儿童乳糜泻的内镜和组织学胃病变：黏膜受累不仅局限于十二指肠。

Endoscopic and histological gastric lesions in children with celiac disease: mucosal involvement is not only confined to the duodenum.

机构信息

Department of Pediatrics, Sapienza University of Rome, Rome, Italy.

出版信息

J Pediatr Gastroenterol Nutr. 2012 Dec;55(6):728-32. doi: 10.1097/MPG.0b013e318266aa9e.

DOI:10.1097/MPG.0b013e318266aa9e

PMID:22773062

Abstract

OBJECTIVES

Lymphocytic gastritis (LG) has been reported in patients with celiac disease (CD). The aim of the present study was to evaluate gastric mucosa involvement in celiac children and gastroenterological controls (GC).

METHODS

In a retrospective study on 226 patients with CD (82 M; median age: 5.7 years) at diagnosis and 154 GC (66 M; median age: 7.4 years), the evaluation of gastric and duodenal mucosa was performed. CD was diagnosed according to the North America Society for Pediatric Gastroenterology, Hepatology, and Nutrition criteria. Gastric lesions were classified according to Updated Sydney System. Anti-gastric parietal cell antibodies (GPCA) were assayed by enzyme-linked immunosorbent assay.

RESULTS

A total of 21.2% and 7% of patients with CD showed chronic superficial gastritis (CSG) and LG, respectively. Helicobacter pylori (Hp) infection was found in 6 (2.7%) children with CD (66.7% had CSG, 16.7% LG, and 16.7% interstitial gastritis). CSG was present in 21.4% of controls. No control subject showed LG. Hp infection was found in 24 (15.6%) children with GC (91.7% had CSG). Among patients with CSG, Hp infection was more frequent in controls than in celiac children (P < 0.0001). Ten of 90 patients with CD and 1 of 29 controls were positive for GPCA.

CONCLUSIONS

Gastritis is a common finding in children with CD and adolescents. In celiac subjects, CSG is the most frequently detected. Our data suggest the hypothesis that LG may be related to a longer exposure to gluten. The presence of GPCA may suggest the presence of an underlying autoimmune process.

摘要

目的

淋巴细胞性胃炎（LG）已在乳糜泻（CD）患者中报道。本研究旨在评估乳糜泻患儿和胃肠病对照组（GC）的胃黏膜受累情况。

方法

在一项回顾性研究中，对 226 例初诊 CD 患者（82 例男性；中位年龄：5.7 岁）和 154 例 GC（66 例男性；中位年龄：7.4 岁）进行胃和十二指肠黏膜评估。CD 按照北美小儿胃肠病、肝病和营养学会的标准诊断。胃病变根据悉尼系统更新版分类。通过酶联免疫吸附试验检测抗胃壁细胞抗体（GPCA）。

结果

21.2%和 7%的 CD 患者分别表现为慢性浅表性胃炎（CSG）和 LG。6 例（2.7%）CD 患儿存在 Hp 感染（66.7%有 CSG，16.7% LG，16.7%间质炎）。21.4%的对照组存在 CSG。无对照组出现 LG。24 例（15.6%）GC 患儿存在 Hp 感染（91.7%有 CSG）。在 CSG 患者中，Hp 感染在对照组中比在乳糜泻患儿中更为常见（P<0.0001）。90 例 CD 患者中有 10 例和 29 例对照组中有 1 例 GPCA 阳性。