Duodenal Intraepithelial Lymphocytosis in Helicobacter pylori Gastritis: A Comparison after Treatment.
Kelly A Lloyd, Matthew M Yeh. University of Washington, Seattle
Background: Duodenal intraepithelial lymphocytosis is present in, and indeed necessary for the diagnosis of, many inflammatory and autoimmune conditions, including celiac sprue, Crohn's disease, and post-infectious duodenitis. The isolated presence of increased lymphocytes within the duodenal epithelium without villus blunting, neutrophilic inflammation, or chronic architectural distortion has been noted in patients with Helicobacter pylori gastritis. Our aim was to confirm this assertion and compare the degree of lymphocytosis in the duodenal biopsies of patients with active H. pylori gastritis, treated/resolved H. pylori gastritis, and no H. pylori gastritis.
Design: We conducted a retrospective review in our institute to identify duodenal and gastric biopsies obtained between 2006 and 2010. Biopsies from patients with a history of celiac sprue, inflammatory bowel disease, or autoimmune gastritis were excluded. Each duodenal biopsy was reviewed and the intraepithelial lymphocytes were counted in five consecutive villi within the area of the most prominent lymphocytosis. The concurrent gastric biopsy and Genta stain were then evaluated for the presence of H. pylori organisms. Biopsies negative for H. pylori in the setting of a prior positive H. pylori antibody test (IgG by EIA) were considered to be successfully treated.
Results: A total of 108 paired duodenal/gastric biopsies from 108 patients were identified, including 50 biopsies histologically positive for H. pylori and 58 biopsies without histologic evidence of H. pylori. Eight of the biopsies found to be histologically negative were previously treated following a positive H. pylori antibody test (IgG by EIA). The average number of intraepithelial lymphocytes identified in duodenal biopsies with concurrent H. pylori gastritis was 25.3 (SD 16.1, SEM 2.3) lymphocytes per villus. Duodenal biopsies taken from patients without H. pylori gastritis had an average of 11.3 (SD 7.6, SEM 1.1) lymphocytes per villus. Patients who had laboratory evidence of H. pylori subsequently eradicated had an average of 7.9 lymphocytes per villus (SD 3.3, SEM 1.2).
Conclusions: This study confirms previous reports of increased duodenal intraepithelial lymphocytes in patients with concurrent H. pylori gastritis(p<0.0001), an important differential to be considered with this finding. Additionally, our results show that the number of intraepithelial lymphocytes per villus decreases, approximating the number seen in H. pylori naive biopsies, following antibiotic therapy and eradication of H. pylori (p=0.0039).
Tuesday, March 1, 2011 1:00 PM
Poster Session IV # 59, Tuesday Afternoon