Chronic Gastritis in Dermatitis Herpetiformis: A Controlled Study

Abstract

Background and Objective. Previous small studies suggest that chronic atrophic gastritis is common in dermatitis herpetiformis (DH). We here examined the frequency and topography of chronic gastritis in 93 untreated DH subjects and in 186 controls with dyspepsia. Methods. Specimens were drawn from the gastric corpus and antrum and examined for atrophy, intestinal metaplasia, and Helicobacter pylori. Duodenal biopsies were taken. Results. Atrophic corpus gastritis was more frequent in DH than in controls (16.0% and 2.7%, resp., P < 0.001); atrophy in the antrum was rare in both groups (3.2% and 1.1%, P = 0.34). Intestinal metaplasia was present in 13 (14.0%) DH and 12 (6.5%) control patients (P = 0.038) and H. pylori in 17 (18.3%) and 17 (9.3%) (P = 0.028), respectively. Small-bowel villous atrophy was seen in 76% of the DH patients, equally in patients with and without chronic gastritis. One DH patient with atrophic gastritis developed gastric cancer. Conclusion. In DH, chronic atrophic gastritis was common in the corpus, but not in the antrum. H. pylori will partly explain this, but corpus atrophy is suggestive of an autoimmune etiology. Atrophic gastritis may increase the risk of gastric cancer. We advocate performing upper endoscopy with sufficient histologic samples in DH.

Gastrointestinal Symptoms Increase the Burden of Illness in Dermatitis Herpetiformis: A Prospective Study

“…In previous studies the prevalence of GI symptoms in DH cohorts has varied from 30% to none (3,(25)(26)(27). Since both patients' and dermatologists' primary focus is on the troublesome skin symptoms, there is a possibility that, especially milder, GI symptoms are ignored or not fully addressed.…”

“…Diagnosis of DH is based on typical cutaneous symptoms and demonstration of granular immunoglobulin A (IgA) deposits in a skin biopsy (2). In addition to the skin manifestations, patients with DH also evince a coeliac-type glutensensitive small-bowel enteropathy, the majority having some degree of small-bowel mucosal villous atrophy (3). However, according to the present understanding, DH patients rarely experience gastrointestinal (GI) symptoms, although the evidence is scant.…”

Reduced mortality in dermatitis herpetiformis: a population‐based study of 476 patients

“…All patients with an intensive rash were started on dapsone. Gastroscopy with small intestinal biopsy was performed on more than half of the patients with DH and small bowel villous atrophy was graded morphologically as subtotal or partial villous atrophy or normal mucosa 23 . All patients were placed on a GFD.…”

“…Gastroscopy with small intestinal biopsy was performed on more than half of the patients with DH and small bowel villous atrophy was graded morphologically as subtotal or partial villous atrophy or normal mucosa. 23 All patients were placed on a GFD. They were given written dietary instructions and also encouraged to join the local Coeliac Society.…”

Quality of Life and Gastrointestinal Symptoms in Long-Term Treated Dermatitis Herpetiformis Patients: A Cross-Sectional Study in Finland

“…The majority of DH patients evince small-bowel mucosal villous atrophy characteristic of celiac disease, and the remainder have celiac-type inflammation in the gut. Regardless of the mucosal damage, DH patients are thought to suffer only rarely from gastrointestinal symptoms or have signs of malabsorption [4,5].…”