguishable without invasive examinations like biopsy. This prospective observational cross-sectional study was carried out at the Department of Pediatric Gastroenterology, Jinnah Postgraduate Medical Centre (JPMC), Karachi, aiming to elaborate the diagnostic utility of these hematological markers in differentiating BRG from H. pylori gastritis. One hundred twenty children aged five to 15 years with endoscopically and histologically confirmed gastritis were recruited from January to December 2024, of which the BRG (n = 60) and H. pylori gastritis (n = 60) groups had equal number of participants. Research data was gathered with the help of a structured proforma, endoscopic examination and confirmed by biopsy from pretreatment blood samples. The determined hematologic parameters were as follows: hemoglobin (Hb), total leukocyte count (TLC), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean corpuscular volume (MCV), red cell distribution width (RDW) and platelet counts. t-tests, Chi-square tests, Mann-Whitney U tests and receiver operating characteristic (ROC) curve analyses were used for statistical analysis. The children with H. pylori gastritis demonstrated lower levels of hemoglobin (10.9±1.2 g/dL vs 11.8±1.3 g/dL, p=0.001), MCV (80.1±5.7 fL vs 82.6±6.2 fL, p=0·04) and higher RDW (15.6±2.0% vs 14.5±1.9%, p=0.003), indicating iron-deficiency with microcytic anemia in the former group than the latter groups respectively with no such differences seen among patients who were Helicobacter free. On the other hand, NLR was significantly higher in BRG patients (2.6±0.8 vs 2.1±0.7, p=0.001), reflecting an increased neutrophil-mediated inflammation. PLR was higher in H. pylori gastritis (148.7±34.2 vs 131.5±29.1, p=0.02), whereas platelet counts were similar between the two groups (p=0.21). By ROC analysis, NLR (area under the curve (AUC)=0.72) and RDW (AUC=0.70) were the best discriminative factors, as well as hemoglobin level (AUC=0.68). These results indicated that the simple and inexpensive hematological parameters NLR, RDW, and Hb could have clinical application value as adjuncts for distinguishing between BRG children and H. pylori gastritis patients. An approach like this might reduce the use of invasive procedures, increase diagnostic accuracy, and help in clinical decision making, particularly in low-resource health care settings.