Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Orlando, October 22-24, 1998
GLUTEN-INDUCED ENTEROPATHY DOES NOT PREVENT THE DEVELOPMENT OF GASTRIC METAPLASIA
Duodenal gastric metaplasia (GM) is seen in 60-100% of biopsies with peptic and infectious duodenitis. In contrast, GM is rarely described in untreated celiac disease (CD) and when reported was found in 7% of pediatric biopsies. The low incidence could represent under reporting , a low incidence of GM in pediatric patients or a unique feature of CD. The purpose of this study was to reexamine the incidence of GM in duodenal biopsies from children with untreated CD using specific antigenic markers for gastric foveolar cells to improve detection. Methods: Formalin-fixed paraffin biopsies were selected from hospital archival material, sectioned, and stained with PAS/alcian blue to distinguish neutral (gastric) mucus from acidic (intestinal) mucus. MUC2 (intestinal mucin), MUC5AC (gastric mucin) and pS2 (gastric trefoil factor) antigens were localized by specific antibodies using an antigen retieval protocol. 42 duodenal biopsies from untreated patients with CD (22) and controls of similar age with normal histology (22) were examined, comprising 10 celiac and 10 control biopsies taken at upper endoscopy (ages 1-16 years) and 12 celiac and 12 control biopsies obtained more distally by Crosby capsule (age 1-18). GM had not been previously identified in any biopsy by H&E. Results: 15 of 22 (68%) of the celiac and 2 of 22 (9%) control biopsies contained GM, identified by patches of gastric type cells containing MUC5AC, pS2 and neutral (PAS-positive) mucin. Neutral mucin was present in all cells containing MUC5AC and pS2. In CD the incidence of GM was same in endoscopic (70%) and capsule (67%) biopsies. Both GM pos. control biopsies were taken by capsule. Ten of 16 patients <age 6 had GM (63%). Conclusion: GM occurs in 68% of biopsies in untreated CD regardless of biopsy site and patient age. The enteropathy of CD does not prevent GM. Neutral mucin is strongly correlated with specific gastric markers. PAS/alcian blue is superior to H&E for detecting GM Dr. Shaoul is supported by the CCFF and Janssen/Ortho, and holds the Univ. of Toronto Dyson award and the Amer. Phys. Fellowship for Med. in Israel.
Intestine/Colon/IBD© 1998 Lippincott Williams & Wilkins, Inc.