Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis

Abstract

We have observed expansions of intraepithelial lymphocytes in duodenal biopsies from patients with Helicobacter pylori gastritis. This study was undertaken to prospectively evaluate, unselected, paired gastric and duodenal biopsies from 50 patients with H. pylori gastritis and a comparison group of 30 patients with other types of gastritis (10 autoimmune and 20 reactive) to: (1) quantify duodenal intraepithelial lymphocytes, determine their distribution patterns, epithelial location, and phenotype, and (2) correlate the intraepithelial lymphocyte elevations with various features of gastric and duodenal pathology. Intraepithelial lymphocytes were analyzed with antibodies including CD3, CD8, and TIA-1. A stain for H. pylori was performed on all gastric and duodenal biopsies. Duodenal intraepithelial lymphocytes from patients with H. pylori gastritis (using CD3) ranged from 3 to 42 lymphocytes/100 epithelial cells (mean 18.5) compared to 3 to 18 lymphocytes/100 epithelial cells (mean 6.6) in the comparison group. Intraepithelial lymphocyte elevations were seen in 44% of the duodenal biopsies from patients with H. pylori gastritis (using CD3). Significant differences in the intraepithelial lymphocyte counts between patients with H. pylori gastritis and the comparison group were seen for all three T-cell antigens (Po0.001 for CD3 and CD8 and Po0.002 for TIA-1). Duodenal intraepithelial lymphocytes in the H. pylori þ cases had a latent cytotoxic phenotype, H. pylori was not visualized in any of the duodenal biopsies from patients with H. pylori gastritis, and no patient had clinical evidence of celiac disease. Our study highlights frequent duodenal intraepithelial lymphocytosis in individuals with H. pylori gastritis and the lymphocyte distribution patterns (and numbers) overlapped with those described for celiac disease patients. H. pylori gastritis must be considered as a possible explanation for duodenal intraepithelial lymphocytosis with normal villous architecture, especially when lymphocytosis is patchy, intraepithelial lymphocytes display a 'latent' cytotoxic phenotype, and the clinical findings and serologic profile does not fit celiac disease.

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

“…Previous publications have referred to an early study reporting increased IEL counts in the duodenum of patients with peptic ulcers, prior to the discovery of H. pylori. 29 Memeo et al 30 studied 50 H. pylori positive adults and found a higher rate of increased IELs when compared with 30 patients with non-H. pylori gastritis. The study used a very low limit of IELs (20), and only few patients were tested for CD (posing an alternative explanation of duodenal lymphocytosis).…”

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

“…In contrast to the Guz-Mark study, Memeo et al reported an increase in IEL count in their group of 50 Hp positive adult patients compared with 30 Hp negative patients but this study used a lower limit of IELs (20 IEL/100) and only few patients were tested for CD [24].…”

Duodenal lymphocytosis with no or minimal enteropathy: much ado about nothing?

“…Furthermore, a subset of these cases resolves when the infection is eradicated. [36][37][38] Tropical enteropathy (sprue), which may present with normal villi but increased IELs, is diagnosed in patients who have lived in tropical regions, even for a limited time. The morphology is identical to that of celiac disease (Figure 3).…”