Review article: intestinal lymphoid nodular hyperplasia in children – the relationship to food hypersensitivity

Abstract

Summary Background Lymphoid aggregates are normally found throughout the small and large intestine. Known as lymphoid nodular hyperplasia (LNH), these aggregates are observed especially in young children and are not associated with clinical symptoms being considered ‘physiological’. In children presenting with gastrointestinal symptoms the number and size of the lymphoid follicles are increased. Patients suffering from gastrointestinal symptoms (i.e. recurrent abdominal pain) should systematically undergo gastroduodenoscopy and colonoscopy. With these indications LNH, especially of the upper but also of the lower gastrointestinal tract has been diagnosed, and in some children it may reflect a food hypersensitivity (FH) condition. Aim To review the literature about the relationship between LNH and FH, particularly focusing on the diagnostic work‐up for LNH related to FH. Methods We reviewed literature using Pubmed and Medline, with the search terms ‘lymphoid nodular hyperplasia’, ‘food hypersensitivity’, ‘food allergy’ and ‘food intolerance’. We overall examined 10 studies in detail, selecting articles about the prevalence of LNH in FH patients and of FH in LNH patients. Results Collected data showed a median of 49% (range 32–67%) LNH in FH patients and a median of 66% (range 42–90%) FH in LNH patients. Literature review pointed out that the most important symptom connected with LNH and/or FH was recurrent abdominal pain, followed by diarrhoea and growth retardation. Both LNH and FH are associated with an increase in lamina propria γ/δ+ T cells, but the mechanisms by which enhanced local immune responses causing gastrointestinal symptoms still remain obscure. Conclusions When assessing FH, we rely on clinical evaluation, including elimination diet and challenge tests, and endoscopic and immunohistochemical findings. Considering the possible co‐existence of duodenal and ileo‐colonic LNH, upper endoscopy can be recommended in children with suspected FH, especially in those presenting with additional upper abdominal symptoms (i.e. vomiting). Likewise, lower endoscopy might be additionally performed in patients with suspected FH and LNH of the duodenal bulb, also presenting with lower abdominal symptoms (i.e. recurrent abdominal pain).

A Rodent Model of Anxiety: The Effect of Perinatal Immune Challenges on Gastrointestinal Inflammation and Integrity

“…Increased intestinal permeability is thought to underlie the “leaky gut” hypothesis, which postulates that a GBA deficit may begin through a hyperpermeable intestinal epithelial barrier [52, 53]. Furthermore, the increase in lymphoid aggregates, indicative of lymphoid nodular hyperplasia, observed in the MIA neonatal offspring has been associated with an increase in lamina propria gamma-delta IELs [54]. In support of our animal model, lymphoid nodular hyperplasia is associated with viral and bacterial infection and mostly present in the small intestine.…”

“…In many cases it represents chronic inflammation in lamina propria, with or without subtle cytologic or architectural alteration [55, 56]. Furthermore, children presenting with GI symptoms have been found to have an increase in the number of intestinal lymphoid aggregates [54]. …”

Nodular lymphoid hyperplasia complicated with ileal Burkitt's lymphoma in an adult patient with selective IgA deficiency

“…NLH is a condition characterized with numerous small nodules diffusely distributed along the segments of the GI tract, histologically evaluated as reactive follicular hyperplasia [6]. In children, NLH has a benign course and is often associated with viral infections and food allergies [7]. In adults, associations were found with immunodeficiency disorders, Giardia infection, celiac disease and HP infection [8].…”

Nodular lymphoid hyperplasia: A marker of low-grade inflammation in irritable bowel syndrome?

“…The association between food allergies and NLH has been already documented[12,33,34]. Conversely, to the best of our knowledge, there are no published data on the relationship between NLH and allergic contact allergy.…”