Gastric antral narrowing in chronic granulomatous disease of childhood.

Abstract

Five boys, examined because of continued vomiting, were found to have a peculiar annular narrowing of the lumen of the gastric antrum. The roentgenographic appearance was almost uniform from case to case. The narrowing in all four cases examined histologically was caused by gross thickening of the antral wall by local granuloma formation. Four boys were later shown to have chronic granulomatous disease of childhood; the unoperated child was already known to be suffering from this disease. In one child the granulomatous narrowing of the antrum was the first manifestation of the disease. Crohn9s disease of the antrum, peptic ulcerative disease, eosinophilic granuloma, and eosinophilic gastritis had been considered in these cases before the correct diagnosis was made. The nitro-blue tetrazolium (NBT) test should be used in obscure lesions of the antrum, especially when there is annular narrowing of that structure in boys. In children with chronic granulomatous disease and antral narrowing, proper antibiotic therapy may make surgical intervention unnecessary,