H. Pylori, Lymphocytic Colitis, Lymphocytic Gastritis, Microscopic Colitis

The Gluten File


On H. Pylori:

Pathogenesis and Management of Iron Deficiency Anemia: Emerging Role of Celiac Disease, Helicobacter pylori, and Autoimmune Gastritis.
PMID: 19786202  Oct 2009

RESULTS: CD was positive in 11 out of 25 patients (44%), H. pylori infection in 12 out of 25 patients (48%), while GER was diagnosed in 11 out of 25 patients (44%).  ...In conclusion, refractory IDA may be due to clinically unapparent H. pylori gastritis and CD. CD is one of the most common causes of intestinal malabsorption during childhood which leads to impairment of iron absorption. Apart from offering them gluten-free diet rich in iron, early detection and treatment of IDA and prophylactic iron and folic acid supplementation will go a long way to optimize their mental and psychological functions. Eradication of H. pylori infection with concomitant iron therapy should correct the anemia.
Prevalence of celiac disease, Helicobacter pylori and gastroesophageal reflux in patients with refractory iron deficiency anemia.
PMID: 17908698  Feb 2008

H. pylori infection increases absorption of an intact food antigen across the corpus gastric mucosa. This phenomenon may contribute to the maintenance of gastric inflammation and could play a role in the development of allergic sensitization to dietary antigens in susceptible individuals.
Helicobacter pylori increases the epithelial permeability to a food antigen in human gastric biopsies. PMID: 15046209

This study shows a significant association between H. pylori infection and iron-deficiency anaemia in patients with coeliac disease.
Link between Helicobacter pylori infection and iron-deficiency anaemia in patients with coeliac disease.
PMID: 11761018

The purpose of this review is to highlight two types of gastritis that have recently received much greater attention: lymphocytic gastritis and the gastritis associated with Crohn's disease. Lymphocytic gastritis is a distinctive pattern of inflammation that resembles that seen in celiac disease and lymphocytic colitis. It is associated with a diverse and unusual group of disorders in their own right, as well as having a possible relationship (real or phantom) with H. pylori infection.
Emerging gastritides.
PMID: 11696291

Dysmotility-like dyspeptic symptoms in coeliac patients: role of gluten and Helicobacter pylori infection PMID: 10975762 (no abstract)

Increased prevalence of Helicobacter pylori infection in patients with celiac disease.
PMID: 11151941 (no abstract)

The percentage of H. pylori positivity was similar in children with untreated and treated celiac disease. Recurrent abdominal pain was the only symptom that helped to distinguish between H. pylori-positive and H. pylori-negative children. However, symptoms disappeared in patients with celiac disease after gluten withdrawal, irrespective of H. pylori status. All endoscopic (erythema, nodularity) and histologic (superficial-, interstitial-, lymphocytic-gastritis, activity, lymphoid follicles) findings did not differ between celiac and nonceliac H. pylori-positive children.
Helicobacter pylori infection in children with celiac disease: prevalence and clinicopathologic features. PMID: 9932844

H pylori positivity in patients with coeliac disease and dermatitis herpetiformis increased with age, reaching 50% and 70%, respectively, in patients over 50 years. An increasing prevalence of H pylori seropositivity with age in coeliac disease and dermatitis herpetiformis paralleled that of the control groups. Gastritis in coeliac disease and dermatitis herpetiformis is largely caused by H pylori infection at a level that is no different from that of the general population.
Helicobacter pylori serology in patients with coeliac disease and dermatitis herpetiformis.
PMID: 1517459

On Lymphocytic and Collagenous Gastritis/ Lymphocytic Duodenosis:

Lymphocytic Gastritis in Pediatric Celiac Disease. 
PMID: 21244234  Jan 2011
Results  Coeliac disease was present in 16% of patients with lymphocytic duodenosis. In the absence of a positive coeliac diagnosis, lymphocytic duodenosis was most commonly associated with drugs (21%), infection (19%), immune dysregulation (4%), inflammatory bowel disease (2%), microscopic colitis (2%), sarcoidosis (1%) and IgA deficiency (1%). Of 34 with no known associations, 18 had symptoms of irritable bowel syndrome (IBS), and in 29 patients investigated with repeat duodenal biopsies, the IEL count returned to normal in 22. Conclusions  In 66% of cases of lymphocytic duodenosis, a known association can be found by further investigations; importantly, 16% will have coeliac disease. In those with no apparent cause, there may be an association with IBS and the IEL count becomes normal on repeat biopsy in 76%.
A prospective study into the aetiology of lymphocytic duodenosis.
PMID: 21050242  Dec 2010

In the stomach, it is particularly important to exclude Helicobacter pylori infection and celiac sprue before diagnosing lymphocytic gastritis. Duodenal lymphocytic infiltrates, inextricably tied with alterations of the villous architecture of the mucosa, are often caused by gluten sensitivity. However, similar morphologic changes may be caused by a vast array of other conditions that must be carefully considered and excluded. Lymphocytic and collagenous colitis are most often unexplained, but their frequent association with autoimmune conditions or certain medications deserve a thorough investigation in each case.  
Lymphocytic disorders of the gastrointestinal tract: a review for the practicing pathologist. 
PMID: 19700939   Sept 2009

A 25-year-old patient presented with epigastric pain, which on gastric biopsy revealed the characteristic appearance of collagenous gastritis. There was a thick prominent subepithelial band that was confirmed to be collagen with a Masson's trichrome stain. There was associated Helicobacter pylori gastritis but no evidence of a lymphocytic gastritis. The patient did not have watery diarrhea. Collagenous gastritis can occur in young patients, be restricted to the stomach, and can be associated with celiac disease.  
Collagenous Gastritis. 
PMID: 19103610 Dec 2008

Lymphocytic gastritis and celiac disease in indian children: evidence of a positive relation.
PMID: 18979579  Nov 2008

Lymphocytic gastritis represents a small subset among the numerous gastridities.[4] Its reported frequency in routine practice is 1% to 9% among patients undergoing endoscopy for dyspepsia and 15% to 45% among patients with celiac disease (also known as celiac sprue).[3] Differentiation between lymphocytic gastritis and other chronic gastritides and normal mucosa requires documenting intraepithelial lymphocytes, with the intraepithelial lymphocytes numbering approximately 20 to 30 per 100 epithelial cells.

The cause of lymphocytic gastritis is unknown. The most common disease associations include celiac sprue and H pylori infection. Approximately one third of patients with lymphocytic gastritis have concomitant celiac sprue; approximately 10% to 30% of patients with celiac sprue have lymphocytic gastritis.[12,18,19] It has been suggested that lymphocytic gastritis represents a host response to an intraluminal antigen, either gluten or another.[2] Hayat and colleagues[20] have found similar HLA antigens in both celiac sprue and lymphocytic gastritis.

In summary, lymphocytic gastritis is an uncommon form of gastritis that may be an incidental finding at endoscopy or be a cause of hypoalbuminemia, gastrointestinal bleeding, anorexia, or weight loss. The discovery of lymphocytic gastritis should prompt clinical consideration of celiac sprue. Serologic testing for H pylori should also be performed and treatment initiated if results are positive.
Grand Rounds in Gastroenterology from Baylor College of Medicine - A Man With Rheumatoid Arthritis and Iron-Deficiency Anemia (Medscape)  2007

Lymphocytic gastritis (LG) is defined by the recognition of >25 intraepithelial lymphocytes (IEL) per 100 surface epithelial cells. Approximately 50% of children with celiac disease (CD) present LG, which mainly involves the gastric antrum and disappears after a gluten-free diet.
Lymphocytic gastritis in pediatric celiac disease - immunohistochemical study of the intraepithelial lymphocytic component.
PMID: 14704635   Jan 2004

Lymphocytic gastritis is a distinctive pattern of inflammation that resembles that seen in celiac disease and lymphocytic colitis
Emerging gastritides.
PMID: 11696291  Dec 2001

Some studies report the lymphocytic gastritis in almost 45% of cases of sprue, with the gastritis regressing in response to a gluten-free diet, while others report a correlation of lymphocytic gastritis with serologically and/or histologically confirmed H. pylori infection, with the lymphocytic gastritis being cured by H. pylori eradication treatment in a high percentage of the cases
Lymphocytic gastritis--a rare disorder of the gastric mucosa.
PMID: 11225446  Jan 2001

The pattern of involvement of gastric mucosa in lymphocytic gastritis is closely related to the associated duodenal pathology.
The pattern of involvement of the gastric mucosa in lymphocytic gastritis is predictive of the presence of duodenal pathology.
PMID: 10690170  Nov 1999

Lymphocytic gastritis occurred in 10% of patients with coeliac disease.
Lymphocytic gastritis and coeliac disease: evidence of a positive association.
PMID: 9659261  Mar 1998

There is a high prevalence of lymphocytic gastritis in untreated celiac disease associated with elevated gastric permeability. Celiac disease seems to be a general disorder of the gastrointestinal tract associated with disturbed permeability.
Lymphocytic gastritis and gastric permeability in patients with celiac disease.
PMID: 8698227  Jul 1996

CONCLUSIONS: The persistence of LG with time, the association with increased duodenal IELs and abnormal small intestinal permeability suggests LG may be a manifestation of a diffuse lymphocytic gastroenteropathy related to sensitivity to gluten or some other agent.
Lymphocytic gastritis and associated small bowel disease: a diffuse lymphocytic gastroenteropathy?
PMID: 8537495  Oct 1995  Free full text

Lymphocytic gastritis is characterized by lymphocytic infiltration of the surface and pit epithelium. Its cause has not been established, but an association with Helicobacter pylori infection or celiac disease has been suggested
Lymphocytic gastritis: a positive relationship with celiac disease.
PMID: 8283376  Jan 1994

This is a type of chronic gastritis with dense infiltration of the surface and foveolar epithelium by T lymphocytes, and associated chronic infiltrates are in the lamina propria. Because of similar histopathology relative to celiac disease, lymphocytic gastritis has been proposed to result from intraluminal antigens. High anti–H pylori antibody titers have been found in patients with lymphocytic gastritis, and, in limited studies, the inflammation disappeared after H pylori eradication. However, many patients with lymphocytic gastritis are serologically negative for H pylori. A number of cases may develop secondary to intolerance to gluten and drugs such as ticlopidine.
Lymphocytic gastritis


On Lymphocytic or Collagenous  or Microscopic Colitis:

A retrospective study on a cohort of patients with lymphocytic colitis.
PMID: 20575599  June 2010

Common disease associations include celiac disease, lymphocytic colitis, and autoimmune enteropathy. Pediatric colonic intraepithelial lymphocytosis, in the absence of other histologic findings, is associated with various diseases, including celiac disease, lymphocytic colitis, and autoimmune enteropathy. Colonic intraepithelial lymphocytosis in the presence of other inflammatory changes indicates the possibility of idiopathic inflammatory bowel disease. These findings are similar to those seen in adults, with the exception of autoimmune enteropathy.
Clinical significance of colonic intraepithelial lymphocytosis in a pediatric population.
PMID: 19116628 Jan 2009

Microscopic forms of colitis have been described, including collagenous colitis. This disorder generally has an apparently benign clinical course. However, a number of gastric and intestinal complications, possibly coincidental, may develop with collagenous colitis. Distinctive inflammatory disorders of the gastric mucosa have been described, including lymphocytic gastritis and collagenous gastritis. Celiac disease and collagenous sprue (or collagenous enteritis) may occur.
Complications of collagenous colitis.
PMID: 18350593  March 2008

CONCLUSIONS: Intraepithelial lymphocytosis in an otherwise normal small bowel biopsy is somewhat nonspecific, but in nearly 10% of cases can be the initial presentation of GS. Therefore all patients with this finding should be investigated for GS. Increased IELs may also be associated with autoimmune disorders and NSAIDs.
Significance of intraepithelial lymphocytosis in small bowel biopsy samples with normal mucosal architecture.
PMID: 14499783 Sept 2003

Seventy nine (40%) patients reported associated diseases, of which thyroid disorders, coeliac disease, and diabetes mellitus were the most common.
Lymphocytic colitis: a retrospective clinical study of 199 Swedish patients.
PMID: 15016748

If there is no abatement of symptoms, rule out other etiologies of diarrhea such as thyroid dysfunction, celiac disease, or bacterial overgrowth
Lymphocytic and Collagenous Colitis.
PMID: 11097741

A shared set of predisposing HLA-DQ genes account for the epidemiological overlap of celiac sprue and microscopic colitis.Although further studies will be necessary to determine if this enteropathy is induced by dietary gluten, we speculate that the small intestinal but not colonic histopathology in patients with microscopic colitis is caused by immunological gluten sensitivity.
High prevalence of celiac sprue-like HLA-DQ genes and enteropathy in patients with the microscopic colitis syndrome.
PMID: 10950045

Symptomatic remission was induced with a gluten/lactose-free diet, oral prednisone, and sulfasalazine and has been maintained with gluten restriction alone. We propose that, in this instance, collagenous enterocolitis represented a diffuse manifestation of gluten sensitivity
Collagenous enterocolitis: a manifestation of gluten-sensitive enteropathy
PMID: 1500661

CONCLUSIONS:: MC is more common in patients with CD than in the general population. Patients with CD and MC have severe villous atrophy and frequently require steroids or immunosuppressant therapies to control symptoms.
An Association Between Microscopic Colitis and Celiac Disease.
PMID: 19631283  July 2009

CONCLUSION: This is the largest group of patients with MC known to the authors that has been studied to date. Conditions such as celiac disease, IBS, and thyroid diseases were found to be related to MC. Furthermore, neither an increased risk of colorectal cancer nor IBD was associated with MC in this study. 
Microscopic colitis: a large retrospective analysis from a health maintenance organization experience.
PMID: 19575491   July 2009

There is an association with other autoimmune disorders such as celiac disease, diabetes mellitus, thyroid disorders and arthritis. Budesonide is the best-documented short-term treatment, but the optimal long-term strategy needs further study. The long-term prognosis is good and the risk of complications including colonic cancer is low.
Diagnosis and management of microscopic colitis.
PMID: 19109861 Dec 2008

Etiologies and predictors of diagnosis in nonresponsive celiac disease.
PMID: 17382600 April 2007

Predisposing HLA-DQ2 and HLA-DQ8 haplotypes of coeliac disease and associated enteropathy in microscopic colitis.
PMID: 16292086  Dec 2005

Proximal small bowel enteropathy in patients with microscopic colitis: is it gluten-sensitive?
PMID: 11246342   Mar 2001

High prevalence of celiac sprue-like HLA-DQ genes and enteropathy in patients with the microscopic colitis syndrome.
PMID: 10950045  Aug 2000

Microscopic and collagenous colitis in treated celiac disease due to food allergy?
PMID: 10029639  Mar 1999

A novel enteropathy with partial villous atrophy, microscopic colitis, and pemphigoid change.
PMID: 2661662   April 1989

Collagenous colitis and microscopic colitis: the watery diarrhea-colitis syndrome.
PMID: 2741886  July 1989

Autoimmunity in diarrhoeal disease.
PMID: 4020570 June 1985