LYMPHOCYTIC GASTRITIS AND ASSOCIATED SMALL-BOWEL DISEASE - A DIFFUSE LYMPHOCYTIC GASTROENTEROPATHY

Aim - To investigate the natural history of lymphocytic gastritis (LG) and its relation to Helicobacter pylori infection and to coeliac dise ase using serology, duodenal biopsy and a small intestinal permeabilit y test. Method - Twenty two patients diagnosed as having LG between 19 84 and 1994 were investigated by upper gastrointestinal endoscopy at w hich gastric and duodenal biopsy specimens were taken for histological assessment and immunohistology. Serum was collected for measurement o f anti-H pylori, anti-gliadin and anti-endomysial antibodies. A lactul ose/mannitol absorption test was performed within one week of endoscop y. Control groups were studied by histology, serology and permeability tests. Results - Three patients had been recently diagnosed as having LG while 15 still had the condition after a mean of 13.9 (range two t o 38) months. LG involved the antrum alone in three patients, antrum a nd body in seven, body alone in six, and gastric remnant in two. Gastr oduodenal intraepithelial lymphocytes (IELs) were T cells and predomin antly of T suppressor (CD8) type. Duodenal IELs were increased compare d to age/sex matched controls with chronic gastritis. Four patients ha d duodenal villous atrophy. Four patients no longer had LG after a mea n of 29.3 (10-70) months but had increased gastroduodenal IELs. H pylo ri was present in four (22%) of 18 patients with LG but H pylori serol ogy was positive in 11 (61%) of 18. There was no difference in seropos itivity when compared with age/sex matched controls with dyspepsia. El even of 20 patients with LG tested had abnormal lactulose/mannitol abs orption (v none of 22 controls with chronic gastritis). Four patients with LG, all with villous atrophy, were seropositive for IgA endomysia l antibody. Conclusions - The persistence of LG with time, the associa tion with increased duodenal IELs and abnormal small intestinal permea bility suggests LG may be a manifestation of a diffuse lymphocytic gas troenteropathy related to sensitivity to gluten or some other agent.