Effects of Helicobacter Pylori Infection on Serology and Intestinal Mucosal Changes in Pediatric Patients With Celiac Disease: A Retrospective Cohort Study

Abstract

Introduction Helicobacter pylori (HP) and celiac disease (CD) can cause similar mucosal damage to the duodenal mucosa. For this reason, the relationship between these two diseases has been the subject of research recently. Our study aims to investigate the effects of HP infection on serology and pathology in pediatric patients with CD or potential celiac disease (PCD). Methods It is a retrospective cohort study conducted in the third-level education and research hospital between July 2017 and May 2019. The serological and pathological data of patients diagnosed with CD or PCD were compared statistically according to the presence of HP. Results An analysis of the histopathological data of the endoscopic biopsy samples showed Helicobacter pylori in eight (50%) of PCD patients and 37 (41.6%) of CD patients. No significant difference was found between the two groups (P=0.531). We found that dokutransglutaminas antibody level (DTG) and endomysium antibody level (EMA) serology decreased significantly after HP eradication therapy in HP (+) PCD (P=0.002, P<0.001). Intestinal metaplasia was not present in PCH. However, intestinal metaplasia was present in five patients (13.5%) with HP (+) CD and two patients (3.8%) with HP (-) CD. However, that difference was not statistically significant between the two groups (P=0.095). Conclusion Our study demonstrated that HP may augment CD's serology and serological improvement is possible after HP treatment particularly in HP (+) PCD. Therefore, we recommend re-perform diagnostic studies after HP treatment before commencing a gluten-free diet in HP (+) suspected CD cases.

Epidemiological, clinical, and histological presentation of celiac disease in Northwest China

“…We evaluated the relationship between H. pylori infection and CD and found that H. pylori -positive CD patients demonstrated more severe mucosal damage than H. pylori -negative CD patients (Marsh grades 2 and 3) ( P = 0.018). This finding is similar to that of Gungor et al [ 40 ]. However, it has been reported that in individuals without CD, H. pylori infection itself can cause duodenal mucosal damage[ 41 ].…”

Review article: Becoming and being coeliac—special considerations for childhood, adolescence and beyond

“…It is crucial to avoid misdiagnosis of PCD, either by overlooking another cause for TTG IgA elevation or by failing to diagnose CD. Transient TTG IgA elevation in the absence of CD has been described in giardiasis, 100 Helicobacter pylori infection, 101 liver disease, 102 inflammatory bowel disease, 103 autoimmune pancreatitis, 104 Graves disease 105 and fever 70 . Failure to identify histologic findings when present is a major contributor to underdiagnosis of CD and may arise from patient, clinician or laboratory factors.…”