HISTOPATHOLOGICAL CHANGES OF GASTRIC MUCOSA IN CELIAC DISEASE
Abstract
Background: Celiac disease (CD) is a chronic autoimmune disease caused by ingestion of gluten in genetically susceptible individuals. Lymphocytic gastritis (LG) can be found in CD patients, with possible lower incidence of chronic Helicobacter pylori (Hp) positive gastritis.
Aim: The aim was to assess the frequency and type of histopathological changes of gastric mucosa in patients with proven CD.
Materials and methods: This study included patients who underwent esophagogastroduodenoscopy (EGDS) and histopathological examination. Patients were distributed into two groups: patients with and without histopathological alterations indicative of CD.
Results: The study included 351 patients. CD was detected in 145 (41.3%) patients, while the control group consisted of 206 (58.7%) patients without CD confirmation.
The most common symptom in CD patients was diarrhea, while patients in the control group most often complained of dyspepsia, fatigue and bloating (p=0.001).
Chronic superficial gastritis was the most common gastritis in both groups of patients (76% and 63.6%; p>0.05). Gastritis associated with Hp infection was present in 29.3% of CD patients, which is significantly less than in people without CD where 62% of gastritis is associated with Hp infection (p<0.001). In this study we haven't discovered other forms of gastritis.
Patients with CD had significantly lower incidence of Hp infection compared to the control group (15.7% vs. 37.9%; p<0.001).
Marsh IIIa degree was significantly more prevalent in Hp- patients compared to Hp+ patients (39.8% vs. 9.1%; p=0.005). Marsh IIIc was more prevalent in Hp+ patients (63.6% prema 35%; p=0.011). The presence of Hp infection affects the degree of damage to duodenal mucosa (p= 0.011).
Conclusion: The prevalence of Hp infection was significantly lower in CD patients. The higher degree of damage to duodenal mucosa in Hp+ CD patients may contribute to the possible synergistic effect of infection and autoimmunity in CD.
Key words: Coeliac disease, Helicobacter pylori, gastritis, Marsh qlassification
References
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.