Akademik Veri Yönetim Sistemi
ESPGHAN 52. Annual Meeting, Birleşik Krallık, 5 - 08 Haziran 2019, sa.1
Objectives and Study: Moderately elevated coeliac antibodies have been described in various
pathologies without any evidence of celiac disease (CD). Additionally, duodenal intraepithelial
lymphocytosis with a normal villous architecture (Marsh I lesion) is a relative common finding in
duodenal biopsies. The differential diagnosis includes bacterial overgrowth, NSAID injury in addition to
CD. H.pylori, which is the most common gastric pathogen, has been reported to induce morphological
changes in the duodenum ranging from intraepithelial lymphocytosis to crypt hyperplasia, as it is the
case in CD. Thus, the diagnosis of CD in the presence of H.pylori gastritis might be challenging. To
our knowledge, H.pylori associated coeliac seropositivity has not been considered before. In this
study, we analysed patients who underwent endoscopy because of a positive celiac serology, and
found to have concurrent H.pylori infection
Methods: The endoscopy database were reviewed for the patients who underwent an endoscopy
because of elevated celiac serology, and 10 patients having concurrent H.pylori infection were
compiled. The demographic features, clinical manifestations, serologic tests and histopathology
records were reviewed. The histological features of gastritis were evaluated according to the modified
Sydney classification system. Duodenal histopathology was evaluated according the Marsh
classification
Results: The mean age was 8.3 ± 3.8 years and 8 of the patients were female. Of 10 patients 5 were
asymptomatic, and identified while routine screening for CD (2 type 1 DM, 1 Down syndrome, 1 Turner
syndrome and 1 hypothyroidism). All of the patients were anti-tTG positive and 3 out of 10 were also
positive for anti-EMA. Anti-tTG IgA level was higher than 5 times of the upper limit of normal in 5
patients, one of whom had concomitant anti-EMA positivity as well. Seven out of 10 patients had no
mucosal changes indicative of CD, One of the remaining 3 patients solely had intraepithelial
lymphocytosis that is consistent with Marsh 1, other 2 patients had partial villous atrophy in the distal
duodenum, and classified as Marsh 3A. All of the patients had H.pylori associative gastritis without any
sign of mucosal atrophy or intestinal metaplasia. All of the patients, infected with H.pylori received
eradication, thereafter checked for the serum anti-tTG IgA, and serum tTG titers decreased in all
patients, and 3 patients with positive EMA converted into negative as well. Two patients who had
Marsh 3A histopathology were evaluated by a repeat endoscopy, and mucosal recovery was detected
in both of them.
Conclusion: Moderately elevated serum anti-tTG has been described in several autoimmune
diseases and infections (giardiasis). The association between H.pylori infection and elevated celiac
serology has not been reported before. Our results suggest that H.pylori infection may be related to
false positive celiac serology in individuals who have a predisposition to celiac disease. Given to the
fact that the prevalence of both H.pylori infection and celiac disease is high in some geographical
areas, a positive celiac serology should be carefully interpreted in the presence of an H.pylori
infection.