LYMPHOCYTIC GASTRITIS AND PEDIATRIC CELIAC DISEASE
KK Prasad*, NR Thapa**, CK Nain***, S Lal****, AK Sharma*****
Division of Pediatric GE, GE Histopathology, GE Enzymology & GE Virology Department of Superspeciality of Gastroenterology, PGIMER, Chandigarh. *, Division of Pediatric GE, GE Histopathology, GE Enzymology & GE Virology Department of Superspeciality of Gastroenterology, PGIMER, Chandigarh. **, Division of Pediatric GE, GE Histopathology, GE Enzymology & GE Virology Department of Superspeciality of Gastroenterology, PGIMER, Chandigarh. ***, Division of Pediatric GE, GE Histopathology, GE Enzymology & GE Virology Department of Superspeciality of Gastroenterology, PGIMER, Chandigarh. ****, Division of Pediatric GE, GE Histopathology, GE Enzymology & GE Virology Department of Superspeciality of Gastroenterology, PGIMER, Chandigarh.*****
Background: Lymphocytic gastritis is a histological entity characterized by intense lymphocytic infiltration (>25 lymphocytes/100 epithelial cells) in the gastric surface and pit epithelium. Its cause has not been established, but an association with H. Pylori infection or celiac disease has been suggested.

Aims: To evaluate the number of intraepithelial lymphocytes (IELs) in gastric mucosa of children with celiac disease and to study the presence of H. Pylori infection in these patients.

Material and Methods: This prospective study included 147 children with celiac disease (M:F-1:0.7; mean age 8.1 years) diagnosed between June 6, 2003 and August 25, 2005 in whom gastric and duodenal biopsy was taken simultaneously. The control consisted of 147 non-celiac children matched for sex and age (within on year) without any peptic ulcer gastric resection or malignancy in whom upper digestive endoscopy was performed. H Pylori were recognized in gastric biopsy on H&E sections; a Modified Giemsa stain was performed in biopsy suspicious for H. pylori.

Results: Lymphocytic gastritis was found in 61 celiac patients. Positive cases had a mean of 42.6 IELs/100 surface epithelial cells, compared with a mean of 13.2 in negative cases, and 7.6 in non-celiac controls. Cases not showing lymphocytic gastritis did however show significantly increased gastric intraepithelial lymphocytes compared with non-celiac controls (p <0.0001). Nine of 147 cases were positive for H pylori, and 4 of 61 cases of lymphocytic gastritis were H. pylori positive.

Conclusions: Lymphocytic gastritis occurred in 41.5% of children with celiac disease. A celiac disease without lymphocytic gastritis also showed increased gastric intraepithelial lymphocytes. The other cause of lymphocytic gastritis may be H. pylori infection in children.
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