Ulcers (helicobacter Pylori Infection )

[DrMom]

H. pylori status does not alter GFD response in celiac disease patients

06 July 2006

Am J Gastroenterol 2006; Advance online publication

The presence of Helicobacter pylori infection in patients with celiac disease does not change their response to a gluten-free diet (GFD), but the disease may hide mild duodenal lesions caused by the bacterial infection, research findings show.

These data emerge from a study in which gastric and duodenal biopsies from 80 adults with celiac disease were evaluated before and after 12-18 months on a GFD. Thirty of the patients were infected with H. pylori.

Reporting in the American Journal of Gastroenterology, the investigators comment that adherence to a GFD produced significant improvement in all duodenal features regardless of H. pylori status.

However, examinations at baseline showed that lymphoid follicles, typical of H. pylori gastritis, were detected at a higher rate in patients who were infected with the bacterium than those that were not, at 23% versus 2%.

Moreover, these were the only gastric features that changed after GFD, as they resolved in two H. pylori-positive and 10 H. pylori-negative patients.

In addition, at baseline a greater prevalence of villous atrophy was found among H. pylori-negative individuals, although milder forms of this condition were more commonly detected among H. pylori-positive patients.

"The higher prevalence of milder duodenal lesions in celiac disease 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," lead author Vincenzo Villanacci, from the Spedali Civili in Brescia, Italy, and co-workers comment.

Furthermore, while noting that the response of celiac disease sufferers to a GFD was good irrespective of H. pylori status, they state: "The resolution of lymphocytic gastritis in 12 patients in response to a GFD… is a further strong indication that this condition is pathogenetically related to celiac disease.

"Therefore, we suggest that duodenal biopsies and pertinent laboratory tests should be performed in all [celiac disease] patients in whom lymphocytic gastritis is diagnosed, irrespective of the presence or absence of malabsorption."