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Lymphocytic Gastritis and Celiac Disease: Evidence of A Positive Relationship

Prasad, K K; Sinha, S K; Sharma, A K; Nain, C K; Bhasin, D K; Singh, K

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Department of Superspeciality of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh (UT), India

Aim: Lymphocytic gastritis (LG) is a histological entity characterised by intense lymphocytic infiltration (≥25 lymphocytes/100 epithelial cells) in the gastric surface and pit epithelium. Its cause has not been established, but an association with Helicobacter pylori infection or celiac disease (CD) has been suggested. The aim of this study was to verify the association of LG in adults with CD, with and without H. pylori infection.

Methods: This prospective study included 63 adults with CD in whom gastric and duodenal biopsy was taken simultaneously. The adults were diagnosed as cases of CD based on the modified ESPGHAN criteria and positive serology. The control consisted of 63 non‐celiac adults matched for gender and age (within 2 years) without any gastric or duodenal ulcer in whom upper digestive endoscopy was performed. Helicobacter pylori were recognised in gastric biopsy on H&E sections; a modified Giemsa stain was performed in biopsy suspicious for H. pylori. The results were expressed as number and percentage or mean+SEM. Comparisons of quantitative measurements between groups were performed with Student's t test.

Results: The mean age of CD cases (M:F 27:36) at presentation was 34.7±2.2 years. LG was found in 22 (34.9%) CD cases. CD cases positive for LG had a mean gastric IEL/100 surface epithelial cells of 43.2±3.5, compared with a mean of 10.5±0.7 in negative cases. CD cases not showing LG, however, did show significantly increased gastric IEL compared with non‐celiac controls (10.5±0.7 vs 4.9±0.3; p<0.0001). Three of 63 (4.8%) CD patients were positive for H. pylori, and none of 22 cases of LG were H. pylori positive.

Conclusions: This study shows support for a pathogenetic relationship between celiac disease and lymphocytic gastritis. Celiac disease without lymphocytic gastritis also showed increased gastric intraepithelial lymphocytes. Histopathologists should be alerted to the distinct appearance of lymphocytic gastritis, and duodenal biopsy may be considered to pick up the celiac disease cases.

© 2009 Royal College of Pathologists of Australasia

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