DISAPPEARANCE OF GASTRIC MUCOSA-ASSOCIATED LYMPHOID-TISSUE IN CELIAC PATIENTS AFTER GLUTEN WITHDRAWAL

Background: Mucosa-associated lymphoid tissue (MALT) develops in gastr ic mucosa in response to chronic antigenic stimulation, such as Helico bacter pylori infection. However, reactive lymphoid follicles have bee n found also in the stomach of H. pylori-negative coeliac patients, su ggesting that other environmental factors may be involved in MALT gene sis. The aim of our study was to evaluate the effects of gluten withdr awal in H. pylori-negative coeliac patients with gastric MALT. Methods : We studied 23 H. pylori-negative untreated coeliac patients with gas tric MALT. All patients underwent determination of antigliadin (AGA) a nd antiendomysium antibodies (EMA) and upper endoscopy with multiple b iopsies in duodenum, gastric corpus, and antrum. Lymphoid follicles an d H. pylori status were assessed by histopathologic and enzymatic anal ysis. All patients were started on a gluten-free diet and were reevalu ated after 12 months. To consider their adherence to the gluten-free d iet we relied on direct patient questioning. Thirteen patients who had strictly adhered to the gluten-free diet constituted our study group. Ten patients who had not strictly adhered to gluten withdrawal from t heir diet constituted the control group. Results: Regression of MALT w as obtained in 9 of 13 (69%) patients who strictly followed the gluten -free diet; in the control group MALT disappeared in 2 of 10 (20%) pat ients (P=0.0361). Discussion: Disappearance of reactive lymphoid folli cles in the gastric mucosa of H. pylori-negative coeliac patients afte r gluten withdrawal suggests that antigens related to alimentary glute n may constitute persistent stimuli fur development of gastric MALT in coeliac patients.