The coeliac stomach: gastritis in patients with coeliac disease

Abstract

Background Lymphocytic gastritis (LG) is an uncommon entity with varying symptoms and endoscopic appearances. This condition, as well as two forms of H. pylori-negative gastritis (chronic active gastritis [CAG] and chronic inactive gastritis [CIG]), appears to be more common in patients with coeliac disease (CD) based on single-center studies. Aim To compare the prevalence of LG, CAG, and CIG among those with normal duodenal histology (or non-specific duodenitis) and those with CD, as defined by villous atrophy (Marsh 3). Methods We analyzed all concurrent gastric and duodenal biopsy specimens submitted to a national pathology laboratory during a six-year period. We performed multiple logistic regression to identify independent predictors of each gastritis subtype. Results Among patients who underwent concurrent gastric and duodenal biopsy (n=287,503), the mean age was 52 and the majority (67%) was female. Compared to patients with normal duodenal histology, LG was more common inpartial villous atrophy (OR 37.66; 95% CI 30.16–47.03), and subtotal/total villous atrophy (OR 78.57; 95% CI 65.37–94.44). CD was also more common in CAG (OR for partial villous atrophy 1.93; 95%CI 1.49–2.51, OR for subtotal/total villous atrophy 2.42; 95%CI 1.90–3.09) and was similarly associated with CIG (OR for partial villous atrophy 2.04; 95%CI 1.76–2.35, OR for subtotal/total villous atrophy 2.96; 95% CI 2.60–3.38). Conclusion LG is strongly associated with CD, with increasing prevalence correlating with more advanced villous atrophy. CAG and CIG are also significantly associated with CD. Future researchshould measure the natural history of these conditions after treatment with a gluten-free diet.

Letter: hepatocellular carcinoma risk after hepatitis B surface antigen seroclearance

“…We show that the endoscopic appearance of the stomach was normal in a significant proportion of cases of gastritis. Although no difference in the severity of villous atrophy between the groups was found (possibly due to information biases), which differs from other reports of severe villous atrophy in association with gastritis, 1,5,6 we feel that the increase in tTG antibodies observed in the gastritis group might indicate either a longer disease duration in these individuals or perhaps a role of the gastric mucosa in the gluten-mediated immune reaction, knowing that tTG is ubiquitous and active in gastric mucosal cells in several diseases. 7,8 SIRS, In 2016 several studies published in Alimentary Pharmacology & Therapeutics focussing on the role of hepatitis B surface antigen (HBsAg) seroclearance and risk of hepatocellular carcinoma (HCC) were published.…”

“…7,8 SIRS, In 2016 several studies published in Alimentary Pharmacology & Therapeutics focussing on the role of hepatitis B surface antigen (HBsAg) seroclearance and risk of hepatocellular carcinoma (HCC) were published. [1][2][3][4] We read with great interest these articles, especially the one entitled 'Nested case-control study:…”

Letter: the coeliac stomach – a significant increase in tissue transglutaminase antibodies is associated with gastritis

“…Like Lebwohl et al, the majority of our coeliac disease cohort had abnormal gastric histology (63.75%). 1 We observed a higher proportion of chronic inactive gastritis (CIG) (31.25%), a similar occurrence of chronic AP&T invited editorial and correspondence columns are restricted to letters discussing papers that have been published in the journal. A letter must have a maximum of 500 words, may contain one table or figure, and should have no more than 10 references.…”

“…1,2 Some relevant clinical data were missing from these analyses and we believe our results could further the understanding of the 'coeliac stomach'. Our cohort of newly diagnosed coeliac disease adult patients includes only patients with suggestive duodenal histology with positive tissue transglutaminase (tTG) antibodies analysed at our centre in the 3 months preceding the gastroscopy.…”

“…7,8 SIRS, In 2016 several studies published in Alimentary Pharmacology & Therapeutics focussing on the role of hepatitis B surface antigen (HBsAg) seroclearance and risk of hepatocellular carcinoma (HCC) were published. [1][2][3][4] We read with great interest these articles, especially the one entitled 'Nested case-control study: hepatocellular carcinoma risk after hepatitis B surface antigen seroclearance' by Gounder et al 1 Although effective vaccines for hepatitis B virus have been available for more than two decades, chronic hepaitits B (CHB) virus infection remains a leading cause of severe liver cirrhosis and HCC worldwide. In real-life clinical practice, hepatitis B surface antigen (HBsAg) seroclearance has been regarded as an important endpoint in both natural history of hepatitis B virus infection and treatment of CHB.…”