Histopatološke promjene sluznice želuca u celijakiji
Sažetak
Uvod: Celijakija je hronično autoimunsko oboljenje uzrokovano unošenjem glutena kod genetski predisponiranih osoba. U želucu, kod pacijenata sa celijakijom, može se udruženo naći limfocitni gastritis (LG) uz moguću manju učestalost hroničnog Helicobacter pylori (Hp) pozitivnog gastritisa.
Cilj: Cilj rada je bio da se ispita učestalost i tip histopatoloških promjena sluznice želuca u bolesnika sa dokazanom celijakijom.
Materijali i metode: U istraživanje su uključeni pacijenti kojima je urađena ezofagogastroduodenoskopija (EGDS) i histopatološki utvrđena ili isključena celijakija.
Bolesnici su podijeljeni u dvije grupe: bolesnici sa prisutnim histopatološkim promjenama koje su ukazivale na celijakiju i bolesnici kod kojih nije utvrđeno postojanje celijakije.
Rezultati: Istraživanjem je obuhvaćen 351 pacijent. Celijakija je dokazana u 145 (41,3%) pacijenata, dok je kontrolnu grupu činilo 206 (58,7%) pacijenata kod kojih bolest nije potvrđena.
Najčešći simptom u grupi bolesnika sa celijakijom bila je dijareja, dok su se bolesnici u kontrolnoj grupi najčešće žalili na dispeptične tegobe, osjećaj malaksalosti i nadimanje (p=0,001).
Obje posmatrane grupe bolesnika najčešće su imali hronični superficijalni gastritis (76% i 63,6%; p>0,05). U bolesnika sa celijakijom gastritis je udružen sa Hp infekcijom u 29.3% što je značajno manje u odnosu na osobe bez celijakije kod kojih je 62% gastritisa udruženo sa Hp infekcijom (p<0,001). Nisu otkrivene druge forme gastritisa.
Osobe oboljele od celijakije imale su manju učestalost Hp infekcije u odnosu na kontrolnu grupu (15,7% prema 37,9%; p<0,001).
Marsh IIIa stepen histoloških promjena sluznice duodenuma je više bio zastupljen kod Hp- pacijenata (39,8% prema 9,1%; p=0,005). Marsh IIIc je češće bio zastupljen kod Hp+ pacijenata (63,6% prema 35%; p=0,011). Prisustvo Hp infekcije utiče na stepen oštećenja sluznice duodenuma (p=0,011).
Zaključak: Prevalenca Hp infekcije značajno je manja u oboljelih od celijakije. Teži stepen oštećenja sluznice duodenuma oboljelih od celijakije čiji je želudac kolonizovan sa Hp govori u prilog mogućeg sinergičkog djelovanja infekcije i autoimunskog procesa u celijakiji.
Ključne riječi: celijakija, Helicobacter pylori, gastritis, Marsh klasifikacija
Reference
Rodrigo L. Celiac Disease. Beijing 100023, China: World Journal of Gastroenterology, The WJG Pres; 2006. p. 6585-659.
Koning F, Schuppan D, Cerf-Bensussan N, Sollid LM. Pathomechanisms in celiac disease. Best Pract Res Clin Gastroenterol. 2005;19(3):373-87.
Kagnoff MF. Overview and pathogenesis of celiac disease. Gastroenterology. 2005;128(4 Suppl 1):S10-8.
Dube C, Rostom A, Sy R, Cranney A, Saloojee N, Garritty C, et al. The prevalence of celiac disease in average-risk and at-risk Western European populations: a systematic review. Gastroenterology. 2005;128(4 Suppl 1):S57-67.
Armstrong MJ, Hegade VS, Robins G. Advances in coeliac disease. Curr Opin Gastroenterol. 2012;28(2):104-12.
Rubio-Tapia A, Murray JA. Celiac disease. Curr Opin Gastroenterol. 2010;26(2):116-22.
Dewar DH, Ciclitira PJ. Clinical features and diagnosis of celiac disease. Gastroenterology. 2005;128(4 Suppl 1):S19-24.
Farrell RJ, Kelly CP. Diagnosis of celiac sprue.
Mulder CJ, Cellier C. Coeliac disease: changing views. Best Pract Res Clin Gastroenterol. 2005;19(3):313-21.
Green PH. The many faces of celiac disease: clinical presentation of celiac disease in the adult population. Gastroenterology. 2005;128(4 Suppl 1):S74-8.
De Giacomo C, Gianatti A, Negrini R, Perotti P, Bawa P, Maggiore G, et al. Lymphocytic gastritis: a positive relationship with celiac disease. J Pediatr. 1994;124(1):57-62.
Lasa J, Zubiaurre I, Dima G, Peralta D, Soifer L. HELICOBACTER PYLORI PREVALENCE IN PATIENTS WITH CELIAC DISEASE: results from a cross-sectional study. Arq Gastroenterol. 2015;52(2):139-42.
Marsh MN. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity ('celiac sprue'). Gastroenterology. 1992;102(1):330-54.
Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol. 1999;11(10):1185-94.
Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol. 1996;20(10):1161-81.
Green PH, Jabri B. Coeliac disease. Lancet. 2003;362(9381):383-91.
Diamanti A, Maino C, Niveloni S, Pedreira S, Vazquez H, Smecuol E, et al. Characterization of gastric mucosal lesions in patients with celiac disease: a prospective controlled study. Am J Gastroenterol. 1999;94(5):1313-9.
Nenna R, Magliocca FM, Tiberti C, Mastrogiorgio G, Petrarca L, Mennini M, et al. Endoscopic and histological gastric lesions in children with celiac disease: mucosal involvement is not only confined to the duodenum. J Pediatr Gastroenterol Nutr. 2012;55(6):728-32.
Lebwohl B, Green PH, Genta RM. The coeliac stomach: gastritis in patients with coeliac disease. Aliment Pharmacol Ther. 2015;42(2):180-7.
Rugge M, Genta RM. Staging and grading of chronic gastritis. Hum Pathol. 2005;36(3):228-33.
Jevon GP, Dimmick JE, Dohil R, Hassall EG. Spectrum of gastritis in celiac disease in childhood. Pediatr Dev Pathol. 1999;2(3):221-6.
Aydogdu S, Cakir M, Yuksekkaya HA, Tumgor G, Baran M, Arikan C, et al. Helicobacter pylori infection in children with celiac disease. Scand J Gastroenterol. 2008;43(9):1088-93.
Feeley KM, Heneghan MA, Stevens FM, McCarthy CF. Lymphocytic gastritis and coeliac disease: evidence of a positive association. J Clin Pathol. 1998;51(3):207-10.
Santarelli L, Gabrielli M, Santoliquido A, Cuoco L, Cazzato A, Candelli M, et al. Interaction between Helicobacter pylori infection and untreated coeliac disease on gastric histological pattern. Scand J Gastroenterol. 2006;41(5):532-5.
Okazaki K, Ohana M, Oshima C, Uchida K, Nishi T, Iwano M, et al. Interaction of Helicobacter pylori-induced follicular gastritis and autoimmune gastritis in BALB/c mice with post-thymectomy autoimmune gastritis. J Gastroenterol. 2003;38(12):1131-7.
Ohana M, Okazaki K, Oshima C, Kawasaki K, Fukui T, Tamaki H, et al. Inhibitory effects of Helicobacter pylori infection on murine autoimmune gastritis. Gut. 2003;52(8):1102-10.
Ciacci C, Squillante A, Rendina D, Limauro S, Bencivenga C, Labanca F, et al. Helicobacter pylori infection and peptic disease in coeliac disease. Eur J Gastroenterol Hepatol. 2000;12(12):1283-7.
Lebwohl B, Blaser MJ, Ludvigsson JF, Green PH, Rundle A, Sonnenberg A, et al. Decreased risk of celiac disease in patients with Helicobacter pylori colonization. Am J Epidemiol. 2013;178(12):1721-30.
Simondi D, Ribaldone DG, Bonagura GA, Foi S, Sapone N, Garavagno M, et al. Helicobacter pylori in celiac disease and in duodenal intraepithelial lymphocytosis: Active protagonist or innocent bystander? Clin Res Hepatol Gastroenterol. 2015.
Jozefczuk J, Bancerz B, Walkowiak M, Glapa A, Nowak J, Piescikowska J, et al. Prevalence of Helicobacter pylori infection in pediatric celiac disease. Eur Rev Med Pharmacol Sci. 2015;19(11):2031-5.
Crabtree JE, O'Mahony S, Wyatt JI, Heatley RV, Vestey JP, Howdle PD, et al. Helicobacter pylori serology in patients with coeliac disease and dermatitis herpetiformis. J Clin Pathol. 1992;45(7):597-600.
Rostami-Nejad M, Villanacci V, Mashayakhi R, Molaei M, Bassotti G, Zojaji H, et al. Celiac disease and Hp infection association in Iran. Rev Esp Enferm Dig. 2009;101(12):850-4.
Arnold IC, Dehzad N, Reuter S, Martin H, Becher B, Taube C, et al. Helicobacter pylori infection prevents allergic asthma in mouse models through the induction of regulatory T cells. J Clin Invest. 2011;121(8):3088-93.
Chen Y, Blaser MJ. Inverse associations of Helicobacter pylori with asthma and allergy. Arch Intern Med. 2007;167(8):821-7.
Robinson K, Kenefeck R, Pidgeon EL, Shakib S, Patel S, Polson RJ, et al. Helicobacter pylori-induced peptic ulcer disease is associated with inadequate regulatory T cell responses. Gut. 2008;57(10):1375-85.
Hmida NB, Ben Ahmed M, Moussa A, Rejeb MB, Said Y, Kourda N, et al. Impaired control of effector T cells by regulatory T cells: a clue to loss of oral tolerance and autoimmunity in celiac disease? Am J Gastroenterol. 2012;107(4):604-11.
Villanacci V, Bassotti G, Liserre B, Lanzini A, Lanzarotto F, Genta RM. Helicobacter pylori infection in patients with celiac disease. Am J Gastroenterol. 2006;101(8):1880-5.
Wolber R, Owen D, DelBuono L, Appelman H, Freeman H. Lymphocytic gastritis in patients with celiac sprue or spruelike intestinal disease. Gastroenterology. 1990;98(2):310-5.
Cammarota G, Fedeli G, Tursi A, Corazza GR, Gasbarrini G. Coeliac disease and follicular gastritis. Lancet. 1996;347(8996):268.
Vogelsang H, Oberhuber G, Wyatt J. Lymphocytic gastritis and gastric permeability in patients with celiac disease. Gastroenterology. 1996;111(1):73-7.
Brown IS, Smith J, Rosty C. Gastrointestinal pathology in celiac disease: a case series of 150 consecutive newly diagnosed patients. Am J Clin Pathol. 2012;138(1):42-9.
Bhatti TR, Jatla M, Verma R, Bierly P, Russo PA, Ruchelli ED. Lymphocytic gastritis in pediatric celiac disease. Pediatr Dev Pathol. 2011;14(4):280-3.