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Endoscopic and Histological Gastric Lesions in Children With Celiac Disease: Mucosal Involvement Is Not Only Confined to the Duodenum

Nenna, Raffaella*; Magliocca, Fabio Massimo; Tiberti, Claudio; Mastrogiorgio, Gerarda*; Petrarca, Laura*; Mennini, Maurizio*; Lucantoni, Federica*; Luparia, Rita Pia Lara*; Bonamico, Margherita*

Journal of Pediatric Gastroenterology and Nutrition: December 2012 - Volume 55 - Issue 6 - p 728–732
doi: 10.1097/MPG.0b013e318266aa9e
Original Articles: Gastroenterology

Objectives: Lymphocytic gastritis (LG) has been reported in patients with celiac disease (CD). The aim of the present study was to evaluate gastric mucosa involvement in celiac children and gastroenterological controls (GC).

Methods: In a retrospective study on 226 patients with CD (82 M; median age: 5.7years) at diagnosis and 154 GC (66 M; median age: 7.4 years), the evaluation of gastric and duodenal mucosa was performed. CD was diagnosed according to the North America Society for Pediatric Gastroenterology, Hepatology, and Nutrition criteria. Gastric lesions were classified according to Updated Sydney System. Anti-gastric parietal cell antibodies (GPCA) were assayed by enzyme-linked immunosorbent assay.

Results: A total of 21.2% and 7% of patients with CD showed chronic superficial gastritis (CSG) and LG, respectively. Helicobacter pylori (Hp) infection was found in 6 (2.7%) children with CD (66.7% had CSG, 16.7% LG, and 16.7% interstitial gastritis). CSG was present in 21.4% of controls. No control subject showed LG. Hp infection was found in 24 (15.6%) children with GC (91.7% had CSG). Among patients with CSG, Hp infection was more frequent in controls than in celiac children (P < 0.0001). Ten of 90 patients with CD and 1 of 29 controls were positive for GPCA.

Conclusions: Gastritis is a common finding in children with CD and adolescents. In celiac subjects, CSG is the most frequently detected. Our data suggest the hypothesis that LG may be related to a longer exposure to gluten. The presence of GPCA may suggest the presence of an underlying autoimmune process.

*Department of Pediatrics

Department of Experimental Medicine and Pathology

Department of Internal Medicine and Medical Specialties, “Sapienza” University of Rome, Rome, Italy.

Address correspondence and reprint requests to Dr Raffaella Nenna, Department of Pediatrics, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy (e-mail:

Received 29 May, 2012

Accepted 21 June, 2012

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN