Jinga Mariana, Balaban Daniel Vasile, Peride Ileana, Niculae Andrei, DuŢescu Irina Monica, Vasilescu Florina, Mäki Markku, Popp Alina Mihaela
Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania;
Rom J Morphol Embryol. 2017;58(2):685-688.
Patients with Helicobacter pylori (HP) infection have been reported to have in addition to duodenitis architectural changes of the duodenal bulb mucosa including villous atrophy and crypt hyperplasia. We here for the first time present two cases of HP-infected adult patients with a crypt hyperplastic enteropathy also in the distal duodenum mimicking celiac disease (CD).
We evaluated separately the morphology of the anatomical bulb and distal duodenal mucosa using validated quantitative morphometric tools, i.e., the villous height (VH) and crypt depth (CrD) and their ratios. The fresh frozen samples were evaluated for the presence of the CD-specific transglutaminase 2-targeted subepithelial IgA deposits.
Both patients had celiac-type crypt hyperplastic mucosal injury in the distal part of the duodenum in the absence of serum autoantibodies and subepithelial IgA deposits. After two years follow-up, having still a normal gluten-containing diet, none of the patients developed CD. Moreover, in the patient re-biopsied two years later, the CD-type enteropathy had healed after HP eradication.
Prospective studies on HP-infected patients are needed in order to confirm our findings.
据报道，幽门螺杆菌（HP）感染患者除了患有十二指肠炎外，十二指肠球部黏膜还存在结构改变，包括绒毛萎缩和隐窝增生。我们首次报告了两例成年HP感染患者，其十二指肠远端也出现了类似乳糜泻（CD）的隐窝增生性肠病。
我们使用经过验证的定量形态计量工具，即绒毛高度（VH）和隐窝深度（CrD）及其比值，分别评估了解剖学上的十二指肠球部和远端十二指肠黏膜的形态。对新鲜冷冻样本进行评估，以确定是否存在CD特异性转谷氨酰胺酶2靶向的上皮下IgA沉积。
两名患者在十二指肠远端均有乳糜泻型隐窝增生性黏膜损伤，且无血清自身抗体和上皮下IgA沉积。经过两年的随访，在仍保持正常含麸质饮食的情况下，两名患者均未发展为CD。此外，在两年后再次进行活检的患者中，根除HP后，CD型肠病已愈合。
需要对HP感染患者进行前瞻性研究以证实我们的发现。
