Duodenal intraepithelial lymphocytosis is common in children without coeliac disease, and is not meaningfully influenced by <i>Helicobacter pylori</i> infection

Guz‐Mark, Anat; Zevit, Noam; Morgenstern, Sara; Shamir, Raanan

doi:10.1111/apt.12739

Cited by 21 publications

(12 citation statements)

References 38 publications

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“…It has been established that Hp infection causes duodenitis and induces intra‐epithelial lymphocytosis, whereby Hp infection may contribute to more severe damage in patients with CD. In this study, the histologic severity of duodenal lesions was not influenced by the presence of Hp infection, and it was comparable to the previous publications 12,21,30 . However, there are studies demonstrating milder inflammation in the duodenum of celiac patients when there was a concomitant Hp infection.…”

Section: Discussionsupporting

confidence: 90%

Helicobacter pylori infection in children with celiac disease: Multi‐center, cross‐sectional study

et al. 2020

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Background An inverse association has been suggested between celiac disease (CD) and Helicobacter pylori (Hp) infection in children; however, there are inconsistent data. The purpose of this multi‐center study is to evaluate the association between Hp and CD in childhood. Methods Children who underwent endoscopy between July 2016 and November 2017 in four pediatric gastroenterology centers were included in the study. Patients with a history of previous Hp eradication, antibiotic or acid‐suppressive drug therapy in the last 4 weeks, and any underlying chronic disease were excluded. The presence of Hp infection was confirmed by both histopathology and the rapid urease test. The ones who had the diagnosis of CD were compared with the children who underwent endoscopy during the same period and had another diagnosis. Duodenal histopathology of children with CD was categorized according to the modified Marsh classification. Results Of 3056 endoscopies performed in the study period, 2484 cases were eligible for the study. A total of 482 CD patients (mean age: 9.71 ± 4.63 years, 58.5% girls) and 2060 controls (mean age: 9.92 ± 4.66 years, 54.6% girls) were included in the study. The rate of Hp infection was significantly lower in CD group (26.3% vs 50.1%, P < .01). The difference was prominent even in children younger than 6 years old (P < .01). There was no correlation between Hp infection and the modified Marsh scores in CD (P > .05). Conclusion In this cross‐sectional study, where Hp infection is common even in the pediatric population, the frequency of Hp infection was significantly lower in children with CD compared with the controls. Systematic cohort studies are necessary to clarify causal association between Hp infection and the development of celiac disease.

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Section: Discussionsupporting

confidence: 90%

Helicobacter pylori infection in children with celiac disease: Multi‐center, cross‐sectional study

et al. 2020

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“…For H. pylori -related duodenal lymphocytosis, eradication therapy should be proposed [139,140]. Antibiotics have shown effectiveness in both bacteria eradication and ME reversal [76]. Other intestinal infections require treatment that is targeted according to the etiologic agent, such as metronidazole for Giardia spp , rifaximin for SIBO, or fluoroquinolones for other bacterial species [141-143].…”

Section: Treatmentmentioning

confidence: 99%

Lymphocytic duodenitis or microscopic enteritis and gluten-related conditions: what needs to be explored?

Ierardi¹,

Losurdo²,

Iannone³

et al. 2017

aog

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Microscopic enteritis (ME) is characterized by abnormal infiltration of intraepithelial lymphocytes in intestinal mucosa. It was described as duodenal lymphocytosis or lymphocytic duodenitis until the dedicated Consensus Conference of 2015. ME represents a common feature of several gluten-mediated and non-gluten related diseases; therefore, it is an umbrella term embracing several conditions. The most frequent causes of ME are gluten-related disorders (celiac disease, non-celiac gluten sensitivity, wheat allergy), Helicobacter pylori infection and drug-related damages. Less frequently, ME may be secondary to inflammatory bowel disease, some autoimmune conditions, immunoglobulin deficiencies, blood malignancies, infections and irritable bowel syndrome. Therefore, the differential diagnosis of ME may be challenging. The diagnosis of ME needs to be driven by predominant symptoms and patient history. However, it is often difficult to achieve an immediate identification of the underlying condition, and a broad variety of diagnostic tests may be required. Ultimately, long-term surveillance is needed for a final diagnosis in many cases, since a hidden or quiescent condition may be disclosed after a period of latency. In any case, strict collaboration between the clinician and the pathologist is pivotal. The treatment of ME should be personalized, depending on the underlying disease. For gluten-related conditions (celiac disease, gluten sensitivity, wheat allergy, dermatitis herpetiformis), a gluten-free diet may be proposed. For other conditions, a targeted etiologic treatment is necessary. In conclusion, ME represents a novel entity that is attracting increasing interest. The growing epidemiologic trend confirms that it will become a common condition in clinical practice.

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“…In patients without CD, Hp had a marginal effect on the duodenal IEL counts, from an average of 15 IELs/100 to 17 (Hp negative vs. Hp positive respectively). The authors also showed a slight trend among the positive Hp patients to have more severe villous atrophy [21]. This finding contrasts those of both Villanacci and Aydogu, who reported higher rates of low-grade lesions among positive Hp celiac patients [22,23].…”

Section: Resultsmentioning

confidence: 60%

“…Several authors also a correlation with lymphocytic gastritis (LG) which is also the most frequent form of gastritis observed in celiac patients [8][9][10][11]20,21].…”

Section: Resultsmentioning

confidence: 98%

Celiac Disease and Helicobacter Pylori Infection: an Ups and Downs Correlation

Pontone¹

2014

Int J Gastroenterol Disord Ther

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Background: Several studies showed an involvement of the gastric mucosa in celiac disease (CD). Helicobacter pylori (Hp) is the major agent of gastric damage. The aim of this article was to present a literature review of a possible correlation between the two conditions. Methods: A literature search was conducted in Medline, Scopus and Directory of Open Access Journal (DOAJ) using appropriate keywords. We included only articles written in English over the period July 1996 -May 2014. Results: The search for Medline, Scopus and DOAJ provided a total of 530 citation. Twenty five studies met the inclusion criteria and were included in quantitative analysis. The prevalence of Hp infection in celiac children and adults from different geographical areas has been reported. The possible correlation between Hp infection and the increase of intraepithelial lymphocytes (IEL) has also been reported. Conclusion: Several studies showed a wide heterogeneity. This is probably due to differences in Hp prevalence, small series of patients, lack of histological confirmation of Hp and lack of adjustment for sociodemographic characteristics. More studies to clarify the possible correlation between these two conditions are necessary.

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Duodenal intraepithelial lymphocytosis is common in children without coeliac disease, and is not meaningfully influenced by Helicobacter pylori infection

Cited by 21 publications

References 38 publications

Helicobacter pylori infection in children with celiac disease: Multi‐center, cross‐sectional study

Helicobacter pylori infection in children with celiac disease: Multi‐center, cross‐sectional study

Lymphocytic duodenitis or microscopic enteritis and gluten-related conditions: what needs to be explored?

Celiac Disease and Helicobacter Pylori Infection: an Ups and Downs Correlation

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