Helicobacter pylori in celiac disease and in duodenal intraepithelial lymphocytosis: Active protagonist or innocent bystander?

Simondi, Daniele; Ribaldone, Davide Giuseppe; Bonagura, G.; Foi, Simona; Sapone, N.; Garavagno, Marco; Villanacci, Vincenzo; Bernardi, D.; Pellicano, Rinaldo; Rizzetto, M.; Astegiano, Marco

doi:10.1016/j.clinre.2015.03.005

Cited by 35 publications

(36 citation statements)

References 36 publications

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“…In an adult study, Villanacci et al 31 studied 80 celiac patients who were infected with Hp and found milder duodenal damage in Hp ‐infected celiac patients. In another adult study, the rate of Hp was 50% and 33% in Marsh grade I–II and grade III lesions, respectively, reflecting that the rate of Hp infection was higher in celiac patients with less severe duodenal damage 32 . Aydogdu et al 20 found that Marsh grade I duodenal lesion was more common in celiac children infected with Hp, compared to those without Hp infection (57.1% vs. 26.7%, respectively).…”

Section: Discussionmentioning

confidence: 94%

Helicobacter pylori infection in children with celiac disease: Multi‐center, cross‐sectional study

et al. 2020

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Background An inverse association has been suggested between celiac disease (CD) and Helicobacter pylori (Hp) infection in children; however, there are inconsistent data. The purpose of this multi‐center study is to evaluate the association between Hp and CD in childhood. Methods Children who underwent endoscopy between July 2016 and November 2017 in four pediatric gastroenterology centers were included in the study. Patients with a history of previous Hp eradication, antibiotic or acid‐suppressive drug therapy in the last 4 weeks, and any underlying chronic disease were excluded. The presence of Hp infection was confirmed by both histopathology and the rapid urease test. The ones who had the diagnosis of CD were compared with the children who underwent endoscopy during the same period and had another diagnosis. Duodenal histopathology of children with CD was categorized according to the modified Marsh classification. Results Of 3056 endoscopies performed in the study period, 2484 cases were eligible for the study. A total of 482 CD patients (mean age: 9.71 ± 4.63 years, 58.5% girls) and 2060 controls (mean age: 9.92 ± 4.66 years, 54.6% girls) were included in the study. The rate of Hp infection was significantly lower in CD group (26.3% vs 50.1%, P < .01). The difference was prominent even in children younger than 6 years old (P < .01). There was no correlation between Hp infection and the modified Marsh scores in CD (P > .05). Conclusion In this cross‐sectional study, where Hp infection is common even in the pediatric population, the frequency of Hp infection was significantly lower in children with CD compared with the controls. Systematic cohort studies are necessary to clarify causal association between Hp infection and the development of celiac disease.

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Section: Discussionmentioning

confidence: 94%

Helicobacter pylori infection in children with celiac disease: Multi‐center, cross‐sectional study

et al. 2020

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“…In a group of patients with functional dyspepsia, a direct relationship was demonstrated between the presence of H. pylori and ME [71]. Furthermore, in a Spanish prospective study, H. pylori was considered as the starting point for 24.4% of ME cases [72], while 19% of subjects with ME had positivity for H. pylori in an Italian series [73]. Additionally, Memeo et al showed that duodenal IELs from patients with H. pylori gastritis ranged from 3-42 lymphocytes per 100 enterocytes (mean 18.5) compared to 3-18 lymphocytes/100 epithelial cells (mean 6.6) in the control group [74].…”

Section: Origin Of Mementioning

confidence: 99%

Lymphocytic duodenitis or microscopic enteritis and gluten-related conditions: what needs to be explored?

Ierardi¹,

Losurdo²,

Iannone³

et al. 2017

aog

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Microscopic enteritis (ME) is characterized by abnormal infiltration of intraepithelial lymphocytes in intestinal mucosa. It was described as duodenal lymphocytosis or lymphocytic duodenitis until the dedicated Consensus Conference of 2015. ME represents a common feature of several gluten-mediated and non-gluten related diseases; therefore, it is an umbrella term embracing several conditions. The most frequent causes of ME are gluten-related disorders (celiac disease, non-celiac gluten sensitivity, wheat allergy), Helicobacter pylori infection and drug-related damages. Less frequently, ME may be secondary to inflammatory bowel disease, some autoimmune conditions, immunoglobulin deficiencies, blood malignancies, infections and irritable bowel syndrome. Therefore, the differential diagnosis of ME may be challenging. The diagnosis of ME needs to be driven by predominant symptoms and patient history. However, it is often difficult to achieve an immediate identification of the underlying condition, and a broad variety of diagnostic tests may be required. Ultimately, long-term surveillance is needed for a final diagnosis in many cases, since a hidden or quiescent condition may be disclosed after a period of latency. In any case, strict collaboration between the clinician and the pathologist is pivotal. The treatment of ME should be personalized, depending on the underlying disease. For gluten-related conditions (celiac disease, gluten sensitivity, wheat allergy, dermatitis herpetiformis), a gluten-free diet may be proposed. For other conditions, a targeted etiologic treatment is necessary. In conclusion, ME represents a novel entity that is attracting increasing interest. The growing epidemiologic trend confirms that it will become a common condition in clinical practice.

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“…The literature reports that H. pylori infection is related to duodenal lymphocytosis[9], which disappears after bacterial eradication. At the same time, we have recently found an inverse association between MC and H. pylori infection[29].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, there are patients with suggestive symptoms of CD, mild duodenal damage [ i.e ., an increase of intraepithelial lymphocytes (IEL)] defined type I, according to Marsh-Oberhuber classification, and negative antibody tests. This clinical condition, that does not conform with the diagnosis of CD, needs to be investigated for other causes[9]. …”

Section: Introductionmentioning

confidence: 99%

Microscopic colitis in patients with mild duodenal damage: A new clinical and pathological entity (“lymphocytic enterocolitis”)?

Bonagura¹,

Ribaldone²,

Fagoonee³

et al. 2016

WJGP

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AIMTo evaluate the potential association between mild duodenal damage and microscopic colitis (MC).METHODSWe retrospectively included 105 consecutive patients with type I Marsh-Oberhuber duodenal damage and negativity for immunoglobulin A anti-endomysium and anti-tissue transglutaminase. The following parameters were analyzed: Sex, age at execution of esophagogastroduodenoscopy, duodenal damage, and number of intraepithelial lymphocytes at biopsies, prevalence of Helicobacter pylori infection, age at execution of colonoscopy, macroscopic and microscopic features of colonoscopy, family history of gastrointestinal and autoimmune diseases, smoking habits, biochemical parameters of inflammation and autoimmunity, use of proton pump inhibitors or nonsteroidal anti-inflammatory drugs, adverse reactions to drugs or foods, pathologies known to be associated with celiac disease or MC, living on a gluten-free diet or on a gluten-low diet for at least 1 mo.RESULTSColonoscopy was performed in 59 patients, but only in 48 of them biopsies were taken in the entire colon. Considering the latter cohort, the diagnosis of MC was met in 25 (52.1%) patients while in 18 patients other pathologic findings were reported: 13 (27%) cases of nonspecific inflammatory bowel disease, 2 (4.2%) cases of Crohn’s disease, 2 (4.2%) cases of eosinophilic gastroenteritis, and 1 (2.1%) case of autoimmune enteritis. Five (10.4%) patients had a normal colonoscopic result. Matching the groups by age, and considering only patients who underwent colonoscopy (42.7 ± 15.5 years) vs those who did not undergo colonoscopy (36.9 ± 10.6 years), a statistical difference was found (P = 0.039). Focusing on symptoms, diarrhea was statistically more prevalent in MC group than in patients who did not undergo colonoscopy (P = 0.03).CONCLUSIONMild duodenal damage is associated with MC in more than half of the cases. This association supports the hypothesis of a link between these two entities.

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Helicobacter pylori in celiac disease and in duodenal intraepithelial lymphocytosis: Active protagonist or innocent bystander?

Cited by 35 publications

References 36 publications

Helicobacter pylori infection in children with celiac disease: Multi‐center, cross‐sectional study

Helicobacter pylori infection in children with celiac disease: Multi‐center, cross‐sectional study

Lymphocytic duodenitis or microscopic enteritis and gluten-related conditions: what needs to be explored?

Microscopic colitis in patients with mild duodenal damage: A new clinical and pathological entity (“lymphocytic enterocolitis”)?

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