Villanacci Vincenzo, Bassotti Gabrio, Liserre Barbara, Lanzini Alberto, Lanzarotto Francesco, Genta Robert M
2nd Pathology Section, Spedali Civili, Brescia, Brescia, Italy.
Am J Gastroenterol. 2006 Aug;101(8):1880-5. doi: 10.1111/j.1572-0241.2006.00621.x. Epub 2006 Jun 16.
Patients with Helicobacter pylori gastritis are more likely to have increased duodenal intraepithelial lymphocytes (IEL); this can be reversed by H. pylori eradication. We hypothesized that: (1) H. pylori-infected celiac disease (CD) patients could have different clinicopathological features from noninfected subjects; and (2) the histopathological responses to a gluten-free diet could be different in H. pylori-infected and noninfected patients.
Duodenal and gastric biopsies obtained from 80 adults with histologically and serologically confirmed CD before and after 12-18 months of a gluten-free diet were retrospectively evaluated. Gastritis was classified and scored according to the Updated Sydney System; duodenal biopsies were classified using both the Marsh-Oberhuber and a simplified classification proposed by our group.
At baseline, 30 patients had H. pylori infection and 50 did not; at follow-up five new infections were detected. Fifteen patients (3 H. pylori-positive and 12 negative) had lymphocytic gastritis. At baseline, a greater proportion of H. pylori-negative patients had severe villous atrophy (p < 0.01), but milder forms were more prevalent in H. pylori-positive patients (p < 0.01). After a gluten-free diet, significant improvement occurred in all duodenal features (p < 0.001), irrespective of H. pylori status; gastric variables did not change, except for lymphocytic, which resolved in 2 infected and 10 noninfected patients.
The clinical features of CD patients are unrelated to H. pylori gastritis, and a gluten-free diet is equally effective in infected as in uninfected patients. The higher prevalence of milder duodenal lesions in CD patients with H. pylori infection suggests that lymphocytosis induced by H. pylori gastric infection becomes less obvious as profound inflammatory and structural changes alter the mucosal architecture. This study also provides further support for a pathogenetic relationship between CD and lymphocytic gastritis.
幽门螺杆菌胃炎患者十二指肠上皮内淋巴细胞（IEL）更有可能增多；根除幽门螺杆菌可使其逆转。我们推测：（1）幽门螺杆菌感染的乳糜泻（CD）患者可能具有与未感染患者不同的临床病理特征；（2）幽门螺杆菌感染和未感染的患者对无麸质饮食的组织病理学反应可能不同。
回顾性评估了80例经组织学和血清学确诊为CD的成年人在接受12 - 18个月无麸质饮食前后获取的十二指肠和胃活检标本。根据更新的悉尼系统对胃炎进行分类和评分；十二指肠活检标本使用马什 - 奥伯胡伯分类法以及我们团队提出的简化分类法进行分类。
基线时，30例患者有幽门螺杆菌感染，50例没有；随访时检测到5例新感染。15例患者（3例幽门螺杆菌阳性和12例阴性）有淋巴细胞性胃炎。基线时，幽门螺杆菌阴性患者中重度绒毛萎缩的比例更高（p < 0.01），但轻度形式在幽门螺杆菌阳性患者中更常见（p < 0.01）。无麸质饮食后，所有十二指肠特征均有显著改善（p < 0.001），与幽门螺杆菌状态无关；胃的各项指标未改变，但淋巴细胞性胃炎在2例感染患者和10例未感染患者中得到缓解。
CD患者的临床特征与幽门螺杆菌胃炎无关，无麸质饮食对感染患者和未感染患者同样有效。幽门螺杆菌感染的CD患者中较轻十二指肠病变的患病率较高，这表明随着严重的炎症和结构变化改变了黏膜结构，幽门螺杆菌胃部感染诱导的淋巴细胞增多变得不那么明显。本研究也为CD与淋巴细胞性胃炎之间的发病机制关系提供了进一步支持。
